ORIGINAL ARTICLE LOWER AIRWAYS Serum immunoglobulin levels as a predictive factor for a better outcome of non-atopic childhood asthma Safa Baris, Elif Karakoc-Aydiner, Ahmet Ozen, Cevdet Ozdemir, Nerin N. Bahceciler & Isil B. Barlan Division of Pediatric Allergy and Immunology, Marmara University, Istanbul, Turkey To cite this article: Baris S, Karakoc-Aydiner E, Ozen A, Ozdemir C, Bahceciler NN, Barlan IB. Serum immunoglobulin levels as a predictive factor for a better outcome of non-atopic childhood asthma. Pediatr Allergy Immunol 2011; 22: 298–304. Asthma is a heterogeneous condition with different clinical presentations that vary with age, gender, genetic background, and environmental exposures. The general consensus now emerging is that childhood asthma presents with different phenotypes and subphenotypes, rather than a single, uniform disease (1). It was suggested that these various and overlap- ping phenotypes might represent distinct time points in a sin- gle underlying pathological process – airway inflammation – in people with individual susceptibility to different triggers (2). Several epidemiologically distinct wheezing phenotypes in early childhood have been described. Previously, three longi- tudinal patterns (early, late, and persistent wheezers) were identified among children between 0 to 6 yrs of age (3). More recently, six different longitudinal patterns of wheezing between birth and the age of 13 yrs were described adding Keywords atopy; childhood asthma; hypogammaglobulinemia; transforming growth factor-beta Correspondence Cevdet Ozdemir, Seher yildizi sokak 16/10 Etiler, 34337, Istanbul, Turkey Tel.: +90 216 327 1010-Ext 788 E-mail: cozdemir@superonline.com Accepted for publication 2 September 2010 DOI:10.1111/j.1399-3038.2010.01105.x Authors declare no conflict of interest. Abstract Childhood asthma is a heterogeneous condition with different phenotypes. Hereby, we aimed to study impact of serum immunoglobulin levels on clinical phenotypes and outcome of asthma. Seventy-eight children (M: 26, F: 52) aged less than 10 yrs (mean = 8.56 ± 3.23 yrs) and diagnosed as mild-moderate persistent asthma, fol- lowed up for at least 1 yr were included into the study. Asthmatic children were divided into two groups based on serum immunoglobulin levels at admission and were evaluated with respect to demographic data, allergic sensitization, symptom scores, medication usage, pulmonary functions, and non-specific bronchial hyper- reactivity. The age at onset of symptoms (40.88 ± 32.02 vs. 23.04 ± 26.97 months) was significantly younger in children with hypogammaglobulinemia (n = 28) com- pared to normogammaglobulinemia group (n = 50) (p = 0.016). Mean follow-up duration was 3.8 ± 2.1 yrs. Atopic sensitization rate was higher in those with nor- mal immunoglobulin levels (81.2% vs. 17.9%), (p < 0.0001). Normal serum immu- noglobulin levels were associated with atopic asthma (OR, 4.5; 95% confidence interval (CI): 2.0–10.1). For the prediction of atopic asthma, having normal immunoglobulin levels yielded predictive values of: sensitivity = 88.6%, speci- ficity = 71.8%, positive predictive value = 81.1%, negative predictive value = 82.1%. Furthermore, percentages of atopic dermatitis and allergic conjunctivitis, ele- vated serum total IgE levels, eosinophilia, and bronchial hyper-reactivity were more common in normogammaglobulinemia with asthma group (p = 0.040, p = 0.003, p = 0.024, p = 0.030, p = 0.040, respectively). Although marked reductions in asthma scores and inhaled corticosteroid usage were observed in both groups over time, the rate of decline was significantly higher and earlier in hypogammaglobulin- emia group (p = 0.0001, p = 0.004, respectively). In conclusion, asthmatic children with hypogammaglobulinemia presented at an earlier age, with lower rates of atopy, and earlier clinical improvement accompanied with earlier discontinuation of inhaled corticosteroids than children with normal immunoglobulin levels. Our data demonstrated that in children currently named as early-onset non-atopic asthma, hypogammaglobulinemia might be accompanying, providing evidence for a different phenotype of childhood asthma. Pediatric Allergy and Immunology 298 Pediatric Allergy and Immunology 22 (2011) 298–304 ª 2010 John Wiley & Sons A/S