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SummaryIntroduction Some wheezing toddlers develop asthma later in childhood. Sensitization is known to predict asthma in birth cohorts. However, its predictive value in secondary healthcare is uncertain. Aim: This study examines the predictive value of sensitization to inhalant allergens among wheezing toddlers in secondary healthcare for the development of asthma at school age (≥6 years). Methods: Preschool children (1–3 years) who presented with wheezing in secondary healthcare were screened on asthma at school age with the International Study of Asthma and Allergies in Childhood questionnaire. The positive and negative predictive value (PPV and NPV) of specific IgE to inhalant allergens (cut-off concentration 0.35 kU/L) and several non-invasive variables from a child's history (such as hospitalization, eczema, and parental atopy) were calculated. The additional predictive value of sensitization when combined with non-invasive predictors was examined in multivariate analysis and by ROC curves. Results: Of 116 included children, 63% developed asthma at school age. Sensitization to inhalant allergens was a strong asthma predictor. The odds ratio (OR), PPV and NPV were 7.4%, 86%, and 55%, respectively. Eczema (OR 3.4) and hospital admission (OR 2.6) were significant non-invasive determinants. Adding sensitization to these non-invasive predictors in multivariate analysis resulted in a significantly better asthma prediction. The area under the ROC curve increased from 0.70 with only non-invasive predictors to 0.79 after adding sensitization. Conclusion: Sensitization to inhalant allergens is a strong predictor of school age asthma in secondary healthcare and has added predictive value when combined with non-invasive determinants. Pediatr Pulmonol. 2017; 9999:XX–XX. © 2017 Wiley Periodicals, Inc.

Background: a subset of wheezing toddlers will develop asthma. Sensitisation is known to predict asthma among these children in birth cohorts. However, its predictive value among wheezing toddlers in secondary healthcare is uncertain. Objectives: to determine the prognosis and predictive value of sensitisation to inhalant allergens among wheezing toddlers in secondary healthcare for the development of asthma at school age. Methods: wheezing toddlers who visited a Dutch hospital were retrospectively analysed. Asthma at school age (≥ six years) was determined through the International Study of Asthma and Allergies in Childhood questionnaire. The predictive value of sensitisation and several non-invasive determinants were calculated. The added predictive value of sensitisation when combined with non-invasive determinants was examined using ROC curves. Results: of 166 included children, 55% developed asthma at school age. In 116 children specific IgE was measured at preschool age. Within this subgroup, the asthma prevalence was 63%. Sensitisation to inhalant allergens was the strongest predictor of asthma. The OR, positive and negative predictive value were 7.4, 86% and 55%, respectively. Eczema (OR 3.4) and hospital admission (OR 2.6) were statistically significant non-invasive predictors. Adding sensitisation to these variables resulted in a significantly better asthma prediction. The area under the ROC curve increased from 0.696 to 0.793. Conclusions: the majority of wheezing toddlers in secondary healthcare develops asthma at school age. Sensitisation to inhalant allergens is the strongest predictor of asthma and has added predictive value when combined with non-invasive determinants.

Ruud W.H. Meijneke (1), Antoinette Y.N. Schouten-van Meeteren (2), Liesbeth Reneman (3), Martijn Finken (4), Peter H. Bisschop (5), Wouter van Furth (6) Hanneke M. van Santen (7) (1) Student (UMCG) scientifi c project, department of pediatric oncology and department of pediatric endocrinology, Emma Children’s Hospital, AMC (2) Department of pediatric oncology, Emma Children’s Hospital, AMC (3) Department of radiology, AMC (4) Department of pediatric endocrinology, VUMC (5) Department of endocrinology, AMC (6) Department of neurosurgery, AMC (7) Department of pediatric endocrinology, Emma Children’s Hospital, AMC