Allergy and atopic phenotype are associated with earlier gestation and severity of respiratory symptoms in bronchopulmonary dysplasia

Brianna C Aoyama¹, Joseph M Collaco², Amit Agarwal³, Gangaram Akangire⁴, Eric D Austin⁵, Manvi Bansal⁶, Anita Bhandari⁷, A Ioana Cristea⁸, Lystra P Hayden⁹, Jonathan C Levin^{9

10}, Winston M Manimtim⁴, Audrey N Miller¹¹, Paul E Moore⁵, Antonia P Popova¹², Lawrence M Rhein¹³, Catherine A Sheils⁹, Steven H Abman¹⁴, Christopher D Baker¹⁴, Sara K Dawson¹⁵, Mehtap Haktanir Abul¹⁶, Jennifer K Henningfeld¹⁵, Joanne M Lagatta¹⁵, Roopa Siddaiah¹⁷, Nicole Stephenson¹⁸, Demet Toprak¹⁹, Sharon A McGrath-Morrow⁷

Affiliations

¹ Eudowood Division of Pediatric Respiratory Sciences, Johns Hopkins University, Baltimore, MD, USA. baoyama1@jhmi.edu.
² Eudowood Division of Pediatric Respiratory Sciences, Johns Hopkins University, Baltimore, MD, USA.
³ Division of Pulmonary Medicine, Arkansas Children's Hospital and University of Arkansas for Medical Sciences, Little Rock, AR, USA.
⁴ Division of Neonatology, Children's Mercy-Kansas City and University of Missouri Kansas City School of Medicine, Kansas City, Missouri, USA.
⁵ Pulmonary Medicine, Vanderbilt University and Vanderbilt University Medical Center, Nashville, TN, USA.
⁶ Pulmonology and Sleep Medicine, Children's Hospital of Los Angeles, Los Angeles, CA, USA.
⁷ Division of Pulmonary Medicine, Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, PA, USA.
⁸ Division of Pediatric Pulmonology, Allergy and Sleep Medicine, Riley Children's Hospital and Indiana University, Indianapolis, IN, USA.
⁹ Division of Pulmonary Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA.
¹⁰ Division of Newborn Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA.
¹¹ Division of Neonatology, Nationwide Children's Hospital and Ohio State University, Columbus, OH, USA.
¹² Pediatric Pulmonology, University of Michigan, Ann Arbor, MI, USA.
¹³ Neonatal-Perinatal Medicine/Pediatric Pulmonology, University of Massachusetts, Worcester, MA, USA.
¹⁴ Section of Pulmonary and Sleep Medicine, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA.
¹⁵ Department of Pediatrics, Medical College of Wisconsin Milwaukee, Milwaukee, Wisconsin, USA.
¹⁶ Department of Pediatrics, Brown University School of Medicine, Providence, RI, USA.
¹⁷ Pediatric Pulmonology, Penn State Health, Hershey, PA, USA.
¹⁸ Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
¹⁹ Division of Pediatric Pulmonary and Sleep Medicine, University of Washington, Seattle, WA, USA.

PMID: 40646282
DOI: 10.1038/s41390-025-04277-6

Allergy and atopic phenotype are associated with earlier gestation and severity of respiratory symptoms in bronchopulmonary dysplasia

Brianna C Aoyama et al. Pediatr Res. 2025.

. 2025 Jul 11.

doi: 10.1038/s41390-025-04277-6. Online ahead of print.

Authors

Affiliations

¹ Eudowood Division of Pediatric Respiratory Sciences, Johns Hopkins University, Baltimore, MD, USA. baoyama1@jhmi.edu.
² Eudowood Division of Pediatric Respiratory Sciences, Johns Hopkins University, Baltimore, MD, USA.
³ Division of Pulmonary Medicine, Arkansas Children's Hospital and University of Arkansas for Medical Sciences, Little Rock, AR, USA.
⁴ Division of Neonatology, Children's Mercy-Kansas City and University of Missouri Kansas City School of Medicine, Kansas City, Missouri, USA.
⁵ Pulmonary Medicine, Vanderbilt University and Vanderbilt University Medical Center, Nashville, TN, USA.
⁶ Pulmonology and Sleep Medicine, Children's Hospital of Los Angeles, Los Angeles, CA, USA.
⁷ Division of Pulmonary Medicine, Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, PA, USA.
⁸ Division of Pediatric Pulmonology, Allergy and Sleep Medicine, Riley Children's Hospital and Indiana University, Indianapolis, IN, USA.
⁹ Division of Pulmonary Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA.
¹⁰ Division of Newborn Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA.
¹¹ Division of Neonatology, Nationwide Children's Hospital and Ohio State University, Columbus, OH, USA.
¹² Pediatric Pulmonology, University of Michigan, Ann Arbor, MI, USA.
¹³ Neonatal-Perinatal Medicine/Pediatric Pulmonology, University of Massachusetts, Worcester, MA, USA.
¹⁴ Section of Pulmonary and Sleep Medicine, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA.
¹⁵ Department of Pediatrics, Medical College of Wisconsin Milwaukee, Milwaukee, Wisconsin, USA.
¹⁶ Department of Pediatrics, Brown University School of Medicine, Providence, RI, USA.
¹⁷ Pediatric Pulmonology, Penn State Health, Hershey, PA, USA.
¹⁸ Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
¹⁹ Division of Pediatric Pulmonary and Sleep Medicine, University of Washington, Seattle, WA, USA.

PMID: 40646282
DOI: 10.1038/s41390-025-04277-6

Abstract

Background: A history of atopy is associated with respiratory morbidities in term-born children; however, little is known about how allergies/atopy affect respiratory outcomes in children with bronchopulmonary dysplasia (BPD). This study aims to describe the prevalence of reported allergies/atopy in young children with BPD and assess whether allergies/atopy are associated with outpatient outcomes.

Methods: A retrospective longitudinal cohort study of children between 0 and 36 months of age followed at outpatient BPD clinics was performed using data from questionnaires administered during routine clinical encounters. The presence of allergy/atopy was defined by caregiver questionnaires. Generalized estimating equations were used to adjust associations between allergy/atopy and respiratory outcomes.

Results: Rates of reported allergy/atopy in a cohort of infants and children with BPD (21.6%) were similar to previously published rates in healthy children. Children with atopy/allergy were more likely to be born at earlier gestational ages, have pulmonary hypertension, and be non-white and non-Hispanic compared to their non-atopic peers and to experience trouble breathing, nighttime symptoms, activity limitations, and rescue medication use during the first three years of life.

Conclusions: In children with BPD, allergy/atopy was more common among those born at earlier gestational ages and was significantly associated with increased respiratory symptoms during the first 3 years of life. Further studies are needed to assess whether the association between allergy/atopy and increased respiratory morbidity persists throughout childhood and affects later lung function and whether potential interventions, including inhaled steroids, may modify this risk.

Impact: There is limited data on the prevalence of atopy/allergy in children with bronchopulmonary dysplasia (BPD) and the association between allergy/atopy and respiratory outcomes in this population. Our findings demonstrate that in children with BPD, allergy/atopy was more common among those born at earlier gestational ages and was associated with increased respiratory symptoms and rescue medication use during the first 3 years of life. Further studies are needed to determine whether this association persists throughout childhood and affects later lung function and whether potential interventions may modify this risk.

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Conflict of interest statement

Competing interests: The authors declare no competing interests. Ethics approval and consent to participate: Patient consent was required and obtained per local institutional IRBs.

References

1. Collaco, J. M. & McGrath-Morrow, S. A. Respiratory phenotypes for preterm infants, children, and adults: bronchopulmonary dysplasia and more. Ann. Am. Thorac. Soc. 15, 530–538 (2018). - DOI - PubMed
1. Aoyama, B. C., Rice, J. L., McGrath-Morrow, S. A. & Collaco, J. M. Mortality in outpatients with bronchopulmonary dysplasia. J. Pediatr. 241, 48–53.e1 (2022). - DOI - PubMed
1. Baker, C. D., Abman, S. H. & Mourani, P. M. Pulmonary hypertension in preterm infants with bronchopulmonary dysplasia. Pediatr. Allergy Immunol. Pulmonol. 27, 8–16 (2014). - DOI - PubMed - PMC
1. Bhandari, A. & Bhandari, V. Pitfalls, problems, and progress in bronchopulmonary dysplasia. Pediatrics 123, 1562–1573 (2009). - DOI - PubMed
1. Gerner, T. et al. Differences in occurrence, risk factors and severity of early-onset atopic dermatitis among preterm and term children. Acta Derm. Venereol. 102, adv00737 (2022). - DOI - PubMed

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Allergy and atopic phenotype are associated with earlier gestation and severity of respiratory symptoms in bronchopulmonary dysplasia

Affiliations

Allergy and atopic phenotype are associated with earlier gestation and severity of respiratory symptoms in bronchopulmonary dysplasia

Authors

Affiliations

Abstract

Conflict of interest statement

References

LinkOut - more resources

Full Text Sources