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Risk factors for atopic and non-atopic asthma in school-age children from high-income and low- and middle-income
Charlotte E Rutter1, Harriet Mpairwe2, Camila A Figueiredo3
1Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK charlotte.rutter1@lshtm.ac.uk.
Insights
Risk factors for developing asthma are similar whether or not children have atopy. This suggests atopy may not be essential for asthma development, questioning its role in the disease process.
Area of Science:
- Pediatric respiratory health
- Immunology
- Environmental health
Background:
- Asthma presents with different phenotypes, including atopic asthma (AA) and non-atopic asthma (NAA).
- While determinants of AA are well-researched, factors influencing NAA in children remain largely unknown.
- This study investigates risk factors across diverse global populations.
Purpose of the Study:
- To compare risk factors for atopy, AA in atopics, and NAA in non-atopics among children.
- To elucidate the relationship between atopy and asthma development pathways.
- To identify environmental and familial influences on different asthma phenotypes.
Main Methods:
- Analysis of four studies involving 32,741 children aged 6-17 across 23 countries.
- Assessment of asthma status and atopy via skin prick tests.
- Mixed-effects logistic regression models to evaluate risk factors (housing, pets, diet, air quality, etc.) across four defined pathways.
Main Results:
- The sample included 67% with neither condition, 15% with atopy only, 8% with AA, and 10% with NAA.
- Risk factors for developing NAA (pathway 1) were highly similar to those for developing AA (pathway 3) (PCC=0.81).
- Risk factors for developing atopy without asthma (pathway 2) differed significantly from those for AA (pathway 3) (PCC=-0.06).
Conclusions:
- Atopy increases asthma risk, but the factors leading to asthma development appear consistent regardless of atopy status.
- Findings challenge the necessity of atopy in the asthma etiology.
- Further research is needed to determine if atopy is causal or coincidental in asthma development.
Background:
It is well established that there are different asthma phenotypes, but whereas determinants of atopic asthma (AA) are well studied, little is known about non-atopic asthma (NAA). We compared risk factors for atopy, AA in atopics and NAA in non-atopics in children in a wide variety of countries.
Methods:
Using four studies, across 23 countries, we assessed asthma status and atopy (skin prick tests) for children aged 6-17, plus risk factors from housing, heating, pets, family, diet and air quality categories. Using mixed-effects logistic regression models, we assessed risk factors over four pathways: pathway 1-non-atopic non-asthma to NAA; pathway 2-non-atopic non-asthma to atopy (no asthma); pathway 3-atopic non-asthma to AA; pathway 4-non-atopic non-asthma to AA. We compared the log odds of risk factors between pathways using the Pearson correlation coefficient (PCC).
Results:
Our final sample of 32 741 children comprised 67% with neither atopy nor asthma, 15% with atopy but without asthma, 8% with AA and 10% with NAA. Risk factors were similar between pathway 1 and pathway 3 (PCC=0.81, 95% CI 0.68 to 0.94). In contrast, risk factors differed between pathway 2 and pathway 3 (PCC=-0.06, 95% CI -0.29 to 0.17).
Discussion:
These findings indicate that although atopy increases the risk of asthma, the risk factors for subsequently developing asthma are generally the same in those with and without atopy. This raises important questions about the role of atopy in asthma, particularly whether it is an inherent part of the aetiological process or is coincidental.
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