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Severe Respiratory Syncytial Virus Bronchiolitis in Infancy and Asthma and Allergy at Age 13

Department of Pediatrics, Borås Central Hospital, Borås; Queen Silvia Children's Hospital, Göteborg; Department of Pediatrics, Skövde Central Hospital, Skövde, Sweden; and Landspitali University Hospital, Reykjavik, Iceland

Correspondence and requests for reprints should be addressed to Dr. Nele Sigurs, M.D., Ph.D., Department of Pediatrics, Borås Central Hospital, S-50182 Borås, Sweden. E-mail: nele.sigurs{at}telia.com

We have prospectively studied wheezing disorder and allergy in 47 children hospitalized with respiratory syncytial virus (RSV) bronchiolitis in infancy and 93 matched control subjects. Subjects with at least three episodes of wheezing were defined as recurrent wheezers and as having asthma if the episodes were doctor verified. Here we report the outcome at age 13 years in 46/47 children with RSV and 92/93 control subjects. Wheezing disorder and clinical allergy were estimated using a questionnaire. Skin prick tests were performed and serum IgE antibodies measured. Spirometry was undertaken at rest, after dry air challenge, and after ß₂-agonist inhalation. The occurrence of symptoms over the previous 12 months was significantly higher in the RSV group than among the control subjects, 43% versus 8% for asthma/recurrent wheezing and 39% versus 15% for allergic rhinoconjunctivitis. Sensitization to common inhaled allergens was more frequent in the RSV group than in the control subjects, judged by skin prick tests (50% versus 28%; p = 0.022), or by serum IgE antibodies (45% versus 26%; p = 0.038). Compared with the control subjects, the RSV group showed mild airway obstruction both at rest and after bronchodilation, and had slightly more reactive airways. RSV bronchiolitis in infancy severe enough to cause hospitalization is a risk factor for allergic asthma in early adolescence.

Key Words: airway obstruction • atopic hypersensitivity • children • respiratory syncytial virus

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