Early-life respiratory viral infections, atopic sensitization, and risk of subsequent development of persistent asthma.
Early-life respiratory viral infections, atopic sensitization, and risk of subsequent development of persistent asthma.
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DOI：
10.1016/j.jaci.2006.12.669
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发表时间：
2007-05
期刊：
影响因子：
--
通讯作者：
Sly PD
中科院分区：
文献类型：
--
作者：
Kusel MM;de Klerk NH;Kebadze T;Vohma V;Holt PG;Johnston SL;Sly PD
严重下呼吸道感染（LRIs）和特应性致敏已被确定为哮喘的独立危险因素。这些风险因素之间潜在相互作用的性质是本研究的主题。以社区为基础的198名高特应性风险儿童从出生到5岁。记录第一年所有急性呼吸道疾病的发作，并收集鼻后吸入物进行病毒鉴定。每年收集喘息和哮喘病史，并在6个月、2岁和5岁时评估特应性。总共报告了815例急性呼吸道疾病发作，其中33%为LRIs。在69%的抽吸物中检测到病毒，最常见的是鼻病毒（48.3%）和呼吸道合胞病毒（10.9%）。在5年时，28.3%（n = 56）有当前的喘息，这与喘息相关[比值比（OR）， 3.4 (1.2-9.7)；P = .02]和/或发热性LRI [or， 3.9 (1.4-10.5)；P = .007]，特别是由呼吸道合胞病毒或鼻病毒引起的疾病[or， 4.1 (1.3-12.6)；P = .02]。目前的哮喘也有类似的发现。值得注意的是，这些关联仅限于表现出早期致敏的儿童（≤2岁），而在非特应性患者或较晚致敏的患者中未观察到。这些数据表明，婴儿时期的病毒感染与特应性反应相互作用，会促进后来的哮喘。值得注意的是，在这个狭窄的发育窗口期间，这两种事件的发生与随后哮喘的最大风险相关，这表明两类炎症性损伤对疾病发病机制都有贡献。保护“高危”儿童免受婴儿期严重呼吸道感染的影响可能是初级哮喘预防的有效策略。这些策略的潜在益处值得在这个年龄组进行更仔细的评估。
Severe lower respiratory infections (LRIs) and atopic sensitization have been identified as independent risk factors for asthma. The nature of potential interactions between these risk factors was the subject of this study. A community-based cohort of 198 children at high atopic risk was followed from birth to 5 years. All episodes of acute respiratory illness in the first year were recorded and postnasal aspirates were collected for viral identification. History of wheeze and asthma was collected annually, and atopy was assessed at 6 months, 2 years, and 5 years. A total of 815 episodes of acute respiratory illness were reported, and 33% were LRIs. Viruses were detected in 69% of aspirates, most commonly rhinoviruses (48.3%) and respiratory syncytial virus (10.9%). At 5 years, 28.3%(n = 56) had current wheeze, and this was associated with wheezy [odds ratio (OR), 3.4 (1.2-9.7); P = .02] and/or febrile LRI [OR, 3.9 (1.4-10.5); P = .007], in particular those caused by respiratory syncytial virus or rhinoviruses [OR, 4.1 (1.3-12.6); P = .02]. Comparable findings were made for current asthma. Strikingly these associations were restricted to children who displayed early sensitization (≤2 years old) and not observed in nonatopic patients or those sensitized later. These data suggest viral infections interact with atopy in infancy to promote later asthma. Notably the occurrence of both of these events during this narrow developmental window is associated with maximal risk for subsequent asthma, which suggests a contribution from both classes of inflammatory insults to disease pathogenesis. Protection of “high-risk” children against the effects of severe respiratory infections during infancy may represent an effective strategy for primary asthma prevention. The potential benefits of these strategies merit more careful evaluation in this age group.
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影响因子：
6.4
作者：
Rowe, J;Macaubas, C;Holt, PG
通讯作者：
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影响因子：
14.2
作者：
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通讯作者：
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DOI：
10.1164/ajrccm.159.3.9801052
发表时间：
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影响因子：
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通讯作者：
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作者：
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