main outcome measure was maternal report of a provid- er’s diagnosis of eczema or atopic dermatitis in the first 6 months of life. Methods. The authors used a prospective birth cohort study design and multiple logistic-regression models to assess the associations between potential predictors and incidence of atopic dermatitis. Results. The incidence of atopic dermatitis in the first 6 months of life was 17.1%. The risk of atopic dermatitis was increased among infants born to black or Asian mothers (adjusted odds ratio [OR]: 2.41 and 2.58, respectively) and among infants whose mothers had eczema (OR: 2.67). Other predictors included increased gestational age at birth (OR: 1.14; 95% confidence interval: 1.02, 1.27, for each 1-week increment) and male gender (OR: 1.76). Conclusions. These findings suggest that genetic and prenatal and perinatal influences are important in the early presentation of atopic dermatitis. Reviewer’s Comments. There are relatively little data about risk factors for atopic dermatitis in the United States, and the strengths of this study are the prospective evalu- ation of risk factors in a large population with data collec- tion beginning in the prenatal period. The results of the study point to a number of risk factors related to heredity and potentially genetics as being important in early onset of eczema. The preponderance of affected males is inter- esting given that infant boys are also more likely to wheeze. Although this may be due in part to changes in airway mechanics, the results of this study, together with data demonstrating higher total serum IgE levels in boys, suggest that immune development is also related to gen- der. Environmental factors were not prominent as risk factors for eczema, although there was a trend toward an association with greater cockroach exposure. It is likely that environmental exposures play a greater role in deter- mining the persistence of atopic dermatitis or perhaps the incidence after the first 6 months of age. James E. Gern, MD Madison, WI REDUCED INTERFERON  PRODUCTION AND SOLUBLE CD14 LEVELS IN EARLY LIFE PREDICT RECURRENT WHEEZING BY 1 YEAR OF AGE Guerra S, Lohman IC, Halonen M, Martinez FD, Wright AL. Am J Respir Crit Care Med. 2004;169:70 –76 Purpose of the Study. To determine if interferon  (IFN) production and soluble CD14 (sCD14) levels corre- late longitudinally with the risk of developing recurrent wheezing in the first year of life. Both environmental risk factors and variation in the maturation of the immune system seem to have a role in the development of asthma. Previous studies have demonstrated reduced IFN pro- duction in atopic and nonatopic wheezers. IFN produc- tion correlates positively with endotoxin exposure and with sCD14 levels, and CD14 functions as a receptor for endotoxin. Thus, the investigators reasoned that a CD14- mediated response to endotoxin might play a role in the maturation of IFN production, possibly preventing the onset of recurrent wheezing. Study Population. Subjects were 238 infants followed prospectively from birth to 12 months as part of the Infant Immune Study in Arizona. Methods. Mothers of enrolled infants completed ques- tionnaires about known environmental risk factors for wheezing before birth and throughout the infant’s first 12 months of life. At 12 months, the mothers were also asked how often their infant’s chest had ever sounded “wheezy” or “whistling” and the age of the first wheezing episode. Frequency of wheezing was quantified, and any response more than “very rarely” was classified as recurrent wheez- ing. Blood was obtained at birth and 3 months of age for the measurement of sCD14 levels in plasma and IFN production from stimulated peripheral blood mononuclear cells. Results. Wheezing episodes during the first year of life were experienced by 94 infants (39.5%), and 41 experienced recurrent episodes. The mean IFN production and sCD14 levels increased from birth to 3 months. Infants in the lowest quartile of IFN production at 3 months and of sCD14 levels at birth had up to 4.5 and 3.2 increased odds, respectively, of developing recurrent wheezing compared with children in the medium and high quartiles for these parameters. These relationships persisted after adjusting for demographic and environmental asthma risk factors. Conclusions. The authors concluded that reduced plasma sCD14 at birth and impaired IFN production at 3 months of age increase the risk of recurrent wheezing in the first year of life. Because of the interrelationship of CD14 and IFN, a CD14-mediated response to endotoxin may play an important role in enhancing the maturation of IFN production and preventing the inception of recurrent wheezing. Reviewers’ Comments. The relation of CD14 and IFN with endotoxin exposure lends support for the “hygiene hypothesis,” which postulates that decreased exposure to infectious agents in infancy increases the risk for atopy. From this study, it is impossible to assess whether sCD14 levels at birth and IFN production at 3 months of age are simply independent markers that correlate with recurrent wheeze or whether they are truly in the same causal path- way to recurrent wheezing. Additional studies will need to be done to confirm causality. Unfortunately, the design of the study did not allow the investigators to explore whether IFN production and sCD14 levels were impor- tant in atopic versus nonatopic recurrent wheezing. Ivan K. Chinn, MD Vaishali S. Mankad, MD Larry W. Williams, MD Durham, NC SOLUBLE CD14 AS A PREDICTOR OF SUBSEQUENT DEVELOPMENT OF RECURRENT WHEEZING IN HOSPITALIZED YOUNG CHILDREN WITH RESPIRATORY SYNCYTIAL VIRUS-INDUCED BRONCHIOLITIS Soferman R, Bar-Zohar D, Jurgenson U, Fireman E. Ann Allergy Asthma Immunol. 2004;92:545–548 Purpose of the Study. To investigate the relationship between the serum level of soluble CD14 (sCD14) in chil- dren hospitalized because of respiratory syncytial virus (RSV)–induced bronchiolitis and the subsequent develop- ment of recurrent wheezing. Study Population. Twenty-one infants aged 2 to 14 months who were hospitalized because of RSV bronchioli- tis in the winter of 2001–2002. All were at least 37 weeks’ gestation without any neonatal complications or prior ill- ness. Methods. sCD14 was measured on admission to the hospital. RSV infection was documented by direct immu- nofluorescence. Children were assessed every 2 months for 1 year after discharge for the development of recurrent wheezing. Results. Nineteen patients completed the study. Six children did not have recurrent wheezing in the 12-month 538 ALLERGY by guest on May 26, 2020 www.aappublications.org/news Downloaded from