Landmark study identifies asthma in infants

A landmark study shows how clinicians may be able to identify whether asthma will develop in patients as young as one-year-old.

Children at one-year-old who have eczema or atopic dermatitis (AD) and are sensitized to an allergen are seven times more likely than other infants to develop asthma, and significantly more likely to have a food allergy by age three, according to a study published in the The Journal of Allergy and Clinical Immunology.

Sears

“These findings may prompt pediatricians to undertake skin testing early in life in children with apparent skin allergies..to determine if the child is in fact sensitized to food allergens as it is these children who are at higher risk of going on to develop asthma and so more preventative or treatment measures may be indicated,” Malcolm Sears, MD, founding director of the CHILD Study, a professor of medicine at McMaster University in Hamilton, Ontario, and a researcher at the Firestone Institute for Respiratory Health at St. Joseph’s Healthcare Hamilton, told Managed Healthcare Executive.

Using data from more than 2,300 children from across Canada participating in the CHILD Study, A team of Canadian researchers evaluated the presence of AD and allergic sensitization at age one. When the children were three years of age, the researchers performed a clinical assessment to determine the presence of asthma, allergic rhinitis, food allergy and AD.

The combined effect of AD and allergic sensitization was found to be greater than the sum of their individual effects, both on the risk of asthma and on reported food allergy.

“Much of what happens to us later in life is related to the exposures we encounter in early childhood,” Sears said in a statement.

It has long been known that infants with eczema or AD are more likely to develop asthma and allergic rhinitis in later childhood. However, predicting precisely which children with AD will go on to develop these conditions has been difficult.

“Over the years, the clinical community has struggled to explain the atopic march,” Sears said. “These findings help us to understand the interactive effects of AD and early allergic sensitization on the risk of asthma and food allergy, and show that in combination they pose a significant risk for future allergic disease.”

The findings are useful to help predict which children may develop asthma and allergies, according to the study’s lead author, Maxwell Tran, a BHSc graduate from McMaster University and AllerGen trainee who is now studying medicine at the University of Toronto. “There are certain genetic variants that we know are risk factors for allergy, but genotyping is not widely used in clinical practice, so this research offers healthcare professionals an alternative method of identifying at-risk children.”

Meanwhile, the CHILD researchers found that having AD alone, without sensitization to an allergen, did not significantly increase children’s risk of developing asthma.