Three clinical signs to distinguish allergies or infections in allergic children with airway symptoms

Background: Respiratory disorders are common in children. Symptoms of allergy and airway infection overlap. Simple methods are needed to determine the cause of infection or allergen exposure.

Objectives: To determine the diagnostic value of 3 clinical signs (fever, nasal secretions, and symptom continuation) as a differentiator for infection or allergen exposure in allergic patients who experience airway symptoms. 

Method: In this study patients diagnosed with allergies due to food elimination and provocation test, and skin prick test in the Paediatric Allergy Outpatient Clinic Dr Soetomo General Hospital, Surabaya, Indonesia, who experienced airway symptoms, were enrolled. Patients were determined to have 3 clinical signs, by anamnesis and physical examination, and laboratory evaluation (complete blood count, C-reactive protein, and nasopharyngeal swab polymerase chain reaction) as infection markers. Analysis was done using the McNemar and Kappa tests (p <0.05; 95% CI).

Results:A total of 60 patients (60% male) met the inclusion criteria. From laboratory tests, the number of patients who showed infection and non-infection was 26 (43.4%) and 34 (56.6%), respectively. There were 28 (82.4%) patients who met 3 clinical signs of allergy from the results of non-infectious laboratory markers. Sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio and negative likelihood ratio were 82.3%, 80.7%, 84.8%, 77.7%, 4.24 and 0. 22 respectively. 

Conclusions: Fever, nasal secretions, and time of symptom continuation can distinguish well between infection and allergen exposure in allergic children who are experiencing airway symptoms

Sri Lanka Journal of Child Health, 2022; 51(4): 542-546