Bergmann R L, Edenharter G, Bergmann K E, Guggenmoos-Holzmann I, Forster J, Bauer C P, Wahn V, Zepp F, Wahn U
Department of Paediatrics of the Humboldt University Berlin, Germany.
Clin Exp Allergy. 1997 Jul;27(7):752-60.
Atopic family history and cord blood IgE have been used as predictors of atopic disease in newborns for about 20 years, but at least for cord blood IgE the sensitivity has been shown to be very low. The objective of this paper was to evaluate whether parental history and cord blood-IgE were more accurate predictors for the appropriate atopic phenotypes in the infants rather than for any atopy.
A total of 1314 newborn infants was recruited in six German obstetric departments in 1990 and followed-up for 2 years. Four hundred and ninety-nine (38%) were at high risk for atopy with at least two first degree atopic family members and/or elevated cord-blood IgE concentrations.
The cumulative incidence of atopic dermatitis over the first 2 years of life (AD24) amounted to 20.1%, and there was a significant association with AD history of the mother (OR 2.5, 95%CI 1.46-4.26) and of the father (OR 3.53, 95%CI 1.90-6.54). The cumulative incidence of recurrent wheezing in the first 2 years of life (RW24) amounted to 16.1%, and was positively associated with asthma history (OR 2.11, 95%CI 1.33-3.60) and sensitization history (OR 1.64, 95%CI 1.34-2.36) of the mother, but with neither for the father. RW24 was less prevalent in girls than in boys (OR 0.64, 95%CI 0.47-0.89). Thirty-one per cent of infants were sensitized (CAP test value > 0.35 kU/L) against at least one of nine food or inhalative allergens (S24) and this was significantly associated with cord blood-IgE value (OR 2.43, 95%CI 1.69-3.49), and sensitization history of the mother (OR 1.64, 95%CI 1.18-2.41). Using multiple logistic regression analysis, the prediction of AD24 by AD of parents, of RW24 by asthma of parents, and of sensitization by cord blood IgE was of low accuracy.
The predictive capacity of parental history and cord blood IgE is not high enough to recommend them as screening instruments for primary prevention. The majority of atopic manifestations and of sensitization occur in infants with no demonstrable risk at birth.
特应性家族史和脐血IgE作为新生儿特应性疾病的预测指标已应用约20年，但至少对于脐血IgE而言，其敏感性已被证明非常低。本文的目的是评估父母病史和脐血IgE对于婴儿特应性疾病的合适表型而非任何特应性疾病是否是更准确的预测指标。
1990年在德国六个产科部门招募了总共1314名新生儿，并对其进行了2年的随访。499名（38%）婴儿有特应性疾病的高风险，至少有两名一级亲属患有特应性疾病和/或脐血IgE浓度升高。
生命最初2年特应性皮炎的累积发病率（AD24）为20.1%，与母亲的特应性皮炎病史（比值比2.5，95%可信区间1.46 - 4.26）和父亲的特应性皮炎病史（比值比3.53，95%可信区间1.90 - 6.54）显著相关。生命最初2年反复喘息的累积发病率（RW24）为16.1%，与母亲的哮喘病史（比值比2.11，95%可信区间1.33 - 3.60）和致敏病史（比值比1.64，95%可信区间1.34 -
2.36）呈正相关，但与父亲的上述病史无关。RW24在女孩中的患病率低于男孩（比值比0.64，95%可信区间0.47 - 0.89）。31%的婴儿对9种食物或吸入性过敏原中的至少一种致敏（CAP检测值>0.35 kU/L）（S24），这与脐血IgE值（比值比2.43，95%可信区间1.69 - 3.49）和母亲的致敏病史（比值比1.64，95%可信区间1.18 - 2.41）显著相关。使用多因素逻辑回归分析，父母的特应性皮炎病史对AD24的预测、父母的哮喘病史对RW24的预测以及脐血IgE对致敏的预测准确性较低。
父母病史和脐血IgE的预测能力不够高，不足以推荐将其作为一级预防的筛查工具。大多数特应性表现和致敏发生在出生时无明显风险的婴儿中。
