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Virus, allergic sensitisation and cortisol in infant bronchiolitis and risk of early asthma

Jon Olav Gjengstø Hunderi, Leif Bjarte Rolfsjord, Karin C. Lødrup Carlsen, René Holst, Egil Bakkeheim, Teresa Løvold Berents, Kai-Håkon Carlsen, Håvard Ove Skjerven
ERJ Open Research 2020 6: 00268-2019; DOI: 10.1183/23120541.00268-2019
Jon Olav Gjengstø Hunderi
1Dept of Pediatrics and Adolescent Medicine, Østfold Hospital Trust, Grålum, Norway
2Division of Pediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
3Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
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  • ORCID record for Jon Olav Gjengstø Hunderi
  • For correspondence: jonhun@so-hf.no
Leif Bjarte Rolfsjord
3Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
4Dept of Pediatrics, Innlandet Hospital Trust, Elverum, Norway
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Karin C. Lødrup Carlsen
2Division of Pediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
3Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
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René Holst
5Oslo Centre for Biostatistics and Epidemiology, Faculty of Medicine, University of Oslo, Oslo, Norway
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Egil Bakkeheim
2Division of Pediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
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Teresa Løvold Berents
3Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
6Dept of Dermatology, Oslo University Hospital, Oslo, Norway
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Kai-Håkon Carlsen
2Division of Pediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
3Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
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Håvard Ove Skjerven
2Division of Pediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
3Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
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  • FIGURE 1
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    FIGURE 1

    a) The distribution of respiratory syncytial virus (RSV), human rhinovirus (HRV), and HRV species A and B, and C; b) the distribution of sensitisation to inhalant and food allergens; and c) the distribution of morning saliva cortisol sampled the first morning after hospitalisation, in infants hospitalised with acute bronchiolitis at study enrolment (0–12 months of age, mean age 4.2 months), compared to children with recurrent wheeze and no recurrent wheeze at 2-year follow-up. s-IgE: specific immunoglobulin E.

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  • TABLE 1

    Characteristics at birth, study enrolment and 2 years of age are reported stratified by the presence or absence of recurrent wheeze at 2 years of age

    Recurrent wheezeNo recurrent wheezep-value
    Participants143 (48.6%)151 (51.4%)
    At birth
     Male sex96/143 (67.1%)85/151 (56.3%)0.06
     GA weeks38.6±2.438.5±4.00.95
     Born at GA <37 weeks14/110 (12.7%)15/116 (12.9%)0.96
     Birth weight g3347±6323497±6420.05
    At enrolment
     Age days mean (range)134 (14–348)115 (7–363)0.05
     Weight g6650±18866245±17940.06
     Eczema15/131 (11.5%)14/140 (10.0%)0.70
     One previous episode of wheeze34/127 (26.8%)35/133 (26.3%)0.93
     Length of hospital stay h85±7276±590.16
     Need of supportive treatment73/142 (51.4%)79/150 (52.7%)0.83
    Virus detected during acute bronchiolitis
     RSV107/129 (82.9%)112/137 (81.8%)0.80
     HRV45/129 (34.9%)48/137 (35.0%)0.98
     HRV A or B12/129 (9.3%)16/137 (11.7%)0.53
     HRV C33/129 (25.6%)32/137 (23.4%)0.67
     RSV high genomic load68/129 (52.7%)77/137 (56.2%)0.57
     HRV high genomic load8/129 (6.2%)8/137 (5.8%)0.90
     More than one virus80/129 (62.0%)90/137 (65.7%)0.53
    Allergic sensitisation#
     Any sensitisation9/130 (6.9%)13/141 (9.2%)0.49
     Any food sensitisation8/130 (6.2%)12/141 (8.5%)0.46
     Any inhalant sensitisation3/130 (2.3%)2/141 (1.4%)0.59
     Egg sensitisation5/130 (3.8%)3/141 (2.1%)0.40
     Cow's milk sensitisation4/130 (3.1%)9/141 (6.4%)0.20
     Peanut sensitisation1/141 (0.7%)2/130 (1.5%)0.52
     Polysensitisation4/130 (3.1%)3/141 (2.1%)0.62
     Monosensitisation4/130 (3.1%)9/141 (6.4%)0.20
     Cortisol mmol·L−1 geometric mean (95% CI)37.0 (30.2–45.4)33.7 (28.5–39.8)
    At the 2-year follow-up
     Age days mean (range)747 (291–1055)725 (368–979)0.07
     Asthma diagnosed by physician51/143 (35.7%)5/151 (3.3%)<0.001
     Asthma medication used108/134 (80.6%)28/142 (19.7%)<0.001
    Parental education
     Maternal education¶3.93±0.944.05±1.030.31
     Paternal education¶3.76±0.973.92±1.020.21
    Parental allergic diseases
     Any+70/128 (54.7%)60/136 (44.1%)0.09
     Maternal asthma22/112 (19.6%)14/123 (11.4%)0.08
     Paternal asthma16/112 (14.3%)15/123 (12.2%)0.64
     Maternal rhinoconjunctivitis21/124 (16.9%)21/134 (15.7%)0.78
     Paternal rhinoconjunctivitis31/124 (25.0%)25/134 (18.7%)0.22
     Maternal eczema20/128 (15.6%)11/135 (8.1%)0.06
     Paternal eczema15/128 (11.7%)10/135 (7.4%)0.23
    Environment
     Smoking at home19/124 (15.3%)19/129 (14.7%)0.90

    Data are presented as n/N (%) or mean±sd, unless otherwise stated. GA: gestational age; RSV: respiratory syncytial virus; HRV: human rhinovirus. #: specific immunoglobulin E ≥0.35 kU·L−1; ¶: categorised from 1 (no school completed) to 5 (higher education, >3 years); +: reported asthma, eczema and/or rhinoconjunctivitis.

    • TABLE 2

      The odds ratios of having recurrent wheeze at 2 years of age are shown by factors observed among infants (0–12 months of age) who were admitted to hospital with acute bronchiolitis

      Recurrent wheeze OR (95% CI)p-value
      Viral detection during acute bronchiolitis
       RSV0.91 (0.45–1.83)0.78
       HRV1.03 (0.59–1.78)0.93
       HRV A or B0.74 (0.31–1.8)0.51
       HRV C1.19 (0.65–2.19)0.58
       RSV high genomic load0.84 (0.50,1.42)0.52
       HRV high genomic load0.93 (0.30–2.84)0.90
       Multiple viruses0.83 (0.47–1.44)0.50
      Allergic sensitisation#
       Any sensitisation0.72 (0.28–1.89)0.51
       Any food sensitisation0.71 (0.25–1.96)0.50
       Any inhalant sensitisation1.08 (0.19–20.89)0.56
       Egg sensitisation1.33 (0.27–6.45)0.72
       Cow's milk sensitisation0.41 (0.10–1.64)0.21
       Peanut sensitisation00.99
       Polysensitisation1.61 (0.29–32.79)0.35
      Salivary morning cortisol1.00 (0.99–1.01)0.40

      Bivariate odds ratios are adjusted for sex, age at inclusion and parental atopy. RSV: respiratory syncytial virus; HRV: human rhinovirus.#: specific immunoglobulin E ≥0.35 kU·L−1.

      • TABLE 3

        The incidence rate ratio (IRR) for episodes of recurrent wheeze at 2 years of age are given by factors observed in infants admitted to hospital with acute bronchiolitis, based on zero-truncated negative binomial regression analysis

        Recurrent wheeze IRR (95% CI)p-value
        Viral detection during acute bronchiolitis
         RSV0.95 (0.70–1.28)0.86
         HRV0.72 (0.57–0.91)0.16
         HRV A or B0.58 (0.40–0.83)0.14
         HRV C0.84 (0.65–1.09)0.51
         RSV high genomic load0.92 (0.73–1.15)0.70
         HRV high genomic load0.61 (0.38–0.99)0.31
         Multiple viruses0.91 (0.72–1.16)0.69
        Allergic sensitisation#
         Any sensitisation1.46 (0.97–2.19)0.36
         Any food sensitisation1.53 (1.0–2.36)0.32
         Any inhalant sensitisation1.18 (0.48–2.90)0.85
         Egg sensitisation3.58 (1.82–3.58)0.059
         Cow's milk sensitisation0.49 (0.29–0.95)0.17
         Peanut sensitisation1.45 (0.25–8.33)0.83
         Polysensitisation1.44 (0.60–3.49)0.68
        Salivary morning cortisol1.01 (1.0–1.0)0.56

        The zero-truncated negative binomial regression analysis are adjusted for sex, age at inclusion and parental atopy. RSV: respiratory syncytial virus; HRV: human rhinovirus.#: specific immunoglobulin E ≥0.35 kU·L−1.

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        Virus, allergic sensitisation and cortisol in infant bronchiolitis and risk of early asthma
        Jon Olav Gjengstø Hunderi, Leif Bjarte Rolfsjord, Karin C. Lødrup Carlsen, René Holst, Egil Bakkeheim, Teresa Løvold Berents, Kai-Håkon Carlsen, Håvard Ove Skjerven
        ERJ Open Research Jan 2020, 6 (1) 00268-2019; DOI: 10.1183/23120541.00268-2019

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        Virus, allergic sensitisation and cortisol in infant bronchiolitis and risk of early asthma
        Jon Olav Gjengstø Hunderi, Leif Bjarte Rolfsjord, Karin C. Lødrup Carlsen, René Holst, Egil Bakkeheim, Teresa Løvold Berents, Kai-Håkon Carlsen, Håvard Ove Skjerven
        ERJ Open Research Jan 2020, 6 (1) 00268-2019; DOI: 10.1183/23120541.00268-2019
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