We used the so-called ‘loose’ index, which only required infrequent wheezing episodes in early life combined with risk factors for asthma because it has a much higher sensitivity (39%) but slightly lower specificity (82%) and positive predictive value (32%) than the so-called “”stringent”" index. The negative predictive value at all ages was very high for both indices, suggesting that the great majority of children who did not develop asthma during the school years

had a negative predicted index during the first years of life. Because the Asthma Predictive Index is only an approximation to predict which children will subsequently develop persistent asthma, further follow-up at school age is required to definitely determine the relation between MK0683 mouse early Bacteroides fragilis and Clostridium coccoides subcluster XIVa colonisation and asthma. With GSI-IX the exception of our previous study [14] using conventional culture methods,

there are no data linking the Bacteroides fragilis subgroup to asthma but several studies SN-38 manufacturer showed a correlation between Bacteroides and allergy: A higher IgG immune response to Bacteroides vulgaris was found in high school children with allergic symptoms [17]. A positive correlation between the fecal counts of Bacteroides and the serum IgE concentration was demonstrated in 2 studies, one in infants intolerant to an extensively hydrolysed formula [18] and one in non-allergic children at the age of 5 years [19]. A study in adults with pollen allergy showed an increased ratio of fecal counts of Bacteroides fragilis to Bifidobacterium during pollen season. In vitro, using peripheral blood mononuclear cells of these patients, they also demonstrated that Bacteroides fragilis strains induced more Th2 cytokines but fewer Th1 cytokines compared with Bifidobacterium strains [20]. We believe that intestinal Bacteroides

species might be able to induce a Th2 cytokine response through binding of a TLR2 (Toll-like receptor) present on intestinal dendritic cells. Netea et al. showed that Bacteroides species stimulate cytokine release through TLR2-dependent (not TLR4) mechanisms [21]. TLR2 agonists induce a Th2 response by suppressing IL-12 3-oxoacyl-(acyl-carrier-protein) reductase production [22]. Fecal Clostridium colonisation in infants has been linked to asthma before: A higher level of C. difficile-specific IgG was found in one-year-old children with recurrent wheezing [23]. A higher prevalence of C. difficile was detected using quantitative real-time PCR in infants who developed recurrent wheeze during the first 2 years of life [24]. C. difficile belongs to Clostridium cluster XI and is only remotely related to the Clostridium coccoides subcluster XIVa species that we detected [15].