Food Allergy As a Risk Factor for Life-threatening Asthma in Childhood: a Case-controlled Study

Background: No objective clinical risk factors exist for pediatric life-threatening asthma.

Objectives: In this study, we address whether persistent food allergy and degree of atopy are risk factors for life-threatening asthma.

Methods: By use of a case-controlled design, children (1-16 years) ventilated for an exacerbation of asthma were enrolled. Each case was matched by sex, age, and ethnicity, with 2 controls who had attended with a non-life-threatening exacerbation. All subjects were assessed by means of a questionnaire, spirometry, and skin prick or RAST testing. The data were analyzed by conditional logistic regression.

Results: Nineteen cases and 38 controls were enrolled. Compared with controls, cases were found to have the following risk factors: food allergy (odds ratio, 8.58; 95% CI, 1.85-39.71), multiple allergic diagnoses (4.42; 1.17-16.71), early onset of asthma (6.48; 1.36-30.85), and frequent admissions (14.2; 1.77-113.59). After regression analysis, only frequent admission with asthma (9.85; 1.04-93.27) and food allergy (5.89; 1.06-32.61) were independently associated with life-threatening asthma. Half the cases had food allergy compared with only 10% of controls.

Conclusion: This study demonstrates that poorly controlled asthma and food allergy are significant risk factors for life-threatening asthma. More intensive management of this high-risk group of children might help to reduce future morbidity and mortality.