Atopic risk score for allergy prevention

Background. There have been recommendations for allergy prevention in cases of high risk infants; nevertheless, there has been no definite criterium to identify those at risk. Objective: To develop an atopic risk score to identify infants who are at risk and deserve allergy prevention by noting a history of atopic diseases of their 1(st) degree related family. The scoring is weighted by genetic correlation to each atopic disease to determine the score that is the most appropriate for predictive screening for the development of atopic diseases. Method. This is a retrospective study designed by a team of family pediatricians. Three-thousands five-hundred two children aged 1-5 years from Bangkok and other provinces of Thailand were included between April 2005 and March 2006. From their clinics, the family pediatricians recorded the patients' family history of atopic diseases by using the atopic risk score that had been designed, and the health status that had been recorded in the past one-five years. Main outcome parameters were allergic manifestations including cow's milk allergy, atopic dermatitis (AD), chronic rhinitis, and recurrent wheeze. Results: Study subjects were 3,502 children; female (56.4%) and male (43.6%) attending health care facilities in Bangkok and other provinces. The average age of onset of atopic disease was 14.7 months (2 weeks to 5 years) with the median age 9 months. 35.2% had developed atopic diseases mostly during the first year of life (78.3%) and had either a positive or negative family history of atopy. Male children developed significantly more atopic disease than the female with P value <0.001 (OR=1.5; 95%CI=1.300-1.719). The association of the atopic risk score with the development of atopic diseases was determined by using odds ratio as risk estimates. All scores from score one were associated significantly with the development of atopic diseases by OR=2.64-3.22 with p-value <0.001 and 95%CI. The score that could be used for screening of the high-risk infant, was more than 2. Conclusion: The atopic risk score is a practical method to identify the infants with high risk who deserve allergy prevention.