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In this case-control study, food allergy and degree of atopy were assessed as risk factors for life threatening asthma in childhood. Currently, no objective clinical risk factors exist. Nineteen children aged 1–16 years with an exacerbation of asthma requiring ventilation were recruited and compared with 38 controls with a simple exacerbation of asthma. Controls were matched by age, sex, and ethnicity. Food allergy was diagnosed on a basis of history, positive skin prick tests, or serum specific IgE. Food challenge was performed in cases of clinical doubt. Children with a history of type 1 hypersensitivity symptoms in the 24 hours preceding the exacerbation were excluded, as were those with evidence of a viral infection. 50% of cases had food allergy compared with 10% of controls. Multivariate analysis revealed that food allergy (odds ratio (OR) 5.89) and frequent admissions to hospital (OR 9.85) were independent risk factors for life threatening asthma, suggesting that more intensive treatment of this high risk group of children may improve outcome.
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