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RSV-hRV co-infection is a risk factor for recurrent bronchial obstruction and early sensitization 3 years after
Flore Amat1,2, Chloé Plantard3, Aurélien Mulliez4
1Department of Allergology, Centre de l'Asthme et des Allergies, Hôpital d'Enfants Armand Trousseau, Assistance Publique-Hôpitaux de Paris, UPMC Univ Paris 06, Sorbonne Universités; Equipe EPAR, Institut Pierre Louis d'Epidémiologie et de Santé Publique, INSERM, Faculté de Médecine Saint-Antoine Paris, Paris, France.
Insights
Familial history of atopy and co-infection with respiratory syncytial virus (RSV) and human rhinovirus (hRV) are key risk factors for recurrent bronchial obstruction and allergic sensitization in infants after bronchiolitis.
Area of Science:
- Pediatrics
- Allergy and Immunology
- Infectious Diseases
Background:
- Acute bronchiolitis is a common childhood illness, but risk factors for long-term respiratory issues and allergic sensitization remain incompletely understood.
- Understanding these factors is crucial for early intervention and management strategies.
- Previous studies have not comprehensively evaluated the interplay between initial illness characteristics, viral etiology, and subsequent allergic development.
Purpose of the Study:
- To identify risk factors for recurrent bronchial obstruction and allergic sensitization in infants up to 1 year old, three years after an episode of acute bronchiolitis.
- To differentiate risk factors based on initial treatment (ambulatory vs. hospitalization) and clinical presentation.
- To investigate the association between specific viral infections, co-infections, and the development of atopy.
Main Methods:
- A monocentric prospective longitudinal study followed 154 infants under 1 year with acute bronchiolitis.
- Assessments included clinical severity scores, serum Krebs von den Lungen 6 antigen levels, and nasopharyngeal detection of 14 viruses.
- Follow-up involved quarterly interviews and a final clinical examination at 3 years, with measurement of specific IgEs to aero- and food allergens.
Main Results:
- 46.8% of children experienced recurrent wheezing (RW).
- Familial history of atopy (60% vs. 39%, P=0.02) and living in an apartment (35% vs. 15%, P=0.002) were significant risk factors for RW.
- 18.6% of infants were sensitized; familial history of atopy and initial RSV-hRV co-infection were correlated with aeroallergen sensitization at 3 years (P=0.02).
Conclusions:
- Familial history of atopy is a primary risk factor for recurrent bronchial obstruction and allergic sensitization post-bronchiolitis.
- Initial co-infection with respiratory syncytial virus (RSV) and human rhinovirus (hRV) significantly increases the risk of allergic sensitization.
- These findings highlight the importance of family history and early viral infections in predicting long-term respiratory and allergic outcomes.
Abstract:
To assess risk factors of recurrent bronchial obstruction and allergic sensitization 3 years after an episode of acute bronchiolitis, whether after ambulatory care treatment or hospitalization. A monocentric prospective longitudinal study including infants aged under 1 year with acute bronchiolitis was performed, with clinical (severity score), biological (serum Krebs von den Lungen 6 antigen), and viral (14 virus by naso-pharyngeal suction detection) assessments. Follow-up included a quaterly telephone interview, and a final clinical examination at 3 years. Biological markers of atopy were also measured in peripheral blood, including specific IgEs towards aero- and food allergens. Complete data were available for 154 children. 46.8% of them had recurrent wheezing (RW). No difference was found according to initial severity, care at home or in the hospital, respiratory virus involved, or existence of co-infection. A familial history of atopy was identified as a risk factor for recurrent bronchial obstruction (60% for RW infants versus 39%, P = 0.02), as living in an apartment (35% versus 15%, P = 0.002). 18.6% of the infants were sensitized, with 48.1% of them sensitized to aeroallergens and 81.5% to food allergens. Multivariate analysis confirmed that a familial history of atopy (P = 0.02) and initial co-infection RSV-hRV (P = 0.02) were correlated with the risk of sensitization to aeroallergens at 3 years. Familial history of atopy and RSV-hRV co-infection are risk factors for recurrent bronchial obstruction and sensitization.
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