Eysink PE, Bottema BJ, ter Riet G, Aalberse RC, Stapel SO, Bindels PJ. Pediatr Allergy Immunol. 2004;15:394–400
Purpose of the Study.
To identify patterns of clinical history associated with extreme (high or low) probabilities of allergic sensitization in coughing children to restrict allergy testing to those with an intermediate probability of sensitization.
A total of 752 children in the Netherlands, aged 1 to 4 years, visiting their general practitioners for coughing (≥5 days), were studied.
Parents completed a questionnaire on family history of atopy, breastfeeding, smoking, pets, and floor covering. Sera from the children were tested for IgE antibodies to house dust mite, cat, and dog by using the RadioAllergoSorbent Test (RAST). Data of 640 children could be analyzed; 83 children (13%) were IgE positive to at least 1 allergen. In a logistic-regression analysis, a scoring formula for the prediction of being IgE positive was constructed by using variables from the patient’s history.
Significant contributors for sensitization were: 3 to 4 years old (odds ratio[OR]: 2.6), infantile eczema (OR: 5.4), positive family history of mite allergy (OR: 2.2), sibling(s) with pollen allergy (OR: 5.5), and smoking by parents (OR: 1.8). If only 1 of these characteristics is present, the probability of sensitization was <25%.
Patient history–derived information contributes to distinguishing children who are at low risk for sensitization to house dust mite, cat, and dog. Watchful waiting may be preferred over testing if only 1 risk factor is present. Otherwise, a negative RAST may help to exclude sensitization, whereas a positive RAST helps to establish the diagnosis.
Chronic cough is a very common symptom in childhood and accounts for a large number of visits to the pediatrician each year. Although many allergic children have symptoms of cough, there are numerous diagnoses that also need to be considered during an evaluation for chronic cough. This study supports limiting allergy testing in children with persistent cough to those with particular multiple risk factors for atopy to decrease unnecessary testing in young children.