Published ahead of print on January 29, 2009, doi:10.1164/rccm.200808-1361OC Am. J. Respir. Crit. Care Med., Volume 179, Number 9, May 2009, 765-771 A more recent version of this article appeared on May 1, 2009
Submitted on August 28, 2008 Serum Vitamin D Levels and Markers of Severity of Childhood Asthma in Costa RicaJohn M Brehm1,1 Channing Laboratory and the Division of Pulmonary/Critical Care Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States; , Harvard Medical School, Boston, Massachusetts, United States, 2 Channing Laboratory, Division of Pulmonary/Critical Care Medicine, and Center for Genomic Medicine, Brigham and Women, Boston, Massachusetts, United States; Medicine, Harvard Medical School, Boston, Massachusetts, United States, 3 Division of Pediatric Pulmonology, Hospital Nacional de Niños, San Jose, Costa Rica, 4 Channing Laboratory and Division of Pulmonary/Critical Care Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States; Medicine, Harvard Medical School, Boston, Massachusetts, United States, 5 Channing Laboratory and Division of Pulmonary/Critical Care Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States; Medicine, Harvard Medical School, Boston, Massachusetts, United States; Children's Hospital, Division of Pediatric Pulmonology, Boston, Massachusetts, United States, 6 Channing Laboratory, Brigham and Women's Hospital, Boston, Massachusetts, United States, 7 Darby Children's Research Institute, Medical University of South Carolina, Charleston, South Carolina, United States, 8 Channing Laboratory, Brigham and Women, Boston, Massachusetts, United States; Medicine, Harvard Medical School, Boston, Massachusetts, United States * To whom correspondence should be addressed. E-mail: juan.celedon{at}channing.harvard.edu.
Rationale: Maternal vitamin D intake during pregnancy has been inversely associated with asthma symptoms in early childhood. However, no study has examined the relationship between measured vitamin D levels and markers of asthma severity in childhood.
Objectives: To determine the relationship between measured vitamin D levels and both markers of asthma severity and allergy in childhood.
Methods: We examined the relation between 25-hydroxyvitamin D levels (the major circulating form of vitamin D) and markers of allergy and asthma severity in a cross-sectional study of 616 Costa Rican children between the ages of 6 and 14 years. Linear, logistic, and negative binomial regressions were used for the univariate and multivariate analyses.
Measurements and Main Results: Of the 616 asthmatic children, 175 (28%) had insufficient levels of vitamin D ( Key words: Vitamin D • asthma severity • allergy
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30 ng/mL). In multivariate linear regression models, vitamin D levels were significantly and inversely associated with total IgE and eosinophil count. In multivariate logistic regression models, a log10-unit increase in vitamin D levels was associated with reduced odds of: any hospitalization in the previous year (odds ratio [OR]=0.05, 95% confidence interval [CI]=0.004-0.71, P=0.03), any use of anti-inflammatory medications in the previous year (OR=0.18, 95% CI=0.05-0.67, P=0.01), and increased airway responsiveness (a PD20 
8.58 µmol of methacholine ([OR=0.15, 95% CI = 0.024-0.97, p = 0.05]).
Conclusion: Our results suggest that vitamin D insufficiency is relatively frequent in an equatorial population of asthmatic children. In these children, lower vitamin D levels are associated with increased markers of allergy and asthma severity.
