Infant rhinitis and watery eyes predict school-age exercise-induced wheeze, emergency department visits and respiratory-related hospitalizations

Abstract

Background: Rhinitis and conjunctivitis are often linked to asthma development through an allergic pathway. However, runny nose and watery eyes can result from nonallergic mechanisms. These mechanisms can also underlie exercise-induced wheeze (EIW), which has been associated with urgent medical visits for asthma, independent of other indicators of asthma severity or control.

Objective: To test the hypothesis that rhinitis or watery eyes without cold symptoms (RWWC) in infancy predict development of EIW and urgent respiratory-related medical visits at school age, independent of seroatopy.

Methods: Within a prospective birth cohort of low-income, urban children (n = 332), RWWC was queried during the first year of life. Relative risks (RRs) for EIW, emergency department (ED) visits, and hospitalizations for asthma and other breathing difficulties at 5 to 7 years of age were estimated with multivariable models. Seroatopy was determined at 7 years of age.

Results: Infant RWWC was common (49% of children) and predicted school-age EIW (RR, 2.8; P < .001), ED visits (RR, 1.8; P = .001), and hospitalizations (RR, 9.8; P = .002). These associations were independent of infant wheeze. They were also independent of birth order, an indicator of increased risk of exposure to viruses in infancy, and infant ear infections, an indicator of sequelae of upper airway infections. The association between infant RWWC and ED visits at 5 to 7 years of age was attenuated (RR, 1.2; P = .23) when EIW at 5 to 7 years of age was included in the model, suggesting EIW mediates the association. Adjustment for seroatopy did not diminish the magnitudes of any of these associations.

Conclusion: These findings suggest a nonallergic connection between infant nonwheeze symptoms and important consequences of urban respiratory health by school age through EIW.

Figure E1

Prevalence and overlap of wheeze, runny nose without cold, and water eyes without cold in 1^st year of life (n=332).

Figure 1.

Overview of study measurements and hypothesis.

Figure 2.. Reported symptoms (A.) Prevalence and overlap of wheeze and “runny nose and watery eyes without cold” in 1^st year of life (n=332) and (B) prevalence of EIW and other respiratory outcomes from ages 5–9 years reported for the previous 12 months.

Data were available on n=300, 283, 327 and 294 children at ages 5, 6, 7 and 9, respectively.

Figure 2.. Reported symptoms (A.) Prevalence and overlap of wheeze and “runny nose and watery eyes without cold” in 1^st year of life (n=332) and (B) prevalence of EIW and other respiratory outcomes from ages 5–9 years reported for the previous 12 months.

Data were available on n=300, 283, 327 and 294 children at ages 5, 6, 7 and 9, respectively.

Figure 3.. Relative risks for (A.) EIW, (B.) Wheeze, (C.) Waking at night with cough without cold (D.) ED visit and (E.) Hospitalizations in the prior year at age 5–7 years with wheeze, runny nose or watery eyes in the first year of life.

Relative risks were adjusted for sex, race/ethnicity, maternal asthma, material hardship, smoker in the home (prenatal and age 5 years). The frequencies of EIW, wheeze, waking at night with cough without cold, ED visits and hospitalization at ages 5–7 were 20%, 36%, 34%, 29% and 7%. *P<0.05, **P<0.01, ***P<0.001.

Figure 4.. Test for mediation of the association between infant RWWC and age 5–7 ED visits by age 5–7 EIW and frequent wheeze.

All relative risks adjusted for covariates described in Figure 3. The association between RWWC and ED visits was substantially diminished by inclusion of EIW in the model. *P<0.05, ***P<0.001.