Allergic factors associated with the development of asthma and the influence of cetirizine in a double-blind, randomized, placebo-controlled trial: first results of ETAC

Pediatric Allergy and Immunology, 1998;9:116-124

The following abstract also considers:
Determinants of total and specific IgE in infants with atopic dermatitis (Pediatric Allergy and Immunology, 1997; 8:177-184).

The Study

• ETAC (Early Treatment of the Atopic Child) investigated the potential for early therapeutic intervention with cetirizine to prevent the development of asthma in infants with atopic dermatitis.

• The study involved 800 infants between 1 year and 2 years old, all with atopic dermatitis, positive family history, and a high risk of developing asthma. Children who already had asthma or wheezing were excluded.

• Prior to initiation of treatment with cetirizine or placebo, and in addition to a full clinical examination, total and specific serum IgE (house dust mite, cat, egg, and cow's milk) were measured by in vitro testing using ImmunoCAP technology to ensure allergen sensitivity. The status of the patient was evaluated after 18 months.

Summary of Results and Conclusions

• There is a strong association between atopic dermatitis and the subsequent development of asthma - 40 percent of these infants will develop asthma at the age of 3 to 4 years.

• Infants in the placebo group with raised baseline levels of serum total IgE or specific IgE antibodies had an increased relative risk of developing asthma. This increase was observed for all measured IgE antibodies.

• This study is the first to show that sensitization to grass pollen in such young infants is a powerful predictor of the future onset of asthma. And it confirms previous reports indicating that preexisting sensitization to house dust mite or cat dander allergen or raised serum total IgE strongly predicts the subsequent development of asthma. Sensitization to egg and milk was not a significant indicator of asthma, but this may be due to the age of the children in this study.

• Cetirizine halved the number of patients developing asthma in the subgroups sensitized to grass pollen or house dust mite.

• Infants receiving cetirizine who began the study with raised baseline levels of total IgE or specific IgE antibodies had a reduced risk of developing asthma compared with those infants with raised baseline IgE antibodies who received a placebo.

• Cetirizine was determined to be an appropriate intervention strategy to prevent the development of asthma in specifically sensitized infants with atopic dermatitis.

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