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The objective of this study was to evaluate risk factors for persistent wheezing in a group of 2-4-year-old children after an index-wheezing episode in infancy. Eighty infants who had been seen at the Emergency Department for an episode of acute wheezing were followed for 2 yr in this prospective study. Caregivers completed a questionnaire, and children underwent clinical evaluation and skin prick testing 2 yr following the index-wheezing episode. Detection of respiratory viruses and analysis of exposure to major indoor allergens were carried out at enrollment. Immunoglobin E antibodies were measured at the beginning of the study and at the end of follow-up, using the CAP system. Logistic regression analysis was performed to identify factors associated with persistent wheezing. Seventy-three children (44 boys) completed the study. After 2 yr, 38 (52%) reported three or more wheezing episodes in the past 12 months (persistent wheezers). Independent risk factors for persistence of wheezing were allergic sensitization and exposure to cockroach allergen in the kitchen. Breast-feeding for at least 1 month was a protective factor. A strong association between allergic sensitization and persistence of wheezing was found in a group of very young children living in a subtropical area.

Background Risk factors for acute wheezing among children in subtropical areas are largely unknown. Objective To investigate the role of viral infections, allergen sensitization, and exposure to indoor allergens as risk factors for acute wheezing in children 0 to 12 years old. Methods One hundred thirty-two children 0 to 12 years of age who sought emergency department care for wheezing and 65 children with no history of wheezing were enrolled in this case-control study. Detection of respiratory syncytial virus antigen, rhinovirus and coronavirus RNA, adenovirus, influenza, and parainfluenza antigens was performed in nasal washes. Total IgE and specific IgE to mites, cockroach, cat, and dog were measured with the CAP system. Major allergens from mites, cockroach, cat, and dog were quantified in dust samples by ELISA. Univariate and multivariate analyses were performed by logistic regression. Results In children under 2 years of age, infection with respiratory viruses and family history of allergy were independently associated with wheezing (odds ratio, 15.5 and 4.2; P = .0001 and P = .008, respectively). Among children 2 to 12 years old, sensitization to inhalant allergens was the major risk factor for wheezing (odds ratio, 2.7; P = .03). High-level allergen exposure, exposure to tobacco smoke, and lack of breast-feeding showed no association with wheezing. Conclusions Some risk factors for wheezing previously identified in temperate climates were present in a subtropical area, including respiratory syncytial virus infection in infants and allergy in children older than 2 years. Rhinovirus was not associated with wheezing and did not appear to be a trigger for asthma exacerbations.

Methods Sixty one of 76 children who participated in a previous study (Camara et al JACI 2004;113;551-7) aimed at identifying risk factors for acute wheezing in infancy were re-evaluated at the ages of 2-4 and 8-12 years. They had been seen at the Emergency Room (ER) for an episode of wheezing at the age of 6-24 months. At the age of 8-12 years, parents completed a questionnaire on respiratory symptoms; 52 children underwent skin prick testing with a panel of inhalant and food allergens and 48 performed methacholine challenge tests. Children were considered asthmatic at the age of 8-12 years if they presented previous physician-diagnosed asthma, or at least one of the following symptoms in the past 12 months: wheezing, cough or chest tightness with exercise, or dry cough without colds, accompanied by bronchial hyperresponsiveness, defined by a PC20

Rationale We have evaluated risk factors associated with persistence of wheezing beyond the first two years of life among children living in a subtropical area. Methods 80 children who had been seen at the Emergency Room for an episode of wheezing in the first 2 years of life were followed for 2 years in this prospective study. Children underwent clinical evaluation and skin prick testing to inhalant and food allergens two years following the index episode of wheezing. Detection of respiratory viruses and analysis of house dust samples for exposure to major allergens from mites, cockroach, cat and dog (by ELISA) were carried out at enrollment. Total IgE and specific IgE antibodies (Pharmacia CAP system) were measured at the beginning of the study and at the end of follow-up. Multivariate analysis was performed to identify factors associated with persistent wheezing. Results 73 children (44 boys) completed the study. After 2 years, 38 (52%) presented 3 or more wheezing episodes treated with beta-2 agonists in the past 12 months (persistent wheezers). Risk factors for persistence of wheezing were: family history of allergy (OR=48.6; p=0.03), exposure to levels of cockroach allergen Bla g 1 >2U/g in the kitchen (OR=7.6; p=0.03) and allergic sensitization at age 2-4 (OR=11.3; p=0.002). Breast-feeding for at least one month was a protective factor (OR=0.08; p=0.01). Conclusions Environmental exposure to high levels of cockroach allergen in infancy, sensitization to indoor allergens at age 2-4 and family history of allergy were strongly and independently associated with persistent wheezing in children.