Rationale: Aeroallergen sensitization and virus-induced wheezing are risk factors for asthma development during early childhood, but the temporal developmental sequence between them is incompletely understood. Objective: To define the developmental relationship between aeroallergen sensitization and virus-induced wheezing. Methods: A total of 285 children at high risk for allergic disease and asthma were followed prospectively from birth. The timing and etiology of viral respiratory wheezing illnesses were determined, and aeroallergen sensitization was assessed annually for the first 6 years of life. The relationships between these events were assessed using a longitudinal multistate Markov model. Measurements and Main Results: Children who were sensitized to aeroallergens had greater risk of developing viral wheeze than nonsensitized children (hazard ratio [HR], 1.9; 95% confidence interval [CI], 1.2-3.1). Allergic sensitization led to an increased risk of wheezing illnesses caused by human rhinovirus (HRV) but not respiratory syncytial virus. The absolute risk of sensitized children developing viral wheeze was greatest at 1 year of age; however, the relative risk was consistently increased at every age assessed. In contrast, viral wheeze did not lead to increased risk of subsequent allergic sensitization (HR, 0.76; 95% CI, 0.50-1.1). Conclusions: Prospective, repeated characterization of a birth cohort demonstrated that allergic sensitization precedes HRV wheezing and that the converse is not true. This sequential relationship and the plausible mechanisms by which allergic sensitization can lead to more severe HRV-induced lower respiratory illnesses support a causal role for allergic sensitization in this developmental pathway. Therefore, therapeutics aimed at preventing allergic sensitization may modify virus-induced wheezing and the development of asthma.Keywords: virus; wheezing; allergic sensitization; RSV; human rhinovirus Aeroallergen sensitization and virus-induced wheezing episodes during infancy and early childhood are risk factors for subsequent asthma development, and children with both risk factors in early life are at particularly high risk of having asthma at school age (1, 2). Understanding the sequence of events that lead to sensitization and virus-induced wheezing during early life is important to identifying potential causal relationships in the development of atopic asthma. Early allergic sensitization has consistently been identified as a risk factor for asthma development, and plausible mechanisms by which allergic sensitization leads to greater severity of viral respiratory illnesses have also been proposed (3). If allergic sensitization causes subsequent virus-induced wheezing and asthma inception, then preventing or interrupting the development of allergic sensitization would be a potential strategy for asthma prevention.In contrast to this concept, some animal models of early life infection suggest that virus infection could lead to allergic sensitization (4, 5). In clinical studies, S...