Clinical predictors of wheeze trajectories and associations with allergy in Asian children

• Main Authors: Lau, Hui Xing, Chen, Zhaojin, Van Bever, Hugo, Tham, Elizabeth Huiwen, Chan, Yiong Huak, Yap, Qai Ven, Goh, Anne Eng Neo, Teoh, Oon Hoe, Tan, Kok Hian, Yap, Fabian Kok Peng, Godfrey, Keith M., Eriksson, Johan G., Chong, Yap Seng, Lee, Bee Wah, Shek, Lynette Pei-Chi, Loo, Evelyn Xiu Ling
• Other Authors: Lee Kong Chian School of Medicine (LKCMedicine)
• Format: Article
• Language: English
• Published: 2024
• Subjects: Medicine, Health and Life Sciences; Abnormal respiratory sound; Asthma
• Online Access: https://hdl.handle.net/10356/174330
• Institution: Nanyang Technological University

Background: Childhood wheezing is a highly heterogeneous condition with an incomplete understanding of the characteristics of wheeze trajectories, particularly for persistent wheeze. Objective: To characterize predictors and allergic comorbidities of distinct wheeze trajectories in a multiethnic Asian cohort. Methods: A total of 974 mother-child pairs from the prospective Growing Up in Singapore Towards healthy Outcomes (GUSTO) cohort were included in this study. Wheeze and allergic comorbidities in the first 8 years of life were assessed using the modified International Study of Asthma and Allergies in Childhood questionnaires and skin prick tests. Group-based trajectory modeling was used to derive wheeze trajectories and regression was used to assess associations with predictive risk factors and allergic comorbidities. Results: There were 4 wheeze trajectories derived, including the following: (1) early-onset with rapid remission from age 3 years (4.5%); (2) late-onset peaking at age 3 years and rapidly remitting from 4 years (8.1%); (3) persistent with a steady increase to age 5 years and high wheeze occurrence until 8 years (4.0%); and (4) no or low wheeze (83.4%). Early-onset wheezing was associated with respiratory infections during infancy and linked to subsequent nonallergic rhinitis throughout childhood. Late-onset and persistent wheeze shared similar origins characterized by parent-reported viral infections in later childhood. However, persistent wheezing was generally more strongly associated with a family history of allergy, parent-reported viral infections in later childhood, and allergic comorbidities as compared with late-onset wheezing. Conclusion: The timing of viral infection occurrence may determine the type of wheeze trajectory development in children. Children with a family history of allergy and viral infections in early life may be predisposed to persistent wheeze development and the associated comorbidities of early allergic sensitization and eczema.