Abstract
Asthma is a leading cause of morbidity and mortality among children worldwide, as is respiratory syncytial virus (RSV). This report reviews controlled retrospective and prospective studies conducted to investigate whether there is an association between RSV bronchiolitis in infancy and subsequent development of reactive airway disease or allergic sensitization. Findings indicate that such a link to bronchial obstructive symptoms does exist and is strongest for children who experienced severe RSV illness that requires hospitalization. However, it is not yet clear what roles genetic predisposition and environmental or other risk factors may play in the interaction between RSV bronchiolitis and reactive airway disease or allergic sensitization. Randomized, prospective studies utilizing an intervention against RSV, such as a passive immunoprophylactic agent, may determine whether preventing RSV bronchiolitis reduces the incidence of asthma.
Highlights
Childhood asthma is a serious global public health problem
The results of available retrospective and prospective studies (Table 1) of children with mild to moderate or severe respiratory syncytial virus (RSV) Lower respiratory tract infection (LRTI) show that RSV infection in infancy is associated with an increased risk for bronchial obstructive symptoms many years after the infection and that lung function may be affected for several years
According to available studies, it appears certain that a family history of atopy and/or asthma does not explain the reactive airway disease (RAD) symptoms that occur following RSV LRTI
Summary
Childhood asthma is a serious global public health problem. According to the World Health Organization [1], asthma is the most common chronic disease in children. The studies evaluated indicators of allergic sensitization to common inhaled allergens, skin prick tests (SPT), and/or serum IgE antibodies It is currently unclear what the relationship between RSV bronchiolitis and allergy may be in children who had been hospitalized for their infections. Allergic sensitization was significantly higher (P = 0.028) in the RSV group, with 18 out of 44 index cases (41%) versus 19 out of 86 control children (22%) having positive skin prick and serum IgE tests [14]. Airway responsiveness to inhaled histamine at a young age was correlated to asthma, poorer performance on spirometry testing, and lower respiratory tract symptoms in later childhood [25] Those investigators argued that some genetic or environment factors (e.g. in utero exposure to maternal smoking) might have caused the initial predisposition to RAD, and that viral infections and other environmental insults may have inflicted further damage. RSV bronchiolitis was found to be the most significant risk factor for RAD (odds ratio 12.7; P < 0.001)
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