Sensitization patterns to food and inhalant allergens in childhood: a comparison of non-sensitized, monosensitized, and polysensitized children.
The clinical interpretation of children sensitized to numerous allergens is challenging. We examined differences between children sensitized to zero, one, or more allergens. This was a retrospective analysis of all specific IgE tests in children 0-18 yrs of age sent to our laboratory by general practitioners and hospital-based specialists for allergy testing between 1990 and 2003. Of all 9044 children tested, 5439 (60.1%) were not sensitized to any of the aeroallergens or food allergens tested. Three thousand six hundred and five children (39.9%) had one or more positive specific IgE tests, 1120 of which (31.1%) were monosensitized (73% to aeroallergens and 27% to food allergens), 1709 (47.4%) were sensitized to two to four allergens, and 776 (21.5%) to five or more allergens (polysensitization). Polysensitization was more common in children 4-11 yrs of age (24.8%) than in younger (18.7%) or older children (18.3%, p < 0.001), and more common in boys (9.8%) than in girls (7.3%, p < 0.001). Median total IgE values increased with increasing number of positive specific IgE tests (p < 0.001). House dust mite more commonly showed monosensitization (22.2%) than other aeroallergens (grass pollen 10.5%, tree pollen 3.6%, cat 2.9%, and dog 1.5%); cow's milk (27.6%) more commonly than other food allergens (hen's egg 9.7%, peanut 4.6%, wheat 0.8%, soy 0.7%). Between 55.7% (cow's milk) and 87.9% (soy) of children sensitized to food were cosensitized to aeroallergens, while only 25.4% (house dust mite) to 39.5% (dog) of children sensitized to aeroallergens were cosensitized to food. Polysensitization is common in children, in particular in boys. It is most common in school-aged children. The strong association with total serum IgE values and the striking cosensitization between biologically unrelated allergens suggest that polysensitization is the expression of a distinct clinical, more severe, atopic phenotype, and not of biologic cross-reactivity to similar allergens.
de Jong
Adriana Baatenburg
AB
Princess Amalia Children's Clinic Clinical Laboratory, Isala Klinieken, GK Zwolle, the Netherlands.
Dikkeschei
Lambert D
LD
Brand
Paul L P
PL
D000293:Adolescent; D000367:Age Factors; D000485:Allergens / Q000276:immunology*; D000818:Animals; D000829:Animals, Domestic; D002648:Child; D002675:Child, Preschool; D005260:Female; D005502:Food / Q000009:adverse effects*; D006801:Humans; D006967:Hypersensitivity / Q000097:blood / Q000453:epidemiology / Q000276:immunology*; D007073:Immunoglobulin E / Q000097:blood* / Q000276:immunology; D007223:Infant; D008297:Male; D008925:Mites; D009426:Netherlands / Q000453:epidemiology; D011058:Pollen; D012189:Retrospective Studies
D000485:Allergens; D007073:Immunoglobulin E