Does development of asthma with allergic comorbidities start before birth?

Published Online: July 8, 2014

Childhood asthma is frequently preceded by reduced lung function even from birth, and often co-exists with other allergic diseases such as allergic rhinitis and atopic dermatitis. In this study recently published in The Journal of Allergy and Clinical Immunology, Carlsen and colleauges asked if lung function trajectories through childhood would differ with respect to asthma only, or to asthma with the comorbidities allergic rhinitis and atopic dermatitis.

Established in 1992, the Oslo-based prospective birth cohort study “Environment and Childhood Asthma” measured lung function (given as z-scores) at birth by tidal breathing lung function parameters. Among those with infant lung function measurements, 329 subjects of the study were then looked at again at 10 and 16 years of age. These investigations included spirometry. Asthma phenotypes were classified based on repeated wheezy episodes in the first two years of life, and asthma from the 2-10 and the 10-16 years intervals, and by combining asthma, atopic dermatitis and/or allergic rhinitis from 10-16 years. The potential effect of allergic sensitization on lung function trajectories was also investigated by stratifying for the presence of allergic sensitization at 16 years of age. The reference group included 231 subjects who never had asthma or wheezy episodes.

In line with other studies, adolescents with asthma were found to have reduced lung function throughout childhood compared to healthy children. However, compared to all other groups with or without asthma, adolescents who had asthma as well as allergic rhinitis and atopic dermatitis had significantly reduced lung function throughout childhood, beginning at birth. In contrast to previous suggestions, being sensitized to at least one allergen did not appear to influence the lung trajectories.

Based on their results, the authors speculate that reduced lung function observed at birth may be a marker of disease initiation during uterine life in a subset of patients with asthma combined with allergic rhinitis and atopic dermatitis.

The Journal of Allergy and Clinical Immunology (JACI) is an official scientific journal of the AAAAI, and is the most-cited journal in the field of allergy and clinical immunology.

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