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Respiratory syncytial virus bronchiolitis in infancy is an important risk factor for asthma and allergy at age 7
N Sigurs1, R Bjarnason, F Sigurbergsson
1Department of Pediatrics, Borâs Central Hospital, Borâs, Sweden. nele.sigurs@swipnet.se
Insights
Hospitalization for respiratory syncytial virus (RSV) bronchiolitis in infancy significantly increases a child's risk for developing asthma and allergic sensitization by age seven. Early RSV infection impacts long-term respiratory and allergic health.
Area of Science:
- Pediatrics
- Immunology
- Respiratory Medicine
Background:
- Infant respiratory syncytial virus (RSV) bronchiolitis is a common condition.
- Previous studies indicated an increased risk of bronchial obstructive disease and allergic sensitization up to age 3 following severe RSV bronchiolitis.
Purpose of the Study:
- To evaluate the long-term occurrences of bronchial obstructive disease and allergic sensitization at age 7(1/2) in children previously hospitalized for RSV bronchiolitis.
- To identify risk factors associated with asthma and allergic sensitization in these children.
Main Methods:
- Follow-up study of 140 children (47 with prior RSV hospitalization, 93 controls).
- Evaluations included physical examination, skin prick tests, and serum IgE tests for common allergens.
- Multivariate logistic regression was used to assess risk factors.
Main Results:
- Cumulative asthma prevalence was 30% in the RSV group vs. 3% in controls (p < 0.001).
- Cumulative "any wheezing" prevalence was 68% in the RSV group vs. 34% in controls (p < 0.001).
- Allergic sensitization was found in 41% of RSV children vs. 22% of controls (p = 0.039).
- RSV bronchiolitis was the strongest independent risk factor for asthma (OR: 12.7) and allergic sensitization (OR: 2.4).
Conclusions:
- Hospitalization for RSV bronchiolitis in infancy is strongly associated with the development of asthma and allergic sensitization by age 7(1/2).
- Findings support the hypothesis that RSV infection influences the mechanisms underlying childhood asthma and allergy development.
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.