The natural history of IgE sensitisation and atopic disease in early childhood.

We have prospectively followed 57 children of atopic parents up to 5 years of age, documenting clinical atopic disease and allergen skin test reactions. The cumulative prevalences of the clinical features of atopic disease over the 5 years were: atopic dermatitis (58%), wheeze (49%), recurrent wheeze (33%), rhinitis (68%) and immediate food reactions (18%). Atopic dermatitis and immediate food reactions predominated in infancy (birth to 20 months) while wheezing was more prominent in later childhood (20 months to 5 years). Rhinitis was common in both infancy and childhood. IgE sensitisation to ingested allergens was prominent in early infancy and was usually transient. Inhaled allergen sensitisation occurred later in infancy and was generally permanent with wheal sizes tending to increase with age. There was a significant association between IgE sensitisation to ingested but not inhaled allergens and all atopic manifestations in infancy, with the exception of rhinitis. In contrast IgE sensitisation to inhaled allergens was associated with rhinitis and wheeze in later childhood. We found two clinical groups. One group, with only ingested allergen sensitisation had a high incidence of atopic dermatitis but low incidence of respiratory symptoms at 5 years of age. The other group, who developed evidence of IgE sensitisation to inhaled allergens, had a high incidence of rhinitis and wheeze but low incidence of atopic dermatitis at 5 years of age.