Abstract
Background: There are no reference guidelines for health care providers regarding appropriate use and interpretation of urine eosinophil protein X (u‐EPX) in clinical practice. Currently, there are no clear‐cut clinical or laboratory parameters to diagnose asthma in young children. Objective: In this study, we (1) systematically reviewed and qualitatively appraised the epidemiological evidence to determine diagnostic u‐EPX cut points for pediatric asthma, and (2) performed a meta‐analysis to provide u‐EPX estimates for diagnosing pediatric asthma. Methods: Research articles in literature were identified from PubMed/Medline and Web of Science databases from 1966 to August 2015. Children <18 years of age were included. Both serum and urine EPX were included. Twenty‐seven studies met the inclusion criteria for the systematic review and nine studies for the meta‐analysis. Details regarding EPX analyses, treatment efficacy, and outcomes were assessed. For meta‐analyses, effect estimates were abstracted using standardized means. Results: Over 70% of studies found a significant relationship between u‐EPX and childhood asthma. There was 1.94 times higher standardized means of u‐EPX among acute asthmatics compared to healthy controls (confidence interval [CI]: 1.67–2.22). Similarly, the difference in standardized means between asymptomatic asthmatics and healthy controls was 1.58 times higher (CI: 1.27–1.88). Conclusions and Clinical Relevance: Despite differences in sample sizes, EPX processing and measurement, and ages of children, a consistent trend of higher EPX levels with childhood asthma was revealed.
Highlights
There are no reference guidelines for health care providers regarding appropriate use and interpretation of urine eosinophil protein X (u-EPX) in clinical practice
A systematic literature search of PubMed/Medline and Web of Science core collection databases were performed for studies published until August 2015, using the search terms, childhood asthma, pediatric asthma, serum EPX, urine EPX, Eosinophil protein X, Eosinophil-derived neurotoxin, eosinophil-derived neurotoxin (EDN), and inflammatory markers
The severity of asthma was defined based on episodes of wheezing per year, speech interruption, and nocturnal wakening due to wheezing healthy controls
Summary
There are no reference guidelines for health care providers regarding appropriate use and interpretation of urine eosinophil protein X (u-EPX) in clinical practice. There was 1.94 times higher standardized means of u-EPX among acute asthmatics compared to healthy controls (confidence interval [CI]: 1.67–2.22). Asthma is a clinical syndrome characterized by airway inflammation and hyper-responsiveness, often triggered by respiratory infections, inhaled allergens, cold, wind, or dust [1]. It is the most common chronic condition in children [2]. In the United States, more than 10 million children under age 18 have been diagnosed with asthma [3]. This disease is the third-ranking cause of hospitalizations in children [4], and accounts for approximately 175,000 annual hospitalizations [5]. Problems with managing childhood asthma occur because of non-specific symptoms, as well as the inability to obtain reliable pulmonary function test (PFT) results, in children below the age of 6 years [7]
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