In the JournalsPerspective

Infants with rhinovirus C at risk for recurrent wheeze

Infants with bronchiolitis caused by rhinovirus C were more likely to develop recurrent wheeze by age 3 years compared with infants who had bronchiolitis caused by other viruses, according to findings published in JAMA Pediatrics.

“Rhinovirus is the second most common pathogen following respiratory syncytial virus, and it contributes to 20% to 40% of severe bronchiolitis,” Kohei Hasegawa, MD, MPH, an attending physician at Massachusetts General Hospital and an associate professor of emergency medicine at Harvard Medical School, and colleagues wrote. “Epidemiological studies have reported that rhinovirus infection in early life, particularly with allergic sensitization, is associated with a higher risk of developing recurrent wheeze and childhood asthma.”

Hasegawa and colleagues included 716 infants aged younger than 1 year in their multicenter prospective cohort study. The infants were hospitalized for either RSV-only bronchiolitis or rhinovirus bronchiolitis in 17 hospitals in 14 states during the fall and winter seasons between 2011 and 2014. The researchers assessed the relationship between RSV infection or rhinovirus A, B, and C infection and the development of recurrent wheeze at age 3 years.

Bronchiolitis was most often caused by RSV only (76%; n = 541), followed by rhinovirus A (12%; n = 85), rhinovirus C (11%; n = 78) and rhinovirus B (2%; n = 12).

Recurrent wheeze was diagnosed in 32% of the children by age 3 years. The risk for developing recurrent wheeze was similar among infants with RSV-only infection compared with those infected with rhinovirus A (HR = 1.27; 95% CI, 0.86-1.88) or rhinovirus B (HR = 1.39; 95% CI, 0.51-3.77). However, Hasegawa and colleagues observed a significantly higher risk for recurrent wheeze in children who were infected with rhinovirus C (HR = 1.58; 95% CI, 1.08-2.32).

In addition, the researchers found a correlation between rhinovirus C infection and immunoglobulin E (IgE) sensitization in relation to the future development of recurrent wheeze (P < .01). For example, the only infants with significantly higher risk for recurrent wheeze were those who were infected with rhinovirus C and who had IgE sensitization to food or aeroallergens during infancy (HR = 3.03; 95% CI, 1.20-7.61). These infants were also at increased risk for developing recurrent wheeze and asthma at age 4 years (HR = 4.06; 95% CI, 1.17-14.1) compared with infants infected with RSV only.

“Our data facilitate further investigations into the mechanisms underlying the association between distinct respiratory viruses, host immunity and respiratory health in children,” the researchers wrote. “Furthermore, the study identifies infants at higher risk for developing recurrent wheeze and asthma and informs strategies to develop targeted preventive therapies.” – by Katherine Bortz

Disclosures: Hasegawa reports receiving grants from the NIH, Novartis and Teva. Please see the study for a list of all other authors’ relevant financial disclosures.

Infants with bronchiolitis caused by rhinovirus C were more likely to develop recurrent wheeze by age 3 years compared with infants who had bronchiolitis caused by other viruses, according to findings published in JAMA Pediatrics.

“Rhinovirus is the second most common pathogen following respiratory syncytial virus, and it contributes to 20% to 40% of severe bronchiolitis,” Kohei Hasegawa, MD, MPH, an attending physician at Massachusetts General Hospital and an associate professor of emergency medicine at Harvard Medical School, and colleagues wrote. “Epidemiological studies have reported that rhinovirus infection in early life, particularly with allergic sensitization, is associated with a higher risk of developing recurrent wheeze and childhood asthma.”

Hasegawa and colleagues included 716 infants aged younger than 1 year in their multicenter prospective cohort study. The infants were hospitalized for either RSV-only bronchiolitis or rhinovirus bronchiolitis in 17 hospitals in 14 states during the fall and winter seasons between 2011 and 2014. The researchers assessed the relationship between RSV infection or rhinovirus A, B, and C infection and the development of recurrent wheeze at age 3 years.

Bronchiolitis was most often caused by RSV only (76%; n = 541), followed by rhinovirus A (12%; n = 85), rhinovirus C (11%; n = 78) and rhinovirus B (2%; n = 12).

Recurrent wheeze was diagnosed in 32% of the children by age 3 years. The risk for developing recurrent wheeze was similar among infants with RSV-only infection compared with those infected with rhinovirus A (HR = 1.27; 95% CI, 0.86-1.88) or rhinovirus B (HR = 1.39; 95% CI, 0.51-3.77). However, Hasegawa and colleagues observed a significantly higher risk for recurrent wheeze in children who were infected with rhinovirus C (HR = 1.58; 95% CI, 1.08-2.32).

In addition, the researchers found a correlation between rhinovirus C infection and immunoglobulin E (IgE) sensitization in relation to the future development of recurrent wheeze (P < .01). For example, the only infants with significantly higher risk for recurrent wheeze were those who were infected with rhinovirus C and who had IgE sensitization to food or aeroallergens during infancy (HR = 3.03; 95% CI, 1.20-7.61). These infants were also at increased risk for developing recurrent wheeze and asthma at age 4 years (HR = 4.06; 95% CI, 1.17-14.1) compared with infants infected with RSV only.

“Our data facilitate further investigations into the mechanisms underlying the association between distinct respiratory viruses, host immunity and respiratory health in children,” the researchers wrote. “Furthermore, the study identifies infants at higher risk for developing recurrent wheeze and asthma and informs strategies to develop targeted preventive therapies.” – by Katherine Bortz

Disclosures: Hasegawa reports receiving grants from the NIH, Novartis and Teva. Please see the study for a list of all other authors’ relevant financial disclosures.

    Perspective
    Christian Rosas-Salazar

    Christian Rosas-Salazar

    In a large, multicenter, prospective cohort, Hasegawa and colleagues assessed the effect of lower respiratory tract infections (LRTIs) resulting from common respiratory viruses on the development of recurrent wheeze in early childhood. The authors found no association of LRTIs caused by rhinovirus A or B with recurrent wheeze. However, when compared with infants with LRTIs caused by RSV, infants with LRTIs caused by rhinovirus C had a higher risk for recurrent wheeze. This increased risk for recurrent wheeze was particularly strong in children who had both LRTIs due to rhinovirus C and evidence of allergic sensitization.

    These results add to the literature examining the importance of respiratory viruses on the inception of childhood wheezing illnesses. Furthermore, the results could help identify children at high risk for developing childhood asthma phenotypes and who may benefit from education strategies, close follow-up or other preventive interventions.

    • Christian Rosas-Salazar, MD, MPH
    • Assistant professor of pediatrics
      Vanderbilt University School of Medicine

    Disclosures: Rosas-Salazar reports no relevant financial disclosures.