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Histamine challenges discriminate between symptomatic and asymptomatic children

¹ University Children's Hospital Charité of Humboldt University, Berlin, Germany and ² University Children's Hospital, Munich, Germany

CORRESPONDENCE: B. Niggemann, Dept. of Pediatric Pneumology and Immunology, Children's Hospital Charité, Humboldt University, Augustenburger Platz 1, D-13353 Berlin, Germany. Fax: 49 3045066931

Keywords: asthma, bronchial hyperresponsiveness, children, cut-off value, histamine challenge, PC₂₀FEV₁

Received: March 15, 2000
Accepted September 8, 2000

The Multicentre Allergy Study (MAS-90) has been supported by the German Ministry of Research and Technology (BMFT), Grant No. 01EE9406.

The aims of this study were to investigate a threshold value for bronchial responsiveness in children aged 7 yrs, which discriminates between symptomatic and asymptomatic children, and to identify determinants of this responsiveness.

Titrated bronchial histamine challenges using the reservoir method were performed in 645 children aged 7 yrs, from the birth cohort Multicentre Allergy Study (MAS).

When defining a reference population of healthy children within the MAS cohort, the 95th percentile of the provocative concentration causing a 20% fall in forced expired volume in one second PC₂₀ among these asymptomatic study subjects amounted to 0.60 mg·mL^–1. This resulted in a specificity of 93.0% and a sensitivity of 45.9%, for discriminating between "current wheezers" and "non-current wheezers". Determinants of airway responsiveness at this age were pulmonary function, sensitization to indoor allergens, total immunoglobulin E and current wheeze.

The results indicate that a very low cut-off provocative concentration causing a 20% fall in forced expired volume in one second (<1.0 mg·mL^–1) defines airway hyperresponsiveness in children aged 7 yrs using the reservoir method. Provocation protocols for histamine challenges in this age group should therefore start with concentrations markedly below 1.0 mg·mL^–1.

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