Respiratory Syncytial Virus Bronchiolitis in Infancy Is an Important Risk Factor for Asthma and Allergy at Age 7

Abstract

We previously reported an increased risk for bronchial obstructive disease and allergic sensitization up to age 3 in 47 children hospitalized with a respiratory syncytial virus (RSV) bronchiolitis in infancy compared with 93 matched control subjects recruited during infancy. The aims of the present study were to evaluate the occurrences of bronchial obstructive disease and allergic sensitization in these children at age 7(1)/ (2). All 140 children reported for the follow-up, which included physical examination, skin prick tests, and serum IgE tests for common food and inhaled allergens. The cumulative prevalence of asthma was 30% in the RSV group and 3% in the control group (p < 0.001), and the cumulative prevalence of "any wheezing" was 68% and 34%, respectively (p < 0.001). Asthma during the year prior to follow-up was seen in 23% of the RSV children and 2% in the control subjects (p < 0.001). Allergic sensitization was found in 41% of the RSV children and 22% of the control subjects (p = 0.039). Multivariate evaluation of possible risk factors for asthma and sensitization using a stepwise logistic statistical procedure for all 140 children showed that RSV bronchiolitis had the highest independent risk ratio for asthma (OR: 12.7, 95% CI 3.4 to 47.1) and a significantly elevated independent risk ratio for allergic sensitization (OR: 2.4, 95% CI 1.1 to 5.5). In conclusion, RSV bronchiolitis in infancy severe enough to cause hospitalization was highly associatied with the development of asthma and allergic sensitization up to age 7(1)/ (2). The results support the theory that the RSV influences the mechanisms involved in the development of asthma and allergy in children.

Respiratory morbidity of preterm infants of less than 33 weeks gestation without bronchopulmonary dysplasia: a 12-month follow-up of the CASTOR study cohort

“…Furthermore, infants with a history of early hospitalized RSV-confirmed bronchiolitis were more prone to at least one wheezing episode than those with no such history (47% vs. 15·5%), irrespective of their prematurity status, during the CASTOR follow-up period. Our results are consistent with previously published data [38,39], but with lower incidences than those found by Sigurs et al in 3-year-old children with RSV bronchiolitis during the first year of life (60% of infants with RSV history with any wheezing episodes vs. 32% of those with no history, P = 0·003) [12]; those authors confirmed the same tendency in this birth cohort up to the age of 7 years [13]. The ALSPAC Study Team showed a lower prevalence of any wheezing (28%) at 30-42 months after birth in the RSV subgroup (150 infants) of this large British birth cohort compared to our results (47%), despite a very close prevalence in controls (13% and 15·5%, respectively).…”

“…In the Tucson Children's Respiratory Study, early RSV LRTI was an independent risk factor of subsequent wheezing up to age 11 years but ceased to be so at age 13 years [11]. Sigurs and colleagues demonstrated an increased prevalence of asthma or recurrent wheezing and allergic sensitization in a cohort of infants hospitalized with RSV bronchiolitis during the first year of life compared to a matched control cohort at ages 3, 7 and 13 years [12][13][14]. Recently, the same group showed that severe RSV bronchiolitis, requiring hospitalization during the first year of life, is frequently followed by allergic asthma persisting into early adulthood [15], contrasting with previous data suggesting a shorter post-RSV bronchial hyperresponsiveness [16][17][18].…”

Replication of genetic association studies in asthma and related phenotypes

“…20,21 This is in line with the evidences that the epithelial barrier in young asthmatics is inherently abnormal 22 and that RSV bronchiolitis is a more important risk factor for the development of asthma and atopy up to the age of 7 years than heredity or environmental factors. 23 Moreover, the candidate genes showing significant association with both the phenotypes, when the case groups were compared with adult controls separately (childhood asthma vs adult control and adult asthma vs adult control), were the same as those observed in the combined analysis (all asthma vs all controls). Thus, TNF, ADAM33 and NOS1 might represent the common susceptibility gene for adult and childhood asthma.…”

A systematic review of predictive modeling for bronchiolitis

“…14% to 40% of bronchiolitis patients will eventually have asthma [25,196], with the association persisting into adulthood [196][197][198][199][200][201][202][203]. In young children, asthma is heralded by acute bronchiolitis in 90% of cases, one third of which require hospitalization [204].…”