Evidence for a causal relationship between allergic sensitization and rhinovirus wheezing in early life

Daniel J. Jackson, Michael D. Evans, Ronald E. Gangnon, Christopher J. Tisler, Tressa E. Pappas, Wai Ming Lee, James E. Gern, Robert F. Lemanske

Research output: Contribution to journalArticlepeer-review

274 Scopus citations


Rationale: Aeroallergen sensitization and virus-induced wheezing are risk factors for asthma development during early childhood, but the temporal developmental sequence between them is incompletely understood. Objective: To define the developmental relationship between aeroallergen sensitization and virus-induced wheezing. Methods: A total of 285 children at high risk for allergic disease and asthma were followed prospectively from birth. The timing and etiology of viral respiratory wheezing illnesses were determined, and aeroallergen sensitization was assessed annually for the first 6 years of life. The relationships between these events were assessed using a longitudinal multistate Markov model. Measurements and Main Results: Children who were sensitized to aeroallergens had greater risk of developing viral wheeze than nonsensitized children (hazard ratio [HR], 1.9; 95% confidence interval [CI], 1.2-3.1). Allergic sensitization led to an increased risk of wheezing illnesses caused by human rhinovirus (HRV) but not respiratory syncytial virus. The absolute risk of sensitized children developing viral wheeze was greatest at 1 year of age; however, the relative risk was consistently increased at every age assessed. In contrast, viral wheeze did not lead to increased risk of subsequent allergic sensitization (HR, 0.76; 95% CI, 0.50-1.1). Conclusions: Prospective, repeated characterization of a birth cohort demonstrated that allergic sensitization precedes HRV wheezing and that the converse is not true. This sequential relationship and the plausiblemechanisms bywhich allergic sensitization can lead tomore severe HRV-induced lower respiratory illnesses support a causal role for allergic sensitization in this developmental pathway. Therefore, therapeutics aimed at preventing allergic sensitization may modify virus-induced wheezing and the development of asthma.

Original languageEnglish (US)
Pages (from-to)281-285
Number of pages5
JournalAmerican journal of respiratory and critical care medicine
Issue number3
StatePublished - Feb 1 2012
Externally publishedYes


  • Allergic sensitization
  • Human rhinovirus
  • RSV
  • Virus
  • Wheezing


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