Can we predict which wheezy infants will continue to wheeze?

Early intervention strategies in infant wheezing will be dependent on the a bility to predict persistence of disease. We undertook a prospective longit udinal study to determine which factors might be predictive for the persist ence of wheeze. We examined a group of 107 children 3 to 36 mo of age with at least one atopic parent. Children were recruited within 12 wk of first w heeze. Factors assessed included: personal atopy (IgE > 1 SD above age-rela ted normal and/or eczema and/or positive skin tests); parental atopy; numbe r of siblings; age at first wheeze; sex; serum-soluble IL-2R; proliferation of peripheral blood mononuclear cells (PBMC) to beta-lactoglobulin and to D. pteronyssinus; production of IFN-gamma on stimulation of PBMC with beta- lactoglobulin and with D. pteronyssinus. A positive clinical outcome (child requiring prophylactic antiasthma treatment after 1 yr) was observed in 53 (49.5%) children. Predictor variables were assessed by univariate and mult ivariate logistic regression. Wheeze was more likely to be persistent in ol der, atopic children with biparental atopy. The model offering best predict ion of persistent wheeze with least risk of including asymptomatic subjects was age at presentation + slL-2R. Trials of early intervention strategies using a logistic regression equation based on this model for patient recrui tment can now be designed.