The pattern of atopic sensitization is associated with the development of asthma in childhood

doi:10.1067/mai.2001.118786

Journal of Allergy and Clinical Immunology

Volume 108, Issue 5, November 2001, Pages 709-714

https://doi.org/10.1067/mai.2001.118786 Get rights and content

Abstract

Background: Even though atopic sensitization has been shown to be strongly associated with childhood asthma, asthma eventually develops in only one third of atopic children. Objective: The aim of this study was to prospectively investigate the pattern of atopic sensitization typically associated with the development of asthma in childhood. Methods: The German Multicenter Allergy Study followed 1314 children from birth to the age of 7 years. Parental questionnaires on asthma and asthmatic symptoms were completed 6 times up to the age of 2 years and from then on yearly. Determination of specific IgE to 9 food and inhalant allergens was performed yearly, and at the age of 7 years, a bronchial histamine challenge was conducted. Results: Onset of atopic sensitization in atopic children with current asthma at the age of 7 years was significantly earlier than in atopic children without current asthma (39.4% before age 1 year vs 21.0%, P = .015). Early atopic sensitization without any sensitization to inhalant allergens at the age of 7 years conferred no increased risk for asthma at this age. Only those children sensitized to any allergen early in life and sensitized to inhalant allergens by the age of 7 years were at a significantly increased risk of being asthmatic at this age (odds ratio, 10.12; 95% CI, 3.81-26.88). However, even in this group of persistently sensitized children, the risk of being asthmatic at the age of 7 years was only increased if a positive parental history of asthma or atopy was present (odds ratio, 15.56; 95% CI, 5.78-41.83), with the effect being strongest for maternal asthma. Conclusion: Our results indicate that an underlying factor pertaining to asthma and maternal transmission may determine both a certain pattern of sensitization and the expression of asthma. (J Allergy Clin Immunol 2001;108:709-14.)

Section snippets

Study population

The German MAS, a prospective birth cohort study, recruited 1314 newborns in 5 German cities during 1990. A detailed description of study subjects and methods is given elsewhere.² Briefly, 499 newborns with risk factors for atopy (elevated cord blood IgE [≥0.9 kU/L], at least 2 atopic family members, or both) and 815 newborns with none of these risk factors were included in the study. The cohort children were followed up at the age of 1, 3, 6, 12, and 18 months and from then on yearly within 3

Response rates

Of the 1314 children in the MAS birth cohort, 1120 (85.2%) participated in the follow-up survey at age 1 year, and 939 (71.5%) children participated in the final follow-up survey at the age of 7 years (Fig 1).

. Response rates.

The participation rates for blood sampling and for bronchial challenge at age 7 years were slightly lower.

Children were compared with respect to the number of absolved follow-up visits on the basis of data collected at birth to assess potential participation bias. Children

Discussion

We observed that the sensitization pattern typically associated with asthma in childhood is best characterized by an early beginning of sensitization, as well as by the persistence of sensitization. However, only persistently sensitized children with a positive family history of asthma or atopy were at an increased risk of being asthmatic at the age of 7 years. This effect was strongest for a maternal history of asthma, indicating that an underlying factor pertaining to asthma and maternal

Acknowledgements

We thank all participants of the MAS for their cooperation. Furthermore, we thank the collaborators of the MAS group: Volker Wahn, MD, and Marketa Groeger, MD, Düsseldorf; Fred Zepp, MD, and Imke Bieber, MD, Mainz; Johannes Forster, MD, and Uta Tacke, MD, Freiburg; Carl-Peter Bauer, MD, Gaisach; Renate and Karl E. Bergmann, Berlin; nurse Petra Wagner, Berlin; nurse Gabriele Leskosek, Düsseldorf; nurse Roswitha Mayerl, Munich; nurse Brigitte Hampel, Mainz; and statistician Günter Edenharter.

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^☆: Collaborators of the Multicenter Allergy Study (MAS) group were as follows: Volker Wahn, MD, and Marketa Groeger, MD, Düsseldorf; Fred Zepp, MD, and Imke Bieber, MD, Mainz; Johannes Forster, MD, and Uta Tacke, MD, Freiburg; Carl-Peter Bauer, MD, Gaissach; and Renate Bergmann, Berlin.

^☆☆: Supported by the German Ministry of Education and Research (BMBF), Grant-No. 01GC9702/0 and an unrestricted educational grant by Aventis.

^★: The results of this study are part of the doctoral thesis of Sabina Illi.

^★★: Reprint requests: Sabina Illi, MPH, Dr von Haunersches Kinderspital, Lindwurmstr. 4, 80337 Munich, Germany.

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Asthma, Rhinitis, Other Respiratory DiseasesThe pattern of atopic sensitization is associated with the development of asthma in childhood☆,☆☆,★,★★

Abstract

Section snippets

Study population

Response rates

Discussion

Acknowledgements

Is the increase in asthma prevalence linked to increase in allergen load?

Allergy

Atopic family history. Validation of instruments in a multicenter cohort study

Pediatr Allergy Immunol

Atopic diseases in infancy. The German multicenter atopy study (MAS-90)

Pediatr Allergy Immunol

Bronchial histamine challenges in 7 year old children: a PC20FEV1 below 1.0 mg/ml discriminates between symptomatic and non-symptomatic children

Eur Respir J

Reactivity to cold air hyperventilation in normal and in asthmatic children in a survey of 5,697 school children in Southern Bavaria

Am Rev Respir Dis

On early sensitization to allergens and development of respiratory symptoms

Clin Exp Allergy

Longitudinal changes in atopy during a 4-year period: relation to bronchial hyperresponsiveness and respiratory symptoms in a population sample of Australian schoolchildren

J Allergy Clin Immunol

Cord blood IgE against milk and egg antigens

Biol Neonate

The natural course of sensitization and atopic disease in infancy and childhood

Pediatr Allergy Immunol

Natural course of sensitization to food and inhalant allergens during the first 6 years of life

J Allergy Clin Immunol

Asthma, Rhinitis, Other Respiratory Diseases
The pattern of atopic sensitization is associated with the development of asthma in childhood☆,☆☆,★,★★

Bronchial histamine challenges in 7 year old children: a PC₂₀FEV₁ below 1.0 mg/ml discriminates between symptomatic and non-symptomatic children