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Viruses, Food Allergies, and Childhood Wheezing
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Dr. Fischer reports no financial relationships relevant to this field of study.
SOURCE: Hasegawa K, Mansbach JM, Bochkov YA, et al. Association of rhinovirus C bronchiolitis and immunoglobulin E sensitization during infancy with development of recurrent wheeze. JAMA Pediatr 2019; April 1. doi:10.1001/jamapediatrics.2019.0384. [Epub ahead of print].
Bronchiolitis accounts for 130,000 hospitalizations each year in the United States. Approximately one-third of infants sick enough to be hospitalized with bronchiolitis go on to develop recurrent episodes of wheezing and asthma. After respiratory syncytial virus, rhinovirus is the next most common cause of bronchiolitis.
A study of children in Australia revealed that those with atopic dermatitis who became ill with bronchiolitis C were more likely than other children to have further episodes of respiratory illness with wheezing.
With that background, Hasegawa and colleagues at 17 United States medical centers evaluated 716 children hospitalized during the first year of life with bronchiolitis to see if the risk of subsequent wheezing illness depended on the specific viral etiology of the initial bout of illness. They also performed immunoglobulin E (IgE) tests during the initial admission to determine if pre-illness allergic sensitization (to food and/or aeroallergens) altered the risk of subsequent asthma. The study covered three bronchiolitis seasons (November 2011 to April 2014).
The median age of study subjects was 2.9 months. Seventy-six percent of patients had respiratory syncytial virus bronchiolitis; the others had rhinovirus A (12%), B (2%), or C (11%). Overall, 32% developed recurrent wheeze by 3 years of age. Rhinovirus C-infected infants had a 1.58-fold higher risk of developing recurrent wheeze. Those with rhinovirus C who also had IgE sensitization at the time of their initial hospitalization were at greatest risk (3.03-fold risk) of developing recurrent wheeze.
COMMENTARY
Several key lessons emerge from this study. Rhinovirus is not merely a cause of runny...