What's new in the treatment of atopy? Prevention: report of the ETAC study

Atopic dermatitis is known to be associated with the subsequent development of asthma in young children. As cetirizine has confirmed anti-allergic and potential anti-inflammatory properties, it was only natural to consider th e use of this agent in the primary prevention of asthma. Methods: Over a 2- year period, 817 infants aged 1 to 2 years with atopic dermatitis and a clo se family history of atop): were included in the multicentre, randomized do uble-blind placebo-controlled ETAC study (Early Treatment of the Atopic Chi ld). The main criterion was comparison of the incidence of asthma in the 2 groups. The course of clinical symptoms and laboratory signs, including tot al and specific serum IgE assays in relation to certain allergens, was also followed. Results: The relative risk (RR) of developing asthma in the plac ebo group was high in infants with high level of total (> 30 KIU/l) or spec ific serum IgE (> 0.358 KIU/l) directed against grass pollens, house dust m ites and cat allergens (RR between 1.4 and 1.7). In comparison, cetirizine significantly reduced the incidence of asthma in infants sensitized to gras s pollens (RR = 0.5) or house dust mires (RR = 0.6). However no global diff erence was demonstrated between the 2 groups concerning the development of asthma. Safety was the same in the 2 groups. Conclusion: A high level of to tal serum IgE and specific IgE directed against grass pollens, house dust m ites and cat allergens was predictive of the subsequent development of asth ma. Cetirzine reduced this incidence by one half in comparison with placebo in infants sensitized to grass pollens and house dust mites. Cetirizine ca ll therefore be proposed as primary prevention of asthma in these subjects with atopic dermatitis and a family history of allergy.