Predictors of Asthma Three Years After Hospital Admission for  Wheezing in Infancy

Reijonen, Tiina M.; Kotaniemi‐Syrjänen, Anne; Korhonen, Kaj; Korppi, Matti

doi:10.1542/peds.106.6.1406

Cited by 124 publications

(144 citation statements)

References 30 publications

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“…Finally, confirming the study hypothesis, asthma at preschool age was more common after non-RSV bronchiolitis (24%) than after RSV bronchiolitis (8%) in infancy. This observation is in line with previous studies after early-life wheezing from Finland and Wisconsin, USA [9,20,23], but we were not able to confirm the specific role of rhinovirus aetiology of bronchiolitis as an asthma predictive factor.…”

Section: Discussionsupporting

confidence: 86%

Preschool asthma after bronchiolitis in infancy

Koponen¹,

Helminen²,

Paassilta³

et al. 2011

Eur Respir J

105

165

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Asthma risk is lower after wheezing associated with respiratory syncytial virus (RSV) than with non-RSV infection in infancy. RSV is the main wheezing-associated virus in infants aged ,6 months. We evaluated the outcome of children hospitalised for bronchiolitis at ,6 months of age, with special focus on viral aetiology and early risk factors.Out of 205 infants hospitalised for bronchiolitis at ,6 months of age, 127 (62%) attended a control visit at a mean age of 6.5 yrs and the parents of an additional 39 children were interviewed by telephone. Thus, follow-up data collected by identical structured questionnaires were available from 166 (81%) children. Viral aetiology of bronchiolitis, studied on admission by antigen detection or PCR, was demonstrable in 97% of cases.Current asthma was present in 21 (12.7%) children: 8.2% in the 110 former RSV patients versus 24% in non-RSV patients (p50.01). 45 (27%) children had ever had asthma. In adjusted analyses, atopic dermatitis, non-RSV bronchiolitis and maternal asthma were independently significant early-life risk factors for asthma.The risk of asthma was lower after RSV bronchiolitis than after bronchiolitis caused by other viruses in children hospitalised at ,6 months of age.

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Section: Discussionsupporting

confidence: 86%

Preschool asthma after bronchiolitis in infancy

Koponen¹,

Helminen²,

Paassilta³

et al. 2011

Eur Respir J

105

165

View full text Add to dashboard Cite

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“…However, the beneficial effect disappeared shortly after termination of the treatment (the children had a mean age of 10.6 months at inclusion and RSV had been detected in 26%) [104]. In addition, the antiinflammatory therapy had no influence on the occurrence of asthma 3 yrs later [105].…”

Section: Obstructive Airway Diseases After Rsv Bronchiolitismentioning

confidence: 99%

Relationship between respiratory syncytial virus bronchiolitis and future obstructive airway diseases

Wennergren¹,

Kristjánsson²

2001

Eur Respir J

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Relationship between respiratory syncytial virus bronchiolitis and future obstructive airway diseases. G. Wennergren, S. Kristjánsson. #ERS Journals Ltd 2001. ABSTRACT: Evidence from a large number of prospective case-control studies shows that respiratory syncytial virus (RSV) bronchiolitis in infancy is often associated with recurrent wheezing and asthma during subsequent years. However, wheezing tends to diminish and most studies show no significant increase in wheezing compared to controls by school age or adolescence. An unresolved question is whether severe RSV infection during infancy causes the respiratory sequelae or inherent abnormalities predispose an infant to develop severe respiratory infection and sequelae, i.e. RSV is associated with the development of pulmonary sequelae.Studies on long-term outcome of RSV bronchiolitis are reviewed from an evidencebased perspective.The majority of prospective placebo-controlled studies do not show any long-term beneficial effects of corticosteroid treatment, i.e. the risk of subsequent wheezing is not diminished by the treatment. The evidence for an increased risk of allergic sensitization after RSV bronchiolitis is not nearly as strong as the evidence for an increased risk of subsequent wheezing. In fact, most studies do not show any significant increase in atopy after RSV bronchiolitis. This suggests that the increased risk of wheezing after RSV is not linked to an increased risk of atopy. There are some indications that infants who develop severe RSV and subsequent wheezing may have aberrations that predate the RSV infection.To decide whether respiratory syncytial virus bronchiolitis causes, or is associated with the respiratory sequelae (or with subsequent allergy), it will be necessary to conduct prospective, randomized studies, where the cytokine profile prior to bronchiolitis onset is known. Such studies should preferably include some form of intervention against respiratory syncytial virus. A more complete understanding of the risk factors for severe respiratory syncytial virus infection and the role of respiratory syncytial virus infection in the initiation of asthma is needed as a basis for large-scale and cost-effective programmes to prevent respiratory syncytial virus-related morbidity. Eur Respir J 2001; 18: 1044-1058. Respiratory syncytial virus (RSV) bronchiolitis is the most common, severe lower respiratory tract infection in infancy. It now seems well established that RSV bronchiolitis in infancy is associated with recurrent wheezing and asthma during the first decade of life. In some children, wheezing after early lower airway infection with RSV is transient, but in many of the children RSV-induced bronchiolitis represents the onset of asthma. In fact, there are results which indicate that severe RSV bronchiolitis in the young infant may shift the T-helper (Th)1/Th2 balance in favour of a Th2 cytokine pattern, leading to development of allergic sensitization and persistent asthma [1,2]. However, the association with risk of development of atopy...

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“…5 In 1999 -2000, the children were examined for asthma, and the allergen-specific IgE antibodies were measured from frozen sera obtained during the hospitalization for wheezing in infancy. The aim of the present study was to evaluate whether specific IgE antibodies to food and/or inhalant allergens in wheezing infants are predictive of later asthma.…”

mentioning

confidence: 99%

Allergen-Specific Immunoglobulin E Antibodies in Wheezing Infants: The Risk for Asthma in Later Childhood

Kotaniemi‐Syrjänen¹,

Reijonen²,

Romppanen³

et al. 2003

PEDIATRICS

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ABSTRACT. Objective. To evaluate whether the measurement of specific immunoglobulin E (IgE) antibodies to food and/or inhalant allergens in infants who are hospitalized for wheezing can be used to predict later asthma.Methods. Eighty-two children who were hospitalized for wheezing at <2 years of age were followed prospectively until early school age. The baseline data and the characteristics of infancy had been collected at enrollment. At school age, the children were evaluated for asthma and allergic manifestations, including skin prick tests to common inhalant allergens. Frozen serum samples obtained during the index episode of wheezing were available for 80 children for determination of food and inhalant allergen-specific serum IgE antibodies by fluoroenzyme-immunometric assay, UniCAP, applying the Phadiatop Combi allergen panel.Results. Asthma was present in 32 (40%) children at school age. Food-specific IgE antibodies of >0.35 kU/L were found in 37 (46%) wheezing infants, but only specific IgE to wheat and to egg white at the level of >0.35 kU/L were significantly associated with later asthma. In regard to specific IgE to the mixture of food allergens, the cutoff level of >0.70 proved to be significant. Inhalant allergen-specific IgE of >0.35 kU/L was found only in 14 cases (18%), but when present, it was significantly predictive of asthma. Elevated levels of specific IgE antibodies to food or inhalant allergens were significantly associated with allergic rhinitis and skin-test reactivity at school age.Conclusions. When present in wheezing infants, specific IgE of >0.35 kU/L to wheat, egg white, or inhalant allergens are predictive of later childhood asthma. Consequently, detection of those specific IgE antibodies in wheezing infants may facilitate the early diagnosis of asthma, especially in cases with no clinically evident atopic manifestations. A pproximately 20% of all children experience wheezing in infancy, 1 and these children are at increased risk for asthma in later childhood. On the basis of recent prospective follow-up data, up to 40% of them experience asthma at school age. 2 The majority of children with asthma have clinically evident atopic manifestations in later childhood, although allergies may not be apparent in infancy. 2,3 Total serum immunoglobulin E (IgE), 2 blood eosinophilia, 2 and serum eosinophil cationic protein (ECP) 4 are markers that are often used to determine subclinical atopy and susceptibility to respiratory allergy. However, these markers are nonspecific, and to point out the allergen-specific responses, skin prick tests (SPTs) or radioallergosorbent tests (RAST) thus far have had to be performed. Both of these tests are qualitative, and for technical reasons, only a restricted number of allergens are applicable in SPTs in young children. These tests may also be susceptible to technical errors and variations as a result of either nonstandardized or nonautomated methods. Consequently, new approaches are needed to screen those prone to atopy or allergen-induced asthma among ...

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Predictors of Asthma Three Years After Hospital Admission for Wheezing in Infancy

Cited by 124 publications

References 30 publications

Preschool asthma after bronchiolitis in infancy

Preschool asthma after bronchiolitis in infancy

Relationship between respiratory syncytial virus bronchiolitis and future obstructive airway diseases

Allergen-Specific Immunoglobulin E Antibodies in Wheezing Infants: The Risk for Asthma in Later Childhood

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