Risk factors for wheezing in a subtropical environment: role of respiratory viruses and allergen sensitization

Abstract

Background: Risk factors for acute wheezing among children in subtropical areas are largely unknown.

Objective: To investigate the role of viral infections, allergen sensitization, and exposure to indoor allergens as risk factors for acute wheezing in children 0 to 12 years old.

Methods: One hundred thirty-two children 0 to 12 years of age who sought emergency department care for wheezing and 65 children with no history of wheezing were enrolled in this case-control study. Detection of respiratory syncytial virus antigen, rhinovirus and coronavirus RNA, adenovirus, influenza, and parainfluenza antigens was performed in nasal washes. Total IgE and specific IgE to mites, cockroach, cat, and dog were measured with the CAP system. Major allergens from mites, cockroach, cat, and dog were quantified in dust samples by ELISA. Univariate and multivariate analyses were performed by logistic regression.

Results: In children under 2 years of age, infection with respiratory viruses and family history of allergy were independently associated with wheezing (odds ratio, 15.5 and 4.2; P = .0001 and P = .008, respectively). Among children 2 to 12 years old, sensitization to inhalant allergens was the major risk factor for wheezing (odds ratio, 2.7; P = .03). High-level allergen exposure, exposure to tobacco smoke, and lack of breast-feeding showed no association with wheezing.

Conclusions: Some risk factors for wheezing previously identified in temperate climates were present in a subtropical area, including respiratory syncytial virus infection in infants and allergy in children older than 2 years. Rhinovirus was not associated with wheezing and did not appear to be a trigger for asthma exacerbations.

FIG 1

Viral identification in nasal washes by age group. Pink bars indicate nasal washes positive for RSV antigen; dark yellow bars represent nasal washes positive for rhinovirus; green bars indicate nasal washes positive for adenovirus B; and light yellow bars represent nasal washes positive for coronavirus. Other common viral pathogens (influenza A and B and parainfluenza viruses) were not detected. ∗∗∗P < .001 for wheezing versus control subjects in age group.