Risk factors for recurrent wheezing in infants: a case-control study

Roberta Barros de Sousa, Décio Medeiros, Emanuel Sarinho, José Ângelo Rizzo, Almerinda Rêgo Silva, Ana Carolina Dela Bianca, Roberta Barros de Sousa, Décio Medeiros, Emanuel Sarinho, José Ângelo Rizzo, Almerinda Rêgo Silva, Ana Carolina Dela Bianca

Abstract

Objective: To evaluate the association between recurrent wheezing and atopy, the Asthma Predictive Index, exposure to risk factors, and total serum IgE levels as potential factors to predict recurrent wheezing.

Methods: A case-control study with infants aged 6-24 months treated at a specialized outpatient clinic from November 2011 to March 2013. Evaluations included sensitivity to inhalant and food antigens, positive Asthma Predictive Index, and other risk factors for recurrent wheezing (smoking during pregnancy, presence of indoor smoke, viral infections, and total serum IgE levels).

Results: We evaluated 113 children: 65 infants with recurrent wheezing (63.0% male) with a mean age of 14.8 (SD = 5.2) months and 48 healthy infants (44.0% male) with a mean age of 15.2 (SD = 5.1) months. In the multiple analysis model, antigen sensitivity (OR = 12.45; 95%CI 1.28-19.11), positive Asthma Predictive Index (OR = 5.57; 95%CI 2.23-7.96), and exposure to environmental smoke (OR = 2.63; 95%CI 1.09-6.30) remained as risk factors for wheezing. Eosinophilia ≥ 4.0% e total IgE ≥ 100 UI/mL were more prevalent in the wheezing group, but failed to remain in the model. Smoking during pregnancy was identified in a small number of mothers, and secondhand smoke at home was higher in the control group.

Conclusions: Presence of atopy, positive Asthma Predictive Index and exposure to environmental smoke are associated to recurrent wheezing. Identifying these factors enables the adoption of preventive measures, especially for children susceptible to persistent wheezing and future asthma onset.

Conflict of interest statement

Conflict of Interest: The authors declare no conflict of interest.

References

    1. Alcântara-Neves NM, Britto GSG, Veiga RV, Figueiredo CA, Fiaccone RL, Conceição JS, et al. Effects of helminth co-infections on atopy, asthma and cytokine production in children living in a poor urban area in Latin America. 10.1186/1756-0500-7-817BMC Research Notes. 2014;7(817)
    1. Almqvist C, Li Q, Britton WJ, Kemp AS, Xuan W, Tovey ER, et al. Early predictors for developing allergic disease and asthma: examining separate steps in the ‘allergic march’. 10.1111/j.1365-2222.2007.02796.xClin Exp Allergy. 2007;37(9):1296–1302.
    1. Bacharier LB, Boner A, Carlsen KH, Eigenmann PA, Frischer T, Gotz M, et al. Diagnosis and treatment of asthma in childhood: a PRACTALL consensus report. 10.1111/j.1398-9995.2007.01586.xAllergy. 2008;63(1):5–34.
    1. Bacharier LB. Evaluation of the child with recurrent wheezing. 10.1016/j.jaci.2011.07.034J Allergy Clin Immunol. 2011;128(3):690e1–690e5.
    1. Bousquet J, Heinzerling L, Bachert C, Papadopoulos NG, Bousquet PJ, Burney PG, et al. Practical guide to skin prick tests in allergy to aeroallergens. 10.1111/j.1398-9995.2011.02728.xAllergy. 2012;67:18–24.
    1. Brockow I, Zutavern A, Hoffmann U, Grubl A, von Berg A, Koletzko S, et al. Early allergic sensitizations and their relevance to atopic diseases in children aged 6 years: results of the GINI study. J Investig Allergol Clin Immunol. 2009;19(3):180–187.
    1. Castro-Rodríguez JA, Holberg CJ, Wright AL, Martinez FD. A Clinical index to define risk of asthma in young children with recurrent wheezing. 10.1164/ajrccm.162.4.9912111Am J Respir Crit Care Med. 2000;162(4):1403–1406.
    1. Custovic A, Simpson A. The role of inhalant allergens in allergic airways disease. J Investig Allergol Clin Immunol. 2012;22(6):393–401.
    1. Dela Bianca ACC, Wandalsen GF, Miyagi K, Camargo L, Cezarin D, Solé D, et al. Prevalência de sibilância em lactentes: proposta de protocolo internacional de estudo. Rev Bras Alerg Imunopatol. 2007;30(3):94–100.
    1. Emin O, Nermin G, Ulker O, Gokçay G. Skin sensitization to common allergens in turkish wheezy children less than 3 years of age. Asian Pacific J Allergy Immunol. 2004;22(2-3):97–101.
    1. Fasce L, Tosca MA, Baroffio M, Olcese R, Ciprandi G. Atopy in wheezing infants always starts with monosensitization. 10.2500/aap.2007.28.2966Allergy Asthma Proc. 2007;28(4):449–453.
    1. Fitzpatrick AM, Teague WG, Meyers DA, Peters ST, Li X, Li H, et al. Heterogeneity of severe asthma in childhood: confirmation by cluster analysis of children in the NIH/NHLBI Severe Asthma Research Program (SARP) 10.1016/j.jaci.2010.11.015J Allergy Clin Immunol. 2011;127(2):382–389.
    1. Guilbert TW, Morgan WJ, Zeiger RS, Bacharier LB, Boehmer SJ, Krawiec M, et al. Atopic characteristics of children with recurrent wheezing at high risk for the development of childhood asthma. 10.1016/j.jaci.2004.09.020J Allergy Clin Immunol. 2004;114(6):1282–1287.
    1. Host A, Andrae S, Charkin S, Diaz-Vázquez C, Dreborg S, Eigenmann PA, et al. Allergy testing in children: why, who, when and how? 10.1034/j.1398-9995.2003.00238.xAllergy. 2003;58(7):559–569.
    1. Jackson DJ. The role of rhinovirus infections in the development of early childhood asthma. 10.1097/ACI.0b013e3283352f7cCurr Opin Allergy Clin Immunol. 2010;10(2):133–138.
    1. Krawiec ME, Westcott JY, Chu HW, Balzar S, Trudeau JB, Schwartz LB, et al. Persistent wheezing in very young children is associated with lower respiratory inflammation. 10.1164/ajrccm.163.6.2005116Am J Respir Crit Care Med. 2001;163(6):1338–1343.
    1. Kurukulaaratchy RJ, Matthews S, Holgate ST, Arshad SH. Predicting persistent disease among children who wheeze during early life. 10.1183/09031936.03.00005903Eur Respir J. 2003;22(5):767–771.
    1. Mallol J, Garcia-Marcos L, Solé D, Brand P, EISL Study Group International prevalence of recurrent wheezing during the first year of life: variability, treatment patterns and use of health resources. Thorax. 2010;65(11):1004–1009.
    1. Malmstrom K, Pelkonen AS, Malmberg LP, Sarna S, Lindahl H, Kajosaari M, et al. Lung function, airway remodelling and inflammation in symptomatic infants: outcome at 3 years. 10.1136/thx.2010.139246Thorax. 2011;66(2):157–162.
    1. Martinez FD, Wright AL, Taussig LM, Holberg CJ, Halonen M, Morgan WJ, et al. Asthma and wheezing in the first six years of life. 10.1056/NEJM199501193320301N Engl J Med. 1995;332(3):133–138.
    1. Medeiros D, Silva AR, Rizzo JA, Motta ME, Oliveira FHB, Sarinho ESC. Nível sérico de IgE total em alergia respiratória: estudo em pacientes com alto risco de infecção por helmintos. 10.2223/JPED.1503J Pediatr (Rio J) 2006;82(4):255–259.
    1. Medeiros D, Silva AR, Rizzo JA, Sarinho E, Mallol J, Solé D. Prevalência de sibilância e fatores de risco associados em crianças no primeiro ano de vida, residentes no Município de Recife, Pernambuco, Brasil. 10.1590/S0102-311X2011000800010Cad Saude Publica. 2011;27(8):1551–1559.
    1. Naspitz CK, Solé D, Jacob CA, Sarinho E, Soares FJP, Dantas V, et al. Sensibilização a alérgenos inalantes e alimentares em crianças brasileiras atópicas, pela determinação in vitro de IgE total e específica - Projeto Alergia (PROAL) 10.2223/JPED.1184J Pediatr (Rio J) 2004;80(3):203–210.
    1. Pedersen SE, Hurd SS, Lemanske RF, Jr, Becker A, Zar HJ, Sly PD, et al. Global strategy for the diagnosis and management of asthma in children 5 years and younger. 10.1002/ppul.21321Pediatr Pulmonol. 2011;46(1):1–17.
    1. Rhodes HL, Thomas P, Sporik R, Holgate ST, Cogswell JJ. A birth cohort study of subjects at risk for atopy: twenty-two-year follow-up of wheeze and atopic status. 10.1164/ajrccm.165.2.2104032Am J Respir Crit Care Med. 2002;165(2):176–180.
    1. Rosário NA, Filho, Jacob CM, Sole D, Condino A, Neto, Arruda LK, Costa-Carvalho B, et al. Pediatric allergy and immunology in Brazil. 10.1111/pai.12069Pediatr Allergy Immunol. 2013;24(4):402–409.
    1. Söderstrom L, Lilja G, Borres MP, Nilsson C. An explorative study of low levels of allergen-specific IgE and clinical allergy symptoms during early childhood. 10.1111/j.1398-9995.2011.02578.xAllergy. 2011;66(8):1058–1064.
    1. Torrent M, Sunyer J, Garcia R, Harris J, Iturriaga MV, Puig C, et al. Early-life allergen exposure and atopy, asthma, and wheeze up to 6 years of age. 10.1164/rccm.200607-916OCAm J Respir Crit Care Med. 2007;176(5):446–453.
    1. Yu MK, Lin CY, Chen WL, Chen CT. Prevalence of Blomia tropicalis in wheezing children in central Taiwan. J Microbiol Immunol Infect. 2008;41(1):68–73.

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe