Related Experiment Videos
Outcome of wheeze in childhood: the influence of atopy
S Ross1, D J Godden, M Abdalla
1Dept of Medicine and Therapeutics, and Sociology, University of Aberdeen, Scotland.
Insights
Atopy, or allergic tendency, is a key predictor of adult wheeze and bronchial hyperreactivity. However, it does not fully explain why childhood asthma leads to different adult outcomes than infection-induced wheeze.
Area of Science:
- Allergy and Immunology
- Respiratory Medicine
- Pediatric Pulmonology
Background:
- Childhood asthma and infection-induced wheeze have distinct adult outcomes.
- Atopy, characterized by allergic sensitization, is a potential factor influencing these outcomes.
Purpose of the Study:
- To investigate the role of atopy in the long-term outcomes of childhood asthma versus infection-induced wheeze.
- To assess the association of atopy with adult wheezing symptoms and bronchial hyperreactivity.
Main Methods:
- Longitudinal study of 235 individuals (aged 34-40) with childhood classifications: asthma, infection-induced wheeze, or asymptomatic controls.
- Assessment of atopic status (skin tests, IgE, RAST), current respiratory symptoms, and methacholine bronchial reactivity.
- Logistic regression analysis to identify predictors of adult wheezing and bronchial hyperreactivity.
Main Results:
- Individuals with childhood asthma were more atopic than those with infection-induced wheeze.
- Atopy and childhood diagnosis were significant independent predictors of adult wheezing symptoms.
- Atopy, childhood diagnosis, and female gender independently predicted methacholine responsiveness.
Conclusions:
- Atopy is a significant predictor of persistent wheeze and bronchial hyperreactivity into middle age.
- While atopy contributes to differential outcomes, it does not solely account for the distinct adult trajectories of childhood asthma versus infection-induced wheeze.
Abstract:
We have previously demonstrated that the adult outcome of childhood asthma differs from that of wheeze occurring only in the presence of infection. This paper examines the role of atopy in relation to outcome. We investigated the atopic status, current symptoms and bronchial reactivity to methacholine of 235 subjects aged 34-40 yrs, originally classified at age 10-15 yrs as having asthma (asthma group), wheeze only in the presence of infection (wheezy group), or no respiratory symptoms (comparison group). Subjects from the original asthma group were more likely to be atopic as defined by skin test reactivity, total serum immunoglobulin E (IgE) measurement or specific IgE radio allergosorbent test (RAST) measurement than those from the wheezy group. The wheezy group differed significantly from the reference group only in RAST results, when other variables were taken into account. In a logistic regression model, the important independent predictors for adult wheezing symptoms were original group, atopy and current smoking. Methacholine responsiveness was independently associated with original group (the asthma group were more likely to respond positively), atopy and female gender. The results suggest that atopy is an important predictor for wheeze and bronchial hyperreactivity in middle age. However, the difference in outcome for children who had asthma compared to those who had wheeze only in the presence of infection cannot be explained by atopy alone.