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Discordance between aeroallergen specific serum IgE and skin testing in children younger than 4 years.

ABSTRACT: Atopic sensitization to aeroallergens in early life has been found to be a strong risk factor for the development of persisting asthma in young children with recurrent wheeze.To assess the yield of skin prick test (SPT) compared with allergen specific serum IgE (sIgE) testing at identifying aeroallergen sensitization in atopic children younger than 4 years.Concordance between SPT and allergen-specific sIgE testing for 7 common aeroallergens was analyzed in 40 atopic inner-city children 18 to 48 months of age (mean [SD], 36 [9] months) with recurrent wheezing and family history of asthma and/or eczema.In 80% of children one or more allergen sensitizations would have been missed if only SPT had been performed, and in 38% of children one or more sensitizations would have been missed if only sIgE testing had been performed. Agreement between the SPT and sIgE test was fair for most allergens (? = -0.04 to 0.50), as was correlation between sIgE levels and SPT grade (? = 0.21 to 0.55). Children with high total sIgE (?300 kU/L) were more likely to have positive sIgE test results, with negative corresponding SPT results (P = .02).Our study revealed a significant discordance between allergen-specific SPT and sIgE testing results for common aeroallergens, suggesting that both SPT and sIgE testing should be performed when diagnosing allergic sensitization in young children at high risk of asthma.clinicaltrials.gov Identifier: NCT01028560.

SUBMITTER: de Vos G

PROVIDER: S-EPMC4529057 | biostudies-literature | 2013 Jun

REPOSITORIES: biostudies-literature

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Discordance between aeroallergen specific serum IgE and skin testing in children younger than 4 years.

de Vos Gabriele G Nazari Ramin R Ferastraoaru Denisa D Parikh Purvi P Geliebter Rebecca R Pichardo Yikania Y Wiznia Andrew A Rosenstreich David D

Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology 20130411 6

<h4>Background</h4>Atopic sensitization to aeroallergens in early life has been found to be a strong risk factor for the development of persisting asthma in young children with recurrent wheeze.<h4>Objective</h4>To assess the yield of skin prick test (SPT) compared with allergen specific serum IgE (sIgE) testing at identifying aeroallergen sensitization in atopic children younger than 4 years.<h4>Methods</h4>Concordance between SPT and allergen-specific sIgE testing for 7 common aeroallergens wa ...[more]

PMID: 23706713

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Project description:BackgroundThe dissociation between specific IgE and skin prick test reactivity to aeroallergens, a common finding in populations living in low and middle-income countries, has important implications for the diagnosis and treatment of allergic diseases. Few studies have investigated the determinants of this dissociation. In the present study, we explored potential factors explaining this dissociation in children living in an urban area of Northeast Brazil, focusing in particular on factors associated with poor hygiene.MethodsOf 1445 children from low income communities, investigated for risk factors of allergies, we studied 481 with specific IgE antibodies to any of Blomia tropicalis, Dermatophagoides pteronyssinus, Periplaneta americana and Blatella germanica allergens. Data on demographic, environmental and social exposures were collected by questionnaire; serum IgG and stool examinations were done to detect current or past infections with viral, bacterial, protozoan and intestinal helminth pathogens. We measured atopy by skin prick testing (SPT) and specific IgE (sIgE) to aerollergens in serum (by ImmunoCAP). SIgE reactivity to B. tropicalis extract depleted of carbohydrates was measured by an in-house ELISA. Total IgE was measured by in house capture ELISA. SNPs were typed using Illumina Omni 2.5.ResultsNegative skin prick tests in the presence of specific IgE antibodies were frequent. Factors independently associated with a reduced frequency of positive skin prick tests were large number of siblings, the presence of IgG to herpes simplex virus, Ascaris lumbricoides and Trichuris trichiura infections, living in neighborhoods with infrequent garbage collection, presence of rodents and cats in the household and sIgE reactivity to glycosylated B. tropicalis allergens. Also, SNP on IGHE (rs61737468) was negatively associated with SPT reactivity.ConclusionsA variety of factors were found to be associated with decreased frequency of SPT such as unhygienic living conditions, infections, total IgE, IgE response to glycosylated allergens and genetic polymorphisms, indicating that multiple mechanisms may be involved. Our data, showing that exposures to an unhygienic environment and childhood infections modulate immediate allergen skin test reactivity, provide support for the "hygiene hypothesis".

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Discordance between aeroallergen specific serum IgE and skin testing in children younger than 4 years.

Publications

Discordance between aeroallergen specific serum IgE and skin testing in children younger than 4 years.

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