Early life rhinovirus wheezing, allergic sensitization, and asthma risk at adolescence

Abstract

Background: Early life rhinovirus (RV) wheezing illnesses and aeroallergen sensitization increase the risk of asthma at school age. Whether these remain risk factors for the persistence of asthma out to adolescence is not established.

Objective: We sought to define the relationships among specific viral illnesses and the type and timing of aeroallergen sensitization with the persistence of asthma into adolescence.

Methods: A total of 217 children were followed prospectively from birth to age 13 years. The etiology and timing of viral wheezing illnesses during the first 3 years of life were assessed along with patterns of allergen sensitization. The associations between viral wheezing illnesses, presence and pattern of aeroallergen sensitization, and asthma diagnosis at age 13 years were evaluated.

Results: When adjusted for all viral etiologies, wheezing with RV (odds ratio = 3.3; 95% CI, 1.5-7.1), but not respiratory syncytial virus (odds ratio = 1.0; 95% CI, 0.4-2.3), was associated with asthma at age 13 years. Age of aeroallergen sensitization also influenced asthma risk; 65% of children sensitized by age 1 year had asthma at age 13 years, compared with 40% of children not sensitized at age 1 year but sensitized by age 5 years, and 17% of children not sensitized at age 5 years. Early life aeroallergen sensitization and RV wheezing had additive effects on asthma risk at adolescence.

Conclusions: In a high-risk birth cohort, the persistence of asthma at age 13 years was most strongly associated with outpatient wheezing illnesses with RV and aeroallergen sensitization in early life.

Keywords: Rhinovirus; allergic sensitization; asthma; respiratory syncytial virus.

Fig 1

A and B, Impact of viral etiology on asthma risk at age 6, 8, 11, and 13 years. AdV, Adenovirus; CoV, coronaviruses; EV, enteroviruses; Flu, influenza types A and B; MpV, metapneumoviruses; PIV, parainfluenza virus types 1 to 4.

Fig 2

A, Identification of the role of timing of aeroallergen in asthma risk. B, Children sensitized by age 1 or 5 years had similar numbers of positive allergen sensitizations at age 13 years, but significantly more than children not sensitized by age 5 years.

Fig 3

Both aeroallergen sensitization and RV wheezing illnesses in the first 3 years of life increased asthma risk. The effects are additive and those children with both risk factors had the highest risk between age 6 and 13 years.