title: Accuracy of specific IgE in the prediction of asthma: development of a scoring formula for general practice.
abstract: BACKGROUND
  For the diagnosis of asthma in young children, GPs have to rely on history taking and physical examination, as spirometry is not possible. The additional diagnostic value of specific immunoglobulin E (IgE) to inhalent allergens remains unclear.
  
  
  OBJECTIVE
  To assess the predictive accuracy of specific IgE to cat, dog, and/or house dust mites in young children for the subsequent development of asthma at the age of 6 years.
  
  
  METHODS
  Prospective follow-up study.
  
  
  METHODS
  Seventy-two general practices.
  
  
  METHODS
  A total of 654 children, aged 1-4 years, visiting their GPs for persistent coughing (>/= 5 days), were tested for IgE antibodies by radio allergosorbent testing (RAST). Parents completed a questionnaire on potential risk indicators. Those children who showed an IgE-positive status (12.7%) and a random sample of those with an IgE-negative status (<0.5 U/ml) were followed up to the age of 6 years when the asthma status was established. The main outcome measure was asthma at the age of 6 years (combination of both symptoms and/or use of asthma medication, and impaired lung function).
  
  
  RESULTS
  Addition of RAST results to a prediction model based on age, wheeze, and family history of pollen allergy increased the area under the receiver operating characteristic (ROC) curve from 0.76 to 0.87. Furthermore, RAST improved patient differentiation as indicated by a change in the range of asthma probabilities from 6-75% before the IgE test, to 1-95% after the IgE-test.
  
  
  CONCLUSIONS
  Sensitisation to inhalant allergens in 1-4-year-olds, as shown by RAST, is a useful diagnostic indicator for the presence of asthma at the age of 6 years, even after a clinical history has been obtained. This model should preferably be validated in a new population before it can be applied in practice.
authors.affiliation: Department of General Practice, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Petra E D
authors.initials: PE
authors.lastname: Eysink
authors.forename: Gerben
authors.initials: G
authors.lastname: ter Riet
authors.forename: Rob C
authors.initials: RC
authors.lastname: Aalberse
authors.forename: Wim M C
authors.initials: WM
authors.lastname: van Aalderen
authors.forename: Carel M
authors.initials: CM
authors.lastname: Roos
authors.forename: Jaring S
authors.initials: JS
authors.lastname: van der Zee
authors.forename: Patrick J E
authors.initials: PJ
authors.lastname: Bindels
mesh_terms: D000485:Allergens / Q000009:adverse effects*; D000818:Animals; D001249:Asthma / Q000175:diagnosis / Q000276:immunology*; D015415:Biomarkers / Q000097:blood; D002415:Cats / Q000276:immunology; D002675:Child, Preschool; D015331:Cohort Studies; D004285:Dogs / Q000276:immunology; D004391:Dust / Q000276:immunology; D005194:Family Practice; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood*; D007223:Infant; D008297:Male; D008925:Mites / Q000276:immunology; D011237:Predictive Value of Tests; D011446:Prospective Studies
chemical_list: D000485:Allergens; D015415:Biomarkers; D004391:Dust; D007073:Immunoglobulin E
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