RISK FACTORS FOR ACUTE WHEEZING IN INFANTS AND CHILDREN: VIRUSES, PASSIVE SMOKE, AND IMMUNOGLOBULIN E (IgE) IgE ANTIBODIES TO INHALANT ALLERGENS

Abstract

Study Population. Ninety-nine children from age 2 months to 16 years who presented to the Pediatric Emergency Room of the University of Virginia and received treatment for acute wheezing, were enrolled in this study. Fifty-seven control patients were enrolled from the same setting who did not previously or currently manifest wheezing/respiratory symptoms.

Method. Serum for immunoglobulin E (IgE) and radioallergosorbent test (RAST) IgE for D. Pteronyssinus/Farinae, cat epithelium, short ragweed, rye grass, and mixed Cockroach was collected. Nasal saline washes were obtained for respiratory syncytial virus (RSV) antigen detection and respiratory viral cultures. Nasal smears for eosinopils were obtained as well as saliva samples for the nicotine metabolite, cotinine.

Results. IgE RAST testing identified an increasing number of study patients with IgE specific antibodies. Nasal smears revealed similar but not identical findings. Patients over 2 years of age demonstrated a family history of atopy, IgE levels, and positive RAST significantly greater than control (P < .001). Viral infections were more common in younger children <2 years of age (positive in 90% vs 50% in the >2 years 0.05). RSV isolates were greatest in children <2 years old. Seventy five percent of patients compared with 58% of controls had one or more smokers at home. Children <2 were more likely to have an elevated salivary cotinine level than children >2 years old, despite the presence of smokers in the home. Combination risk factors found 66% of patients with two or more risk factors as compared with only 28% of controls (P < .001).