Relationships between lung function, allergy, and wheezing in urban children - 24/04/24

Doi : 10.1016/j.jaci.2024.02.025

Aya Konno-Yamamoto, MD ^a,^⁎ , Vinay Goswamy, MD ^a, Agustin Calatroni, MS ^b, Peter J. Gergen, MD ^c, Molly Johnson, MS ^b, Ronald L. Sorkness, PhD ^d, Leonard B. Bacharier, MD ^e, George T. O’Connor, MD ^f, Meyer Kattan, MD ^g, Robert A. Wood, MD ^h, Lisa Gagalis, RN, BSN ^c, Cynthia M. Visness, PhD ^b, James E. Gern, MD ^a
for the
Childhood Asthma in Urban Settings Program
^a Department of Pediatrics, University of Wisconsin-Madison, Madison, Wis
^b Rho Federal Research Operations, Durham, NC
^c National Institute of Allergy and Infectious Diseases, Rockville, Md
^d Department of Medicine, University of Wisconsin-Madison, Madison, Wis
^e Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tenn
^f Department of Medicine, Boston University School of Medicine, Boston, Mass
^g Department of Pediatrics, Columbia University, New York, NY
^h Division of Pediatric Allergy, Immunology, and Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Md

^∗Corresponding author: Aya Konno-Yamamoto, MD, Department of Pediatrics, University of Wisconsin-Madison, 600 Highland Ave, Madison, WI 53792.Department of PediatricsUniversity of Wisconsin-Madison600 Highland AveMadisonWI53792

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Abstract

Background

Allergic sensitization and low lung function in early childhood are risk factors for subsequent wheezing and asthma. However, it is unclear how allergic sensitization affects lung function over time.

Objective

We sought to test whether allergy influences lung function and whether these factors synergistically increase the risk of continued wheezing in childhood.

Methods

We analyzed longitudinal measurements of lung function (spirometry and impulse oscillometry) and allergic sensitization (aeroallergen skin tests and serum allergen-specific IgE) throughout early childhood in the Urban Environmental and Childhood Asthma study, which included high-risk urban children living in disadvantaged neighborhoods. Intraclass correlation coefficients were calculated to assess lung function stability. Cluster analysis identified low, medium, and high allergy trajectories, which were compared with lung function and wheezing episodes in linear regression models. A variable selection model assessed predictors at age 5 years for continued wheezing through age 12 years.

Results

Lung function adjusted for growth was stable (intraclass correlation coefficient, 0.5-0.7) from age 5 to 12 years and unrelated to allergy trajectory. Lung function and allergic sensitization were associated with wheezing episodes in an additive fashion. In children with asthma, measuring lung function at age 5 years added little to the medical history for predicting future wheezing episodes through age 12 years.

Conclusions

In high-risk urban children, age-related trajectories of allergic sensitization were not associated with lung function development; however, both indicators were related to continued wheezing. These results underscore the importance of understanding early-life factors that negatively affect lung development and suggest that treating allergic sensitization may not alter lung function development in early to mid-childhood.

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Key words : Childhood asthma, lung function, allergic sensitization, impulse oscillometry, spirometry

Abbreviations used : ATS, AX, ERS, FVC, ICC, IOS, sIgE, TLC, URECA