Original Article

Bronchial allergen challenges in children – safety and predictors

Corresponding Author

Johannes Schulze

Department of Allergy, Pulmonology, and Cystic Fibrosis, Children's Hospital, Goethe-University, Frankfurt, Germany

Correspondence

Johannes Schulze, Department of Pulmonology, Allergy and Cystic Fibrosis, Children's Hospital, Goethe-University, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany.

Tel.: +49 69 6301 5381

Fax: +49 69 6301 6061

E-mail: [email protected]

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Wanda Reinmüller,

Wanda Reinmüller

Department of Allergy, Pulmonology, and Cystic Fibrosis, Children's Hospital, Goethe-University, Frankfurt, Germany

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Eva Herrmann,

Eva Herrmann

Institute of Biostatistics and Mathematical Modelling, Goethe-University, Frankfurt, Germany

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Martin Rosewich,

Martin Rosewich

Department of Allergy, Pulmonology, and Cystic Fibrosis, Children's Hospital, Goethe-University, Frankfurt, Germany

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Markus A. Rose,

Markus A. Rose

Department of Allergy, Pulmonology, and Cystic Fibrosis, Children's Hospital, Goethe-University, Frankfurt, Germany

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Stefan Zielen,

Stefan Zielen

Department of Allergy, Pulmonology, and Cystic Fibrosis, Children's Hospital, Goethe-University, Frankfurt, Germany

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Johannes Schulze,

Corresponding Author

Johannes Schulze

Department of Allergy, Pulmonology, and Cystic Fibrosis, Children's Hospital, Goethe-University, Frankfurt, Germany

Correspondence

Johannes Schulze, Department of Pulmonology, Allergy and Cystic Fibrosis, Children's Hospital, Goethe-University, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany.

Tel.: +49 69 6301 5381

Fax: +49 69 6301 6061

E-mail: [email protected]

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Wanda Reinmüller,

Wanda Reinmüller

Department of Allergy, Pulmonology, and Cystic Fibrosis, Children's Hospital, Goethe-University, Frankfurt, Germany

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Eva Herrmann,

Eva Herrmann

Institute of Biostatistics and Mathematical Modelling, Goethe-University, Frankfurt, Germany

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Martin Rosewich,

Martin Rosewich

Department of Allergy, Pulmonology, and Cystic Fibrosis, Children's Hospital, Goethe-University, Frankfurt, Germany

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Markus A. Rose,

Markus A. Rose

Department of Allergy, Pulmonology, and Cystic Fibrosis, Children's Hospital, Goethe-University, Frankfurt, Germany

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Stefan Zielen,

Stefan Zielen

Department of Allergy, Pulmonology, and Cystic Fibrosis, Children's Hospital, Goethe-University, Frankfurt, Germany

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First published: 20 January 2013

https://doi.org/10.1111/pai.12031

Citations: 30

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Abstract

Background

In allergic asthma, the diagnosis of house dust mite (HDM) allergy is mainly based on the patient's history, allergy testing by the skin prick test (SPT) or the levels of allergen-specific IgE. We retrospectively analysed data from 350 bronchial provocations with HDM and related it to the following parameters: specific IgE, bronchial hyperresponsiveness (BHR) to methacholine testing (MCT) and exhaled NO (eNO).

Methods

Approximately 350 patients (5–18 yr of age) with allergic asthma and a positive SPT to HDMs were included. To define the sensitivity and specificity for the detection method of an early asthmatic response (EAR), a receiver-operating characteristic (ROC) curve was plotted. The accuracy was measured by the area under the ROC curve (AUC). A logistic regression model was used to predict the individual probability of a positive challenge. The results of the regression model were validated in a prospective group of n = 75 patients.

Results

The following cut-off values showed the best combination of sensitivity and specificity: specific IgE Dermatophagoides farinae 19.6 kU/l (AUC, 0.88), PD₂₀FEV₁ 0.13 mg methacholine (AUC, 0.73) and eNO 20.1 ppb (AUC, 0.71). The following equation predicted the individual probability of a positive challenge in the retrospective and prospective group: p = 1^.[1 + exp[−(−1.78 + 2.46.¹⁰log D. far − 1.25^.10logPD₂₀ metha)]]⁻¹, (AUC = 0.88).

Conclusions

The value of using the specific IgE and MCT as predictors was confirmed in a large number of patients. We also showed, for the first time, that the eNO predicted the EAR. The logistic regression model is repeatable with a good accuracy.

Supporting Information

References

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Citing Literature

Volume24, Issue1

February 2013

Pages 19-27

This article also appears in:

JM Must Read Articles - Pediatric Allergy and Immunology

Filename	Description
pai12031-sup-0001-TableS1.docWord document, 33.5 KB	Table S1. Kolmogorov-Smirnov-test for normal distribution.
pai12031-sup-0002-TableS2.docWord document, 33 KB	Table S2. Spearman's rank correlation association with the PD₂₀FEV₁ mite.
pai12031-sup-0003-TableS3.docWord document, 30.5 KB	Table S3. FEV₁ (% predicted, mean ± SD) during an EAR and an LAR in the prospective group.

Bronchial allergen challenges in children – safety and predictors

Abstract

Background

Methods

Results

Conclusions

Supporting Information

References

Citing Literature

References

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Bronchial allergen challenges in children – safety and predictors

Abstract

Background

Methods

Results

Conclusions

Supporting Information

References

Citing Literature

References

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