Infant Viral Respiratory Infection Nasal Immune-Response Patterns and Their Association With Subsequent Childhood Recurrent Wheeze

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The development of childhood recurrent wheeze and asthma are thought to result from changes in early immune system development after respiratory syncytial virus (RSV) infection. The purpose of this study was to identify nasal immune phenotypes in response to RSV infection and their association with recurrent wheeze.Investigators analyzed respiratory samples obtained as part of Infant Susceptibility to Pulmonary Infections and Asthma Following RSV Exposure, a birth cohort of term, healthy infants who were managed during the first 2 years of life to capture their first RSV or human rhinovirus (HRV) infection (n = 193).Healthy, term infants born from June to December were managed biweekly during the winter viral season to capture their first infant RSV (or HRV) infection. Nasal wash samples were collected during acute respiratory infection, and viruses were profiled using reverse transcription polymerase chain reaction. Immune response analytes were assayed by using a 53 multianalyte panel. Association between immune response phenotypes and recurrent wheeze at age 1 and 2 years was assessed by using logistic regression.Authors found that in infants with RSV infection, a nasal immune response characterized by lower interferon antiviral immune response mediators and higher type 2 and type 17 cytokines were independently associated with increased risk of recurrent wheeze in the first 2 years of life. In comparison, infants with HRV did not demonstrate this. On the basis of several analytical approaches, researchers found that type 2 and type 17 cytokines were central to immune responses to RSV, whereas growth factors and chemokines were central to the immune response to HRV.The immune response phenotypes to infant RSV infection identified in this study provide insight into the mechanisms and risk factors of developing recurrent wheeze and asthma later on in life.This study highlights the need to improve our understanding of the immune response in infant RSV infection and its association with long-term sequelae. Identifying specific immune response phenotypes in infant RSV infection and their association with risk of recurrent wheeze provides us with foundational insight to build on. Larger studies are needed to help validate the findings of this study. The use of detailed immunologic analyses in RSV infection can impact future development of prophylactic and therapeutic interventions for RSV, leading toward the ultimate goal of reducing the significant acute and long-term morbidity that is associated with this infection in children.