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Published on: August 7, 2017
Serum periostin among infants with severe bronchiolitis and risk of developing asthma: A prospective multicenter
Makiko Nanishi1, Michimasa Fujiogi1, Robert J Freishtat2,3
1Department of Emergency Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA.
Insights
Infants hospitalized for severe bronchiolitis with higher periostin levels face increased asthma risk by age six. This risk is significantly amplified in infants with an allergic predisposition, highlighting periostin as a potential biomarker for childhood asthma development.
Area of Science:
- Respiratory Medicine
- Immunology
- Pediatric Allergy
Background:
- Severe bronchiolitis in infants is a known risk factor for developing childhood asthma.
- The precise biological mechanisms linking bronchiolitis to asthma remain incompletely understood.
- Periostin, an extracellular matrix protein, is upregulated during type 2 inflammation and is investigated as a potential link.
Purpose of the Study:
- To investigate the longitudinal relationship between serum periostin levels during severe bronchiolitis hospitalization and the subsequent development of asthma.
- To determine if allergic predisposition modifies the association between periostin levels and asthma risk.
Main Methods:
- A prospective cohort study involving 847 infants (<1 year) hospitalized for severe bronchiolitis across 17 centers.
- Serum periostin levels were measured at hospitalization and categorized into low, intermediate, and high groups.
- Asthma development was assessed by age 6 years, with analysis stratified by IgE sensitization (allergic predisposition).
Main Results:
- Overall, 28% of infants developed asthma by age 6.
- Compared to the low periostin group, intermediate periostin levels were associated with significantly higher asthma risk (OR 1.68).
- The association between periostin and asthma risk was significant only in infants with IgE sensitization, with higher risks observed in intermediate (OR 4.76) and high (OR 3.19) periostin groups.
Conclusions:
- Serum periostin levels during severe bronchiolitis hospitalization are associated with an increased risk of asthma development by age 6.
- The association between periostin and asthma risk is particularly pronounced in infants with an allergic predisposition (IgE sensitization).
- Periostin may serve as a valuable biomarker for predicting childhood asthma in infants following severe bronchiolitis.
Background:
Infants hospitalized for bronchiolitis (severe bronchiolitis) are at high risk for developing childhood asthma. However, the pathobiological link between these conditions remains unclear. We examined the longitudinal relationship of periostin (an extracellular matrix protein upregulated in response to type 2 inflammation) during bronchiolitis with the subsequent development of asthma.
Methods:
In a 17-center prospective cohort study of infants (aged <1 year) with severe bronchiolitis, we measured the serum periostin level at hospitalization and grouped infants into 3 groups: low, intermediate, and high levels. We examined their association with asthma development by age 6 years and investigated effect modification by allergic predisposition (eg, infant's IgE sensitization).
Results:
The analytic cohort consists of 847 infants with severe bronchiolitis (median age, 3 months). Overall, 28% developed asthma by age 6 years. In the multivariable model adjusting for nine patient-level factors, compared to the low periostin group, the asthma risk was significantly higher among infants in the intermediate group (23% vs. 32%, OR 1.68, 95%CI 1.12-2.51, p = .01) and non-significantly higher in the high-level group (28%, OR 1.29, 95%CI 0.86-1.95, p = .22). In the stratified analysis, infants with IgE sensitization had a significantly higher risk for developing asthma (intermediate group, OR 4.76, 95%CI 1.70-13.3, p = .002; high group, OR 3.19, 95%CI 1.08-9.36, p = .04). By contrast, infants without IgE sensitization did not have a significantly higher risk (p > .15).
Conclusions:
In infants with severe bronchiolitis, serum periostin level at bronchiolitis hospitalization was associated with asthma risk by age 6 years, particularly among infants with an allergic predisposition.
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