HIGH-LEVELS OF EOSINOPHIL CATIONIC PROTEIN IN WHEEZING INFANTS PREDICT THE DEVELOPMENT OF ASTHMA

Background: In association with respiratory tract infections, infants may have episodes of wheezing, which represent the onset of asthma in some of them. Activated eosinophils play a central part in asthmatic i nflammation, Objective: We investigated whether, in infants experienci ng their first episode of wheezing, eosinophil activation is present a nd can predict the development of asthma, Methods: In a prospective tr ial, eosinophil activation was measured by eosinophil cationic protein (ECP) concentrations in serum from 33 nonatopic infants with their fi rst episode of wheezing, 15 nonatopic infants with upper respiratory t ract infection without wheezing, and IS healthy nonatopic infants, One rear later, the children were re-evaluated for a diagnosis of infanti le asthma. Results: Wheezing infants had higher median serum ECP level s (13.4 mu g/L) than children with nonwheezy respiratory tract infecti on (7.6 mu g/L, p < 0.005) or healthy subjects (7.1 mu g/L, p < 0.005) . In addition, wheezing infants (n = 13) with serum ECP concentrations greater than 20 mu g/L sere more likely to hare asthma within 1 gear than patients with ECP levels less than 20 mu g/L (odds ratio = 12.4; confidence interval, 4.6-33.5). Conclusion: Eosinophil activation meas ured hg serum ECP is present in infants with their first episode of wh eezing illness, especially in those infants in whom asthma subsequentl y develops within 1 year. These data mac indicate a predictive value o f serum ECP measurements in children with wheezing to identify those p atients in whom infantile asthma is developing. These findings probabl y also indicate that serum ECP may be used to identify the children wh o need early antiinflammatory treatment.