THE ACCURACY OF FEATURES IN THE CLINICAL HISTORY FOR PREDICTING ATOPIC SENSITIZATION TO AIRBORNE ALLERGENS IN CHILDREN

Background: The clinical history is given considerable weight when on decides which allergens are responsible for a patients symptoms, and i n research studies the clinical history has been used as the ''gold st andard'' with which different tests for allergy are compared. Objectiv es: To determine whether standardized questions accurately predict rep lies to detailed questions asked by an experienced allergist, and to a ssess the utility of certain standardized questions for predicting sen sitization to individual allergen groups. Methods: Trained interviews put standardized questions to parents of 1160 children, aged 1 to 17 y ears, who had respiratory symptoms and had been newly referred to the allergy clinic of a children's hospital. For the first 151 of the subj ects the answers were compared with those elicited by questions asked by a pediatric allergist. Skin prick tests and pollen counts were perf ormed by a technologist. Results: The standardized questions had an ac curacy for predicting the allergist's history of 93% to 97% for all qu estions except one. The standardized questions with the highest accura cy for predicting the skin test results to the appropriate allergens w ere the following: for mite, improvement in symptoms when outdoors (66 .8%);and when in dry areas (69.4%), and aggravation during house clean ing (65.9%) and when bed making (70.6%); for dog, symptoms when with d ogs (80.6%); for cat, symptoms when with cats (77.3%); for tree pollen , symptoms worse in April (70.8%) and when among trees in March and Ap ril (80.8%); and for grass pollen, exacerbation in June (69.2%) and du ring lawn mowing (71.2%). Although specificity was generally above 80% , sensitivity was variable, ranging from 11% to 56%. Conclusions: The standardized questions accurately predicted a detailed history obtaine d by an experienced allergist. Because standardized questions are repr oducible they are the preferred method of history taking for research projects. Because several of the standardized questions have a high sp ecificity they are useful for excluding sensitization to individual al lergen groups, but because they have only a modes sensitivity, they ar e less helpful for detecting those who are sensitized to individual al lergen groups.