Allergic rhinitis as a predictor for wheezing onset in school-aged children

doi:10.1016/j.jaci.2010.09.008

Journal of Allergy and Clinical Immunology

Volume 126, Issue 6, December 2010, Pages 1170-1175.e2

https://doi.org/10.1016/j.jaci.2010.09.008 Get rights and content

Background

Rhinitis in older children and adults has been shown to be a predictor for adolescent- and adult-onset asthma. These findings suggest an interaction between the upper and lower airways. Whether rhinitis is a predictor for childhood-onset asthma is unknown.

Objective

We sought to investigate whether rhinitis in early childhood is an independent predictor for wheezing between the ages of 5 and 13 years in the German Multicentre Allergy Study birth cohort.

Methods

The German Multicentre Allergy Study cohort initially included 1314 healthy children. They were followed from birth to the age of 13 years with regular questionnaires and interviews. Specific IgE levels were measured at yearly intervals. Airway hyperresponsiveness was assessed at 7 years.

Results

Allergic rhinitis until the age of 5 years was found to be a predictor for developing wheezing between the ages of 5 and 13 years, with an adjusted relative risk of 3.82 (P < .001). This association was not attributable to the type of sensitization, the severity of sensitization, or atopic dermatitis during the first 2 years of life. In this group of children, 41.5% of all new cases of wheezing occurred among children with preceding allergic rhinitis.

Conclusions

The first manifestation of allergic rhinitis occurs in preschool children in whom it is a predictor for subsequent wheezing onset. Preschool children with rhinitis might thus benefit from early assessment of allergic sensitization to identify the children at high risk of wheezing.

Section snippets

Study population

The MAS, a birth cohort, recruited 1314 healthy mature infants born in 1990 in 5 German cities. A detailed description of the sampling method and the study participants has been published elsewhere.¹⁴ Briefly, 499 newborns with risk factors for atopy (increased cord blood IgE levels [≥0.9 kU/L], ≥2 atopic family members, or both) and 815 newborns without these risk factors were included in the cohort and the presented analyses (see the Methods section in this article’s Online Repository at //www.jacionline.org

Study population

Of the 1314 children recruited at birth, 1092 (83.1%) were followed to the age of 2 years, 1004 (76.4%) to the age of 5 years, 939 (71.5%) to the age of 7 years, and 766 (58.3%) to the age of 13 years.

Prevalence and incidence of rhinitis, wheezing, sensitization, and AHR

Rhinitis point prevalence was highest at 3 years at 9.2% and ranged between 2.5% and 7.7% throughout the other years. By the age of 13 years, the cumulative incidence of rhinitis was 47.8%. Wheezing point prevalence was highest at the end of the second year, with a value of 19.8% decreasing to

Discussion

The findings of this study suggest that the first manifestation of allergic rhinitis occurs in preschool children. In this age group allergic rhinitis is a risk factor for subsequent wheezing onset. In contrast, neither the rare manifestation of allergic rhinitis in the first 2 years of life nor nonallergic rhinitis up to the age of 5 years was associated with the onset of wheezing in childhood. These findings suggest that some childhood wheezing phenotypes are associated with rhinitis in

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: Supported by the German Ministry of Education and Research (BMBF), grant number 01 EE9406, and cofunded by an unrestricted educational grant from AstraZeneca Germany. M. K. R. was supported by a Marie Curie Actions research grant (MEST-CT-2005-020524-GALTRAIN).

: Disclosure of potential conflict of interest: M. J. Ege has received research grants from the European Union, the German Research Foundation (DFG), and the Behring-Rontgen Foundation. The rest of the authors have declared that they have no conflict of interest.

^∗: The MAS study group: Volker Wahn, Marketa Groeger, Antje Schuster (Dusseldorf, Germany); Fred Zepp, Imke Bieber, Wolfgang Kamin (Mainz, Germany); Johannes Forster, Uta Tacke (Freiburg, Germany); Carl-Peter Bauer (Gaisach, Germany); Renate Bergmann, Young-Ae Lee, Renate Nickel (Berlin, Germany); Ute Hoffmann (Munich, Germany).

View full text

Rhinitis, sinusitis, and upper airway diseaseAllergic rhinitis as a predictor for wheezing onset in school-aged children

Background

Objective

Methods

Results

Conclusions

Section snippets

Study population

Study population

Prevalence and incidence of rhinitis, wheezing, sensitization, and AHR

Discussion

Lancet

Otolaryngol Clin North Am

J Allergy Clin Immunol

Paediatr Respir Rev

Lancet

J Allergy Clin Immunol

Lancet

Lancet

J Allergy Clin Immunol

Chest

J Allergy Clin Immunol

Immunol Allergy Clin North Am

J Allergy Clin Immunol

Ann Allergy Asthma Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

Rhinosinusitis and asthma: the missing link

Curr Opin Pulm Med

Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA(2)LEN and AllerGen)

Allergy

The nose-lung interaction in allergic rhinitis and asthma: united airways disease

Curr Opin Allergy Clin Immunol

Rhinitis, sinusitis, and upper airway disease
Allergic rhinitis as a predictor for wheezing onset in school-aged children