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. 2022 Jan 17;1(2):73-79.
doi: 10.1016/j.jacig.2021.12.005. eCollection 2022 May.

Moderate-to-severe lower respiratory tract infection in early life is associated with increased risk of polysensitization and atopic dermatitis: Findings from the CHILD Study

Maria Medeleanu  1 , Julia E M Upton  2 , Myrtha E Reyna Vargas  1 , Ruixue Dai  1 , Piushkumar J Mandhane  3 , Elinor Simons  4 , Stuart E Turvey  5 , Padmaja Subbarao  1   6 , Theo J Moraes  1   6
Affiliations

Moderate-to-severe lower respiratory tract infection in early life is associated with increased risk of polysensitization and atopic dermatitis: Findings from the CHILD Study

Maria Medeleanu et al. J Allergy Clin Immunol Glob. .

Abstract

Background: Respiratory infections in infancy are associated with the development of allergic asthma and atopy. Delineating whether symptomatic infections are a marker of atopic predisposition or contribute to atopic development is important for preventive strategies. We hypothesized that early, severe lower respiratory tract infections (LRTIs) may be a risk factor for the development of atopic disease.

Objective: Our aim was to determine whether clinically defined, moderate-to-severe LRTIs in infancy are associated with the development of atopic dermatitis and allergic sensitization at preschool age.

Methods: LRTI timing and severity in the first 18 months of life was defined by using the Canadian Healthy Infant Longitudinal Development study questionnaires. Polysensitization and atopic dermatitis were determined by standardized skin prick testing and structured clinical assessments. Longitudinal associations between LRTI severity and clinical outcomes at ages 3 years and 5 years were determined by adjusted repeated measures generalized estimation equations.

Results: Moderate-to-severe LRTIs were associated with increased odds of polysensitization (odds ratio = 1.91 [95% CI = 1.16-3.15]; P = .014) and atopic dermatitis (odds ratio = 2.19 [95% CI 1.41-3.39]; P < .001) as compared with the odds in children with no history of LRTI in the first 18 months of life. The association between moderate-to-severe LRTI and polysensitization or atopic dermatitis remained robust after adjusting for sex; study site; breast-feeding duration; and mother, father, or both-parent atopy or asthma.

Conclusions: These results highlight severe infant LRTI as an important risk factor for allergic and atopic disease (ie, polysensitization and atopic dermatitis), and they suggest that this risk is independent of maternal in utero environment, both-parent history of asthma, and both-parent genetic predisposition.

Keywords: Respiratory infection; allergy; atopic dermatitis; atopy; food allergy; pediatrics.

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Figures

Fig 1
Fig 1
Cumulative number of participants who experienced their first mild or moderate-to-severe LRTI by the age of onset. Age of first LRTI is binned into 0 to 3, 3 to 6, 6 to 9, 9 to 12, and 12 to 18 months.
Fig 2
Fig 2
Prevalence of sensitization or atopic dermatitis at ages 3 and 5 years in each LRTI severity group (no-LRTI, mild LRTI, or moderate-to-severe LRTI) between birth and 18 months of age.
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