Evaluation of airway reactivity and immune characteristics as risk factors for wheezing early in life

• Published in: Journal of allergy and clinical immunology Vol. 126; no. 3; pp. 483 - 488.e1
• Main Authors: Yao, Weiguo, PhD, Barbé-Tuana, Florencia M., PhD, Llapur, Conrado J., MD, Jones, Marcus H., MD, PhD, Tiller, Christina, RRT, Kimmel, Risa, RN, Kisling, Jeffrey, RRT, Nguyen, Evelyn T., MS, Nguyen, James, MS, Yu, Zhangsheng, PhD, Kaplan, Mark H., PhD, Tepper, Robert S., MD, PhD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-09-2010; Elsevier; Elsevier Limited
• Subjects: Age of Onset; airway reactivity; Allergic diseases; Allergies; Allergy and Immunology; Asthma; Asthma - epidemiology; Asthma - immunology; Asthma - physiopathology; atopy; Biological and medical sciences; Chronic obstructive pulmonary disease, asthma; Cytokines; Cytokines - immunology; dendritic cells; Dendritic Cells - cytology; Dendritic Cells - immunology; dermatitis; Digestive allergic diseases; Female; Follow-Up Studies; food allergy; Food Hypersensitivity - immunology; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Humans; Immune system; Immunoglobulin E - blood; Immunopathology; Infant; Infants; Leukocytes, Mononuclear - immunology; Male; Medical sciences; Pneumology; Respiratory Function Tests; Respiratory Sounds - immunology; Risk Factors; Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis; T cell receptors; wheezing; cDC; Conventional dendritic cell; PMA; atopy; Infants; wheezing; PC 30; food allergy; pDC; Plasmacytoid dendritic cell; airway reactivity; dermatitis; dendritic cells; Provocative concentration of methacholine to reduce forced expiratory flow at 75% expired volume by 30; cytokines; Phorbol 12-myristate 13-acetate; PC30; Human; Food allergy; Dendritic cell; Immunopathology; Skin disease; Cytokine; Infant; Wheezing; Respiratory system; Dermatitis; Epidemiology; Atopy; Respiratory tract; Immunology; Reactivity; Antigen presenting cell; Risk factor; Digestive diseases; Early
• ISSN: 0091-6749; 1097-6825
• DOI: 10.1016/j.jaci.2010.06.028

Background Childhood asthma is most often characterized by recurrent wheezing, airway hyperreactivity, and atopy; however, our understanding of these relationships from early in life remains unclear. Respiratory tract illnesses and atopic sensitization early in life might produce an interaction between innate and acquired immune responses, leading to airway inflammation and heightened airway reactivity. Objective We hypothesized that premorbid airway reactivity and immunologic characteristics of infants without prior episodes of wheezing would be associated with subsequent wheezing during a 1-year follow-up. Methods One hundred sixteen infants with chronic dermatitis were enrolled before episodes of wheezing. Airway reactivity, allergen-specific IgE levels, cytokine production by stimulated PBMCs, and percentages of dendritic cells were measured on entry, and airway reactivity was reassessed at the 1-year follow-up. Linear regression models were used to evaluate a predictor's effect on continuous outcomes. Results Milk sensitization, egg sensitization, or both were associated with heightened airway reactivity before wheezing and after the onset of wheezing; however, these factors were not associated with an increased risk of wheezing. There was an interaction between initial airway reactivity and wheezing as a determinant of airway reactivity at follow-up. In addition, cytokine production by stimulated PBMCs was a risk factor for wheezing, whereas increased percentages of conventional dendritic cells were protective against wheezing. Conclusion Our data in a selected cohort of infants support a model with multiple risk factors for subsequent wheezing that are independent of initial airway reactivity; however, the causative factors that produce wheezing very early in life might contribute to heightened airway reactivity.