Serum allergen-specific immunoglobulin E (sIgE) levels increase during an asthma exacerbation in pediatric patients, suggesting that testing for sIgE levels during an asthma exacerbation may assist in identifying triggers and mitigating allergen exposure, according to study results published in Clinical Pediatrics.
Pediatric patients with an acute asthma exacerbation who were admitted to the emergency department between September 2015 and February 2019 were included in the prospective single-center cohort study (n=50). Participants were ≥5 years and ≤18 years of age and were tested for both total IgE and 8 perennial allergen levels in visit 1. Children who tested positive for ≥1 of the allergens were taken to a second visit 4 to 6 weeks later. Among patients who had increased levels of sIgE, retesting was performed after resolution of symptoms. Researchers also performed a review of patients’ medical histories and administered an Asthma Control Test.
The allergens included cat epithelium, dog hair/dander, cockroach, Dermatophagoides farina, Dermatophagoides pteronyssinus, Alternaria alternatum, Aspergillus fumigatus, and Cladosporium herbarum. None of the eligible patients experienced a positive reaction to all 8 of the perennial allergens. The allergens most likely to cause a reaction included cat epithelium (n=40; 80%), dog hair/dander (n=39; 78%), and Dermatophagoides farinae (n=36; 72%). There were significant median differences between visits in tests for cat epithelium (median difference [MD], 0.34; interquartile range [IQR], 13.6; P <.001), dog hair/dander (MD, 0.62; IQR, 5.18; P <.001), D farina (MD, 0.24; IQR, 4.35; P <.001), D pteronyssinus (MD, 0.23; IQR, 0.95; P <.001), cockroach (MD, 0.35; IQR, 1.65; P <.001), A fumigatus (MD, 0.28; IQR, 0.57; P =.004), and C herbarum (MD, 0.31; IQR, 0.33; P =.007).
Limitations of the study included the recruitment of patients from a single center, as well as the small sample size.
The researchers suggested these findings “may enable the development of a guideline regarding the appropriate timing of sIgE testing.” They also noted that the data may be “relevant for inner-city children who suffer disproportionately from asthma morbidity and mortality and who utilize the [emergency department] for their initial and follow-up care.”
James P, Cornish A, Shaw K, et al. Is there benefit in identifying asthma triggers during an exacerbation? [published online November 13, 2019]. Clin Pediatr (Phila). doi:10.1177/0009922819887399