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Cited by 46Asthma and respiratory diseasesAllergic Rhinitis and SensitizationFood Allergy and Anaphylaxis Research

The complexities of defining atopy in severe childhood asthma

Frith, J., Fleming, L., Bossley, C., Ullmann, N., Bush, A.·2011·Clinical & Experimental Allergy
DOI 10.1111/j.1365-2222.2011.03729.x
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Abstract

BACKGROUND: Defining atopy in children with severe, therapy-resistant asthma is complex. There is currently no gold standard test; both skin prick testing (SPT) and allergen-specific IgE (sIgE) are used. Furthermore, atopy is increasingly considered to be a spectrum, not an all-or-none phenomenon. HYPOTHESIS: SPTs and sIgE cannot be used interchangeably, and if both tests are not performed, opportunities for intervention will be missed. Furthermore, the severity of atopy will be defined differently by the two tests. METHODS: Cross-sectional study of 47 children with severe, therapy-resistant asthma, mean age 11.8 years, range 5.3-16.6 years, who underwent SPT, and measurement of total and sIgE as part of their clinical work-up. RESULTS: Overall, 42/47 (89%) were atopic (defined as either one positive SPT or sIgE). There was 98% concordance between the two tests in classifying atopy. When each allergen was considered individually, in 40/200 (20%), the SPT and sIgE results were discordant, most commonly in 25/200 (12.5%), the SPT was negative and the sIgE was positive. House dust mite and cat sensitization were more likely detected by sIgE, but dog sensitization by SPT. When atopy was quantified, the sum of sIgEs compared with the sum of SPT weal diameter showed a moderate correlation (r(2) =0.44, P<0.001). Total IgE increased with an increasing number of positive sIgEs (P=0.028), but not significantly with increasing numbers of positive SPTs. CONCLUSION AND CLINICAL RELEVANCE: SPT and sIgE identify group prevalence of atopy equally well; however, for individual allergens, concordance is poor, and when used to quantify atopy, SPTs and sIgE were only moderately correlated. In a clinical setting, if allergen avoidance is contemplated in children with severe, therapy-resistant asthma, both tests should be performed in order to detect sensitization.

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  • One factor strongly associated with severe asthma in children and adolescents is allergic sensitization.

    “One factor strongly associated with severe asthma in children and adolescents is allergic sensitization (82–87).”

    From Epidemiology of Asthma in Children and Adults (2019) · cites this paper as [83]

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Authors
Frith, J., Fleming, L., Bossley, C., Ullmann, N., & Bush, A.
Affiliations
Royal Brompton Hospital (GB)
Corresponding author
Bush, A.
ORCID
Venue
Clinical & Experimental Allergy
Publisher
Wiley
Published
2011-04-08
Volume
41
Issue
7
Pages
948-953
ISSN
0954-7894 (ISSN-L)
DOI
10.1111/j.1365-2222.2011.03729.x
OpenAlex
W1959184438
Cited by
46
References
18
Citations by year
2025: 2 · 2024: 2 · 2022: 1 · 2021: 5 · 2020: 5 · 2019: 4 · 2018: 3 · 2017: 5 · 2016: 2 · 2015: 4 · 2014: 2 · 2013: 5 · 2012: 4
FWCI
2.84
Type
journal article
Language
en
Open access
closed
Licence
doi.wiley.com/10.1002/tdm_license_1 (tdm, 1607 d)
Locations
  • Clinical & Experimental Allergy (publishedVersion)
  • PubMed (publishedVersion)
Funders
National Institute for Health and Care Research (NF-SI-0508-10212, NF-SI-0510-10192)
Topics
  • Health Sciences › Medicine › Physiology › Asthma and respiratory diseases
  • Health Sciences › Medicine › Immunology and Allergy › Allergic Rhinitis and Sensitization
  • Health Sciences › Medicine › Immunology and Allergy › Food Allergy and Anaphylaxis Research
Keywords
atopy, therapy-resistant asthma, skin prick test, specific IgE, total IgE, test concordance, allergen sensitization, house dust mites, allergen avoidance
MeSH terms
Adolescent, Allergens, Animals, Asthma, Cats, Child, Child, Preschool, Cross-Sectional Studies, Dogs, Female, Humans, Hypersensitivity, Immediate, Immunoglobulin E, Male, Severity of Illness Index, Skin Tests, Prevalence

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