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Han P, Jiao A, Yin J, Zou H, Liu Y, Li Z, Wang Q, Wu J, Shen K. Analysis of risk factors for acute attacks complicated by respiratory failure in children with asthma. Front Pediatr 2024; 11:1335540. [PMID: 38288264 PMCID: PMC10823024 DOI: 10.3389/fped.2023.1335540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 12/31/2023] [Indexed: 01/31/2024] Open
Abstract
Objective To describe the proportion and clinical characteristics of hospitalized children with acute asthma attacks complicated by respiratory failure and to analyze the risk factors. Methods This retrospective study analyzed hospital admissions of children and adolescents with acute asthma attacks between January 2016 and December 2021. Inclusion criteria were used to identify eligible cases, and demographic information and disease characteristics were collected. Patients were categorized into respiratory failure group and the other group based on the result of artery blood gas analysis. Multivariate logistic regression was utilized to investigate the risk factors associated with respiratory failure resulting from acute asthma attacks. The data were analyzed using SPSS 22.0, and significance was considered at P < 0.05. Results Our research involved 225 participants, with 18.7% diagnosed with respiratory failure. The respiratory failure group was found to be younger and have higher percentage of male, while birth weight, nationality, and type of residence did not differ between the two groups. In the respiratory failure group, a significant difference was observed in emergency hospitalization, ICU treatment, severe to critical attack, dyspnea and allergy history. The two groups did not differ in admission season, first asthma diagnosis, respiratory infection and comorbidity. The respiratory failure group exhibited a higher proportion of atopy-only asthma and a lower proportion of T2-high asthma. The eosinophil count, and eosinophil percentage were lower in the respiratory failure group, while neutrophil count was higher. Having a history of allergies (OR = 2.46, 95% CI: 1.08-5.59) and neutrophil count (OR = 1.10, 95% CI: 1.00-1.21) were the risk factors for respiratory failure in children with asthma. There also existed that the risk of respiratory failure increases with decreasing age of the children (OR = 0.85, 95% CI: 0.73-0.99). Conclusion Notably, risk factors for respiratory failure in hospitalized asthma children include age, having a history of allergies, and neutrophil count. The identification of the above factors and the implementation of timely intervention can optimize the treatment of asthma in children.
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Affiliation(s)
- Peng Han
- Respiratory Department, China National Clinical Research Center of Respiratory Diseases, Beijing, China, Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Anxia Jiao
- Department of Interventional Pulmonology, Beijing Children’s Hospital, National Center for Children’s Health, Capital Medical University, Beijing, China
| | - Ju Yin
- Respiratory Department, China National Clinical Research Center of Respiratory Diseases, Beijing, China, Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Huimin Zou
- Respiratory Department, China National Clinical Research Center of Respiratory Diseases, Beijing, China, Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Yuliang Liu
- Respiratory Department, China National Clinical Research Center of Respiratory Diseases, Beijing, China, Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Zheng Li
- Pediatric Intensive Care Unit, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Quan Wang
- Pediatric Intensive Care Unit, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Jie Wu
- Department of Emergency, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Kunling Shen
- Respiratory Department, China National Clinical Research Center of Respiratory Diseases, Beijing, China, Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
- Department of Pediatrics, Shenzhen Children’s Hospital, Shenzhen, China
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2
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Farraj AK, Martin BL, Schladweiler MC, Miller CN, Smoot J, Williams W, Fisher A, Oshiro W, Tennant A, Martin WK, Henriquez AR, Grindstaff R, Gavett SH, Gilmour MI, Kodavanti UP, Hazari MS, Dye JA. Mild allergic airways responses to an environmental mixture increase cardiovascular risk in rats. Toxicol Sci 2022; 191:106-122. [PMID: 36269214 PMCID: PMC9887678 DOI: 10.1093/toxsci/kfac112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Recent epidemiological findings link asthma to adverse cardiovascular responses. Yet, the precise cardiovascular impacts of asthma have been challenging to disentangle from the potential cardiovascular effects caused by asthma medication. The purpose of this study was to determine the impacts of allergic airways disease alone on cardiovascular function in an experimental model. Female Wistar rats were intranasally sensitized and then challenged once per week for 5 weeks with saline vehicle or a mixture of environmental allergens (ragweed, house dust mite, and Aspergillus fumigatus). Ventilatory and cardiovascular function, measured using double-chamber plethysmography and implantable blood pressure (BP) telemetry and cardiovascular ultrasound, respectively, were assessed before sensitization and after single and final allergen challenge. Responses to a single 0.5 ppm ozone exposure and to the cardiac arrhythmogenic agent aconitine were also assessed after final challenge. A single allergen challenge in sensitized rats increased tidal volume and specific airways resistance in response to provocation with methacholine and increased bronchoalveolar lavage fluid (BALF) eosinophils, neutrophils, lymphocytes, cytokines interleukin (IL)-4, IL-5, IL-10, IL-1β, tumor necrosis factor-α, and keratinocyte chemoattract-growth-related oncogene characteristic of allergic airways responses. Lung responses after final allergen challenge in sensitized rats were diminished, although ozone exposure increased BALF IL-6, IL-13, IL-1 β, and interferon-γ and modified ventilatory responses only in the allergen group. Final allergen challenge also increased systolic and mean arterial BP, stroke volume, cardiac output, end-diastolic volume, sensitivity to aconitine-induced cardiac arrhythmia, and cardiac gene expression with lesser effects after a single challenge. These findings demonstrate that allergic airways responses may increase cardiovascular risk in part by altering BP and myocardial function and by causing cardiac electrical instability.
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Affiliation(s)
- Aimen K Farraj
- To whom correspondence should be addressed at US Environmental Protection Agency, 109 T.W. Alexander Drive, Mail Code: B105-02, Research Triangle Park, NC 27709, USA. E-mail:
| | - Brandi L Martin
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee 37830, USA
| | - Mette C Schladweiler
- Public Health and Integrated Toxicology Division, US Environmental Protection Agency, Research Triangle Park, North Carolina 27711, USA
| | - Colette N Miller
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee 37830, USA
| | - Jacob Smoot
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee 37830, USA
| | - Wanda Williams
- Public Health and Integrated Toxicology Division, US Environmental Protection Agency, Research Triangle Park, North Carolina 27711, USA
| | - Anna Fisher
- Public Health and Integrated Toxicology Division, US Environmental Protection Agency, Research Triangle Park, North Carolina 27711, USA
| | - Wendy Oshiro
- Public Health and Integrated Toxicology Division, US Environmental Protection Agency, Research Triangle Park, North Carolina 27711, USA
| | - Alan Tennant
- Biomolecular and Computational Toxicology Division, US Environmental Protection Agency, Research Triangle Park, North Carolina 27711, USA
| | - W Kyle Martin
- Curriculum of Toxicology and Environmental Medicine, UNC Chapel Hill, Chapel Hill, North Carolina 27599, USA
| | - Andres R Henriquez
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee 37830, USA
| | - Rachel Grindstaff
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee 37830, USA
| | - Stephen H Gavett
- Public Health and Integrated Toxicology Division, US Environmental Protection Agency, Research Triangle Park, North Carolina 27711, USA
| | - M Ian Gilmour
- Public Health and Integrated Toxicology Division, US Environmental Protection Agency, Research Triangle Park, North Carolina 27711, USA
| | - Urmila P Kodavanti
- Public Health and Integrated Toxicology Division, US Environmental Protection Agency, Research Triangle Park, North Carolina 27711, USA
| | - Mehdi S Hazari
- Public Health and Integrated Toxicology Division, US Environmental Protection Agency, Research Triangle Park, North Carolina 27711, USA
| | - Janice A Dye
- Public Health and Integrated Toxicology Division, US Environmental Protection Agency, Research Triangle Park, North Carolina 27711, USA
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3
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Luengo O, Galvan-Blasco P, Cardona V. Molecular diagnosis contribution for personalized medicine. Curr Opin Allergy Clin Immunol 2022; 22:175-180. [PMID: 35174793 DOI: 10.1097/aci.0000000000000822] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
PURPOSE OF REVIEW The purpose of the current review is to highlight the most recent findings in molecular allergy and its applicability in precision medicine for allergic patients. RECENT FINDINGS Molecular allergy provides useful information in areas of respiratory allergy (house dust mites, pet dander and pollen allergy), food allergy (tree nuts, peanuts, fruits and vegetables), hymenoptera venom allergy and others, in order to improve management of patients. Regional differences in sensitization profiles, assay characteristics and interpretation of molecular sensitization in relation to whole extracts and total immunoglobulin E need to be taken into account. Studies of the impact of such strategies are needed. SUMMARY Molecular allergy diagnosis represents a major contribution for personalized medicine. It aids in the assesment of risk prediction, disease severity, genuine/cross-reactive sensitization, and finally to apply precise management strategies.
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Affiliation(s)
- Olga Luengo
- Allergy Section, Internal Medicine Department, Hospital Universitari Vall d'Hebron
- Vall d'Hebron Institut de Recerca (VHIR), Immunomediated Diseases and Innovative Therapies, Barcelona
- ARADyAL Research Network, Instituto de Salud Carlos III (ISCIII), Madrid
- Universitat Autonomade Barcelona (UAB), Medicine Department, Barcelona, Spain
| | - Paula Galvan-Blasco
- Allergy Section, Internal Medicine Department, Hospital Universitari Vall d'Hebron
- Vall d'Hebron Institut de Recerca (VHIR), Immunomediated Diseases and Innovative Therapies, Barcelona
- ARADyAL Research Network, Instituto de Salud Carlos III (ISCIII), Madrid
- Universitat Autonomade Barcelona (UAB), Medicine Department, Barcelona, Spain
| | - Victoria Cardona
- Allergy Section, Internal Medicine Department, Hospital Universitari Vall d'Hebron
- Vall d'Hebron Institut de Recerca (VHIR), Immunomediated Diseases and Innovative Therapies, Barcelona
- ARADyAL Research Network, Instituto de Salud Carlos III (ISCIII), Madrid
- Universitat Autonomade Barcelona (UAB), Medicine Department, Barcelona, Spain
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4
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Three patterns of sensitization to mugwort, timothy, birch and their major allergen components revealed by Latent class analysis. Mol Immunol 2022; 145:59-66. [PMID: 35298938 DOI: 10.1016/j.molimm.2022.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 03/01/2022] [Accepted: 03/03/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Mugwort, timothy, and birch are commonly spread pollen allergens across China. Although several studies have described the rates of sensitization to mugwort, timothy, and birch in China, most of them just on specific whole-allergen extracts but little was known about the co-sensitization characteristics of its allergen components. This study aimed to explore the patterns of sensitization to mugwort, timothy, birch, and their major allergen components. METHOD Serum specific IgE (sIgE) levels of allergen components of mugwort, timothy, birch, and cross-reactive carbohydrate determinants (CCD) were detected in 160 patients whose serum showed positive results to at least one of mugwort, timothy, and birch allergens via EUROBlotMaster system. Skin prick testing was utilized to assess the allergic reaction of grass, weed, and tree allergens. Latent class analysis was used to identify underlying patterns of sensitization to a series of allergen components and their corresponding extracts. RESULTS 88.8% of patients with allergic rhinitis and/or asthma were positive for mugwort-sIgE, 30% for timothy-sIgE, and 32.5% for birch-sIgE. By using the LCA model, three sensitization patterns as "Mugwort, Art v 4, Bet v 2 and Phl p 12 co-sensitized", "Timothy, mugwort, and CCD co-sensitized", "Mugwort and Art v 1 co-sensitized" were revealed based on optimal statistical fit in this study. Compared with other clusters, participants in "Mugwort, Art v 4, Bet v 2 and Phl p 12 co-sensitized" pattern were associated with higher sensitization rates of common grass and tree pollens allergen. The spearman's coefficient between CCD and timothy was larger than the corresponding values of CCD with mugwort or birch. CONCLUSION CCD and profilin, as minor allergens in pollens, were associated with other pollen sIgE false positives presumably due to cross-reactivity. Patients sensitized with profilin had a significantly higher risk of sensitization to other pollens.
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Maison N, Omony J, Illi S, Thiele D, Skevaki C, Dittrich AM, Bahmer T, Rabe KF, Weckmann M, Happle C, Schaub B, Meier M, Foth S, Rietschel E, Renz H, Hansen G, Kopp MV, von Mutius E, Grychtol R. T-high asthma phenotypes across life span. Eur Respir J 2022; 60:13993003.02288-2021. [PMID: 35210326 DOI: 10.1183/13993003.02288-2021] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 02/04/2022] [Indexed: 11/05/2022]
Abstract
RATIONALE In adults, personalised asthma treatment targets patients with T2-high and eosinophilic asthma phenotypes. It is unclear whether such classification is achievable in children. OBJECTIVES To define T2-high asthma with easily accessible biomarkers and compare resulting phenotypes across all ages. METHODS In the multicenter clinical ALL Age Asthma Cohort (ALLIANCE), 1125 participants (n=776 asthmatics, n=349 controls) were recruited and followed for 2 years (1 year in adults). Extensive clinical characterisation (questionnaires, blood differential count, allergy testing, lung function and sputum induction (in adults) was performed at baseline and follow-ups. Interleukin (IL)-4, IL-5 and IL-13 were measured after stimulation of whole blood with LPS or anti-CD3/CD28. MEASUREMENTS AND MAIN RESULTS Based on blood eosinophil counts and allergen-specific serum IgE antibodies (sIgE), patients were categorised into four mutually exclusive phenotypes: "Atopy-only", "Eosinophils-only", "T2-high" (eosinophilia+atopy) and "T2-low" (neither eosinophilia nor atopy). The T2-high phenotype was found across all ages, even in very young children in whom it persisted to a large degree even after 2 years of follow-up. T2-high asthma in adults was associated with childhood onset suggesting early origins of this asthma phenotype. In both children and adults, the T2-high phenotype was characterised by excessive production of specific IgE to allergens (p<0.0001) and, from school age onwards, by increased production of IL-5 after anti-CD3/CD28 stimulation of whole blood. CONCLUSIONS Using easily accessible biomarkers, patients with T2-high asthma can be identified across all ages delineating a distinct phenotype. These patients may benefit from therapy with biologicals even at younger age.
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Affiliation(s)
- Nicole Maison
- Institute for Asthma- and Allergy Prevention (IAP), Helmholtz Zentrum Munich, German Research Center for Environmental Health (GmbH), Munich, Germany.,Dr von Hauner Children's Hospital, Ludwig Maximilians University, Munich, Germany.,Comprehensive Pneumology Center - Munich (CPC-M; Member of German Center for Lung Research (DZL), Munich, Germany
| | - Jimmy Omony
- Institute for Asthma- and Allergy Prevention (IAP), Helmholtz Zentrum Munich, German Research Center for Environmental Health (GmbH), Munich, Germany.,Comprehensive Pneumology Center - Munich (CPC-M; Member of German Center for Lung Research (DZL), Munich, Germany
| | - Sabina Illi
- Institute for Asthma- and Allergy Prevention (IAP), Helmholtz Zentrum Munich, German Research Center for Environmental Health (GmbH), Munich, Germany.,Comprehensive Pneumology Center - Munich (CPC-M; Member of German Center for Lung Research (DZL), Munich, Germany
| | - Dominik Thiele
- Institute of Medical Biometry and Statistics (IMBS), University Medical Center Schleswig-Holstein, Luebeck, Germany.,Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Chrysanthi Skevaki
- Institute of Laboratory Medicine and Pathobiochemistry, Molecular Diagnostics, Philipps-University Marburg, Marburg, Germany.,Universities of Giessen and Marburg Lung Center (UGMLC), Philipps University Marburg, German Center for Lung Research (DZL), Marburg, Germany
| | - Anna-Maria Dittrich
- Department of Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH); Member of the German Center for Lung Research (DZL), Hannover, Germany
| | - Thomas Bahmer
- University Hospital Schleswig-Holstein, Campus Kiel, Internal Medicine Department I, Pneumology, Kiel, Germany.,LungenClinic Grosshansdorf GmbH, Grosshansdorf, Germany.,Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Klaus Friedrich Rabe
- LungenClinic Grosshansdorf GmbH, Grosshansdorf, Germany.,Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Markus Weckmann
- Division of Pediatric Pneumology and Allergology, University Medical Center Schleswig-Holstein, Luebeck, Germany.,Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Christine Happle
- Department of Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH); Member of the German Center for Lung Research (DZL), Hannover, Germany
| | - Bianca Schaub
- Dr von Hauner Children's Hospital, Ludwig Maximilians University, Munich, Germany.,Comprehensive Pneumology Center - Munich (CPC-M; Member of German Center for Lung Research (DZL), Munich, Germany
| | - Meike Meier
- Faculty of Medicine, University Children's Hospital, University of Cologne, Cologne, Germany
| | - Svenja Foth
- Universities of Giessen and Marburg Lung Center (UGMLC), Philipps University Marburg, German Center for Lung Research (DZL), Marburg, Germany.,University Children's Hospital Marburg, University of Marburg, Marburg, Germany
| | - Ernst Rietschel
- Faculty of Medicine, University Children's Hospital, University of Cologne, Cologne, Germany
| | - Harald Renz
- Institute of Laboratory Medicine and Pathobiochemistry, Molecular Diagnostics, Philipps-University Marburg, Marburg, Germany.,Universities of Giessen and Marburg Lung Center (UGMLC), Philipps University Marburg, German Center for Lung Research (DZL), Marburg, Germany.,Department of Clinical Immunology and Allergology, Sechenov University, Moscow, Russia
| | - Gesine Hansen
- Department of Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH); Member of the German Center for Lung Research (DZL), Hannover, Germany
| | - Matthias Volkmar Kopp
- Division of Pediatric Pneumology and Allergology, University Medical Center Schleswig-Holstein, Luebeck, Germany.,Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Munich, Germany.,Department of Pediatric Respiratory Medicine, Inselspital, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Erika von Mutius
- Institute for Asthma- and Allergy Prevention (IAP), Helmholtz Zentrum Munich, German Research Center for Environmental Health (GmbH), Munich, Germany .,Dr von Hauner Children's Hospital, Ludwig Maximilians University, Munich, Germany.,Comprehensive Pneumology Center - Munich (CPC-M; Member of German Center for Lung Research (DZL), Munich, Germany
| | - Ruth Grychtol
- Department of Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH); Member of the German Center for Lung Research (DZL), Hannover, Germany
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Atopic Status in Children with Asthma and Respiratory Allergies—Comparative Analysis of Total IgE, ImmunoCAP Phadiatop/fx5 and Euroimmun Pediatric Immunoblot. SINUSITIS 2021. [DOI: 10.3390/sinusitis6010001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Introduction: An atopic status assessment (skin prick test or specific immunoglobulin (sIgE)) in asthmatic children is considered a milestone in identifying potential risk factors and triggers provoking loss of asthma control and asthma exacerbation. Objective: The study aims to perform a comparative analysis of different laboratory methods for a serological assessment of an atopic status in asthma and respiratory allergies in children. Material and methods: A total of 86 children were included, all of whom were diagnosed with bronchial asthma, aged from 5 to 17 years and screened for total IgE level using enzyme-linked immunosorbent assay (ELISA). In 48 randomly selected children, we performed a semi-quantitative serological in vitro assessment of the specific IgE antibodies against food and aeroallergen, using two different laboratory methods—Euroimmun Immunoblot and ImmunoCAP (Phadiatop/fx5). Results: In 70% of the children with a history of allergies, and 65.3% without clinically manifested allergies, multiscreen test ImmunoCAP Phadiatop/fx5 showed positivity and confirmed atopy. Our results showed a significant moderate to strong correlation between multiscreen ImmunoCAP Phadiatop/fx5, and Euroimmun specific IgE titers against aero-allergens—cats, mites, tree mix and food allergens—soy, wheat (р = 0.006), rice, р = 0.090), apple р = 0.007) and peanut. A sensitivity of 63% and specificity of 73.5% was observed for EUROIMMUN Pediatric (food allergens, IgE titer > 1) compared with the gold standard ImmunoCap/fx5. The mean value of total IgE is significantly higher in children with asthma and concomitant with allergic rhinitis compared to those without allergic rhinitis (mean 202.52 U/mL, IQR 102.50 (24.20–363.95) vs. 316.68, IQR 261.00 (109.20–552.50), p = 0.005). Conclusion: Establishing the spectrum of the most common respiratory and food allergens is an essential factor for maintaining asthma control, both through a strategy to avoid allergen exposure and by developing a recommendation plan. The immunoblotting technique is easily applicable in daily clinical and laboratory practice. It is also a cost-effective and reliable alternative to the “gold standard” ImmunoCAP Phadiatop/fx5 in diagnosing atopy in children.
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