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Published on: June 4, 2017
Allergic rhinitis as a predictor for wheezing onset in school-aged children
Mascha K Rochat1, Sabina Illi, Markus J Ege
1Children's Hospital, University of Munich, Munich, Germany. wehntaler@gmail.com
Insights
Allergic rhinitis in preschool children predicts later wheezing. Early allergy screening in young children with rhinitis can identify those at high risk for developing wheezing.
Area of Science:
- Pediatric Allergy and Immunology
- Respiratory Medicine
- Epidemiology
Background:
- Rhinitis is a known asthma predictor in older children and adults, suggesting upper and lower airway interaction.
- The predictive role of early childhood rhinitis for childhood-onset asthma remains unclear.
Purpose of the Study:
- To determine if early childhood rhinitis independently predicts wheezing in children aged 5-13 years.
- Investigate the association within the German Multicentre Allergy Study birth cohort.
Main Methods:
- Longitudinal study of 1314 children from birth to age 13.
- Data collected via questionnaires, interviews, specific IgE measurements, and airway hyperresponsiveness assessment at age 7.
Main Results:
- Allergic rhinitis by age 5 predicted subsequent wheezing (ages 5-13) with an adjusted relative risk of 3.82.
- The association was independent of sensitization type, severity, or early atopic dermatitis.
- 41.5% of new wheezing cases were linked to preceding allergic rhinitis.
Conclusions:
- Allergic rhinitis in preschool children is the first manifestation and a predictor of subsequent wheezing.
- Early allergic sensitization assessment in preschool children with rhinitis may identify high-risk individuals for wheezing.
Background:
Rhinitis in older children and adults has been shown to be a predictor for adolescent- and adult-onset asthma. These findings suggest an interaction between the upper and lower airways. Whether rhinitis is a predictor for childhood-onset asthma is unknown.
Objective:
We sought to investigate whether rhinitis in early childhood is an independent predictor for wheezing between the ages of 5 and 13 years in the German Multicentre Allergy Study birth cohort.
Methods:
The German Multicentre Allergy Study cohort initially included 1314 healthy children. They were followed from birth to the age of 13 years with regular questionnaires and interviews. Specific IgE levels were measured at yearly intervals. Airway hyperresponsiveness was assessed at 7 years.
Results:
Allergic rhinitis until the age of 5 years was found to be a predictor for developing wheezing between the ages of 5 and 13 years, with an adjusted relative risk of 3.82 (P < .001). This association was not attributable to the type of sensitization, the severity of sensitization, or atopic dermatitis during the first 2 years of life. In this group of children, 41.5% of all new cases of wheezing occurred among children with preceding allergic rhinitis.
Conclusions:
The first manifestation of allergic rhinitis occurs in preschool children in whom it is a predictor for subsequent wheezing onset. Preschool children with rhinitis might thus benefit from early assessment of allergic sensitization to identify the children at high risk of wheezing.
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