Prediction of sensitization to inhalant allergens in childhood: evaluatingfamily history, atopic dermatitis and sensitization to food allergens

Background A family history of atopy is a poor predictor of sensitization t o inhalant allergens and allergic disease during childhood. We recently ide ntified early sensitization to food allergens, especially hen's egg, as a v aluable predictor of subsequent sensitization to inhalant allergens. Objective (1) Whether prediction will be improved by in vitro allergy tests at 1 year of age in combination with family history and medical history da ta. (2) Comparison with the capacities of in vitro tests to predict sensiti zation to aeroallergens. Methods Of an observational birth cohort study (MAS) 49 children who were s ensitized to inhalant allergens at 5 years of age and 116 non-sensitized co ntrols were included in the present study. For the prediction of sensitizat ion to inhalant allergens the following prognostic factors were evaluated: atopic family history (FH), atopic dermatitis (AD) during the first year of life, two ir? vitro allergy tests for specific IEE to common food allergen s at I year of age (fx5 [Pharmacia] and single allergen specific tests (sIg E) for four allergens) and 'high' total serum IgE, defined by three differe nt cut off points. Results The combination of medical history data and laboratory tests result ed in the best predictive discrimination. The positive predictive values (P PV) were higher if sensitization to food was detected by single allergen sp ecific tests (PPV: 66%/75%/100% corresponding to the three evaluated risk g roups) than by the qualitative fx5 (PPV: 46%/65%/100%). The negative predic tive values were equal for both tests (69 and 92% for the two low risk grou ps). High total serum IgE had low predictive capacity. Conclusion During infancy the prediction of sensitization to inhalant aller gens should be based on medical history data and allergy tests determining sensitization to food allergens. The in vitro tests improve the predictive discrimination, but the individual risk profile of the child must be consid ered for a reliable and valid prediction.