title: Urinary eosinophilic protein X, atopy, and symptoms suggestive of allergic disease at 3 years of age.
abstract: BACKGROUND
  Urinary eosinophilic protein X (U-EPX) measurement is easy to perform in children. However, its use for prediction, diagnosis, and monitoring of asthma and atopy is unclear.
  
  
  OBJECTIVE
  We sought to investigate the relationship between U-EPX and clinical phenotypes suggestive of allergic diseases.
  
  
  METHODS
  U-EPX measurement (RIA), respiratory questionnaires, and skin testing were completed at age 3 years in 903 children followed prospectively from birth. Specific airway resistance was measured in 503 currently asymptomatic children by using whole-body plethysmography during tidal breathing.
  
  
  RESULTS
  Nonatopic children with wheezing or eczema had slightly increased U-EPX levels compared with nonatopic asymptomatic children. U-EPX levels (geometric mean EPX/creatinine ratio) were as follows: nonatopic asymptomatic children (n = 313), 61.3 microg/mmol (95% CI, 56.4-66.6 microg/mmol); nonatopic children with wheezing (n = 148), 71.2 microg/mmol (95% CI, 63.2-80.1 microg/mmol); nonatopic children with eczema (n = 90), 65.7 microg/mmol (95% CI, 56.7-76.2 microg/mmol); and nonatopic children with wheezing and eczema (n= 86), 79.7 microg/mmol (95% CI, 67.4-94.3 microg/mmol). Children who had persistent atopy early in life had significantly higher U-EPX levels at age 3 years (nonatopic at 1 and 3 years [n = 263], 63.4 microg/mmol [95% CI, 58.4-69.0 microg/mmol]; atopic at 1 but not 3 years [n = 24], 65.1 microg/mmol [95% CI, 43.8-96.7 microg/mmol]; nonatopic at 1 year and atopic at 3 years [n = 62], 90.0 microg/mmol [95% CI, 74.6-108.4 microg/mmol]; atopic at 1 and 3 years [n = 35], 111.5 microg/mmol [95% CI, 89.2-139.3 microg/mmol]; P <.002). Atopy alone and with wheezing, eczema, or both was associated with significantly increased U-EPX levels (P <.0001). Wheezing appeared to be associated with higher U-EPX levels compared with eczema in both atopic and nonatopic children. The highest U-EPX level was found in atopic children with a history of wheezing and eczema (P <.0001). There was no relationship between U-EPX level and lung function.
  
  
  CONCLUSIONS
  U-EPX level reflects the presence of atopy and associated symptoms and might be useful for monitoring the progression of allergic disease.
authors.affiliation: North West Lung Centre, Wythenshawe Hospital, Manchester, United Kingdom.
authors.forename: Claudia
authors.initials: C
authors.lastname: Gore
authors.forename: Christer G B
authors.initials: CG
authors.lastname: Peterson
authors.forename: Patricia
authors.initials: P
authors.lastname: Kissen
authors.forename: Bridget M
authors.initials: BM
authors.lastname: Simpson
authors.forename: Lesley A
authors.initials: LA
authors.lastname: Lowe
authors.forename: Ashley
authors.initials: A
authors.lastname: Woodcock
authors.forename: Adnan
authors.initials: A
authors.lastname: Custovic
mesh_terms: D000818:Animals; D000829:Animals, Domestic; D002675:Child, Preschool; D003371:Cough / Q000209:etiology; D003876:Dermatitis, Atopic / Q000209:etiology; D004485:Eczema / Q000209:etiology / Q000652:urine; D004781:Environmental Exposure; D047208:Eosinophil-Derived Neurotoxin; D006801:Humans; D006967:Hypersensitivity / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology / Q000652:urine*; D008168:Lung / Q000503:physiopathology; D008499:Medical Records; D015999:Multivariate Analysis; D011446:Prospective Studies; D012135:Respiratory Sounds / Q000209:etiology / Q000503:physiopathology; D012260:Ribonucleases / Q000652:urine*; D012882:Skin Tests
chemical_list: D047208:Eosinophil-Derived Neurotoxin; D012260:Ribonucleases