Clinical predictors of wheeze trajectories and associations with allergy in Asian children.
Clinical predictors of wheeze trajectories and associations with allergy in Asian children.
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.
466-473.e6
Lau, Hui Xing
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Chen, Zhaojin
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Van Bever, Hugo
62a49213-7207-41ac-98aa-efe4b351dcb5
Tham, Elizabeth Huiwen
e22014ec-8242-478a-aafc-e4177164f814
Chan, Yiong Huak
3e6bb630-bddc-4713-8a9f-3d90c6dfe712
Yap, Qai Ven
ccb659a8-9154-46cd-8c86-57f3de54ff6e
Goh, Anne Eng Neo
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Teoh, Oon Hoe
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Tan, Kok Hian
4714c94d-334a-42ad-b879-f3aa3a931def
Yap, Fabian
22f6b954-31fc-4696-a52b-e985a424b95b
Godfrey, Keith
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Eriksson, Johan G.
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Chong, Yap-Seng
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Lee, Bee Wah
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Shek, Lynette P.
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Loo, Evelyn Xiu-Ling
229ed4b9-220f-4d95-a384-eb6529f6d2d6
October 2023
Lau, Hui Xing
31f26ca2-82af-47d4-9077-84a4ebc19ba8
Chen, Zhaojin
af67cf8d-1a74-4066-8603-4345a6efbb66
Van Bever, Hugo
62a49213-7207-41ac-98aa-efe4b351dcb5
Tham, Elizabeth Huiwen
e22014ec-8242-478a-aafc-e4177164f814
Chan, Yiong Huak
3e6bb630-bddc-4713-8a9f-3d90c6dfe712
Yap, Qai Ven
ccb659a8-9154-46cd-8c86-57f3de54ff6e
Goh, Anne Eng Neo
9d869111-5368-420f-97dc-336f052bef41
Teoh, Oon Hoe
b6523ca5-10fa-4b0d-b191-92d4162ea6c6
Tan, Kok Hian
4714c94d-334a-42ad-b879-f3aa3a931def
Yap, Fabian
22f6b954-31fc-4696-a52b-e985a424b95b
Godfrey, Keith
0931701e-fe2c-44b5-8f0d-ec5c7477a6fd
Eriksson, Johan G.
eb96b1c5-af07-4a52-8a73-7541451d32cd
Chong, Yap-Seng
7043124b-e892-4d4b-8bb7-6d35ed94e136
Lee, Bee Wah
81ec0089-b824-4835-b908-1fc8e9f62249
Shek, Lynette P.
9a77403c-0e0c-4536-a5ad-628ce94b279a
Loo, Evelyn Xiu-Ling
229ed4b9-220f-4d95-a384-eb6529f6d2d6
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, Godfrey, Keith, Eriksson, Johan G., Chong, Yap-Seng, Lee, Bee Wah, Shek, Lynette P. and Loo, Evelyn Xiu-Ling
(2023)
Clinical predictors of wheeze trajectories and associations with allergy in Asian children.
Annals of Allergy, Asthma and Immunology, 131 (4), .
(doi:10.1016/j.anai.2023.06.024).
Abstract
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.
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Accepted/In Press date: 27 June 2023
e-pub ahead of print date: 5 July 2023
Published date: October 2023
Additional Information:
Funding Information:
The authors thank the Growing Up in Singapore Towards healthy Outcomes (GUSTO) study group including Allan Sheppard, PhD; Amutha Chinnadurai, MRCPCH; Anne Eng Neo Goh, MBBS; Anne Rifkin-Graboi, PhD; Anqi Qiu, PhD; Arijit Biswas, MD; Bee Wah Lee, MD; Birit Froukje Philipp Broekman, PhD; Boon Long Quah, FAMS; Chai Kiat Chng, MBBS; Cheryl Shufen Ngo, MS; Choon Looi Bong, FRCA; Christiani Jeyakumar Henry, PhD; Daniel Yam Thiam Goh, PhD; Doris Ngiuk Lan Loh, FILCA; Fabian Kok Peng Yap, FRCPCH; George Seow Heong Yeo, FRCOG; Helen Yu Chen, MBBS; Hugo P.S. van Bever, PhD; Iliana Magiati, PhD; Inez Bik Yun Wong, MBBS; Ivy Yee-Man Lau, PhD; Jeevesh Kapur, FRCR; Jenny L. Richmond, PhD; Jerry Kok Yen Chan, PhD; Joanna Dawn Holbrook, PhD; Joshua J. Gooley, PhD; Keith M. Godfrey, PhD; Kenneth Yung Chiang Kwek, MD; Kok Hian Tan, MBBS; Krishnamoorthy Naiduvaje, FAMS; Leher Singh, PhD; Lin Lin Su, MBBS; Lourdes Mary Daniel, MMed; Lynette Pei-Chi Shek, MBBS; Marielle V. Fortier, FRCP; Mark Hanson, FRCPCH; Mary Foong-Fong Chong, PhD; Mary Rauff, FRCOG; Mei Chien Chua, MBBS; Michael J. Meaney, PhD; Mya Thway Tint, PhD; Neerja Karnani, PhD; Ngee Lek, FRCPCH; Oon Hoe Teoh, MBBS; P.C. Wong, FAMS; Peter David Gluckman, DSc; Pratibha Keshav Agarwal, MMed; Rob Martinus van Dam, PhD: Salome A. Rebello, PhD; Seang Mei Saw, PhD; Shang Chee Chong, MBBS; Shirong Cai, PhD; Shu-E. Soh, PhD; Sok Bee Lim, PhD; Stephen Chin-Ying Hsu, PhD; Victor Samuel Rajadurai, MBBS; Walter Stunkel, PhD; Wee Meng Han, PhD; Wei Wei Pang, PhD; Yap Seng Chong, MD; Yin Bun Cheung, PhD; Yiong Huak Chan, PhD; and Yung Seng Lee, PhD. The authors also thank all clinical and home-visit staff involved and the patients for their voluntary participation in this study. Dr Chong and Mr Godfrey reports receiving reimbursement for speaking at conferences and are part of an academic consortium that has received research funding from Abbott Nutrition, Nestle, and Danone. The remaining authors have no conflicts of interest to report. This research is supported by the Singapore National Research Foundation under the Translational and Clinical Research (TCR) Flagship Programme and administered by the Singapore Ministry of Health's National Medical Research Council (NMRC), Singapore (NMRC/TCR/004-NUS/2008; NMRC/TCR/012-NUHS/2014). Dr Tham is supported by the National Medical Research Council (NMRC) Transition Award grant (MOH-TA18nov-003) from NMRC, Singapore. Mr Godfrey is supported by the UK Medical Research Council (MC_UU_12011/4), the National Institute for Health Research (NIHR) (Senior Investigator [NF-SI-0515-10042] and NIHR Southampton Biomedical Research Centre [IS-BRC-1215-20004]), the European Union (Erasmus+ Programme ImpENSA 598488-EPP-1-2018-1-DE-EPPKA2-CBHE-JP), and the British Heart Foundation (RG/15/17/3174, SP/F/21/150013). Additional funding is provided by the Singapore Institute for Clinical Sciences, Agency for Science Technology and Research (A*STAR), Singapore. Supplementary data related to this article can be found at https://doi.org/10.1016/j.anai.2023.06.024.
Funding Information:
Funding: This research is supported by the Singapore National Research Foundation under the Translational and Clinical Research (TCR) Flagship Programme and administered by the Singapore Ministry of Health's National Medical Research Council (NMRC), Singapore (NMRC/TCR/004-NUS/2008; NMRC/TCR/012-NUHS/2014). Dr Tham is supported by the National Medical Research Council (NMRC) Transition Award grant (MOH-TA18nov-003) from NMRC, Singapore. Mr Godfrey is supported by the UK Medical Research Council (MC_UU_12011/4), the National Institute for Health Research (NIHR) (Senior Investigator [NF-SI-0515-10042] and NIHR Southampton Biomedical Research Centre [IS-BRC-1215-20004]), the European Union (Erasmus+ Programme ImpENSA 598488-EPP-1-2018-1-DE-EPPKA2-CBHE-JP), and the British Heart Foundation (RG/15/17/3174, SP/F/21/150013). Additional funding is provided by the Singapore Institute for Clinical Sciences, Agency for Science Technology and Research (A*STAR), Singapore.
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© 2023 The Authors
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Local EPrints ID: 478942
URI: http://eprints.soton.ac.uk/id/eprint/478942
ISSN: 1081-1206
PURE UUID: f0d19377-4233-4f9b-9143-b4760b67e9b4
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Date deposited: 14 Jul 2023 17:03
Last modified: 18 Mar 2024 02:38
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Author:
Hui Xing Lau
Author:
Zhaojin Chen
Author:
Hugo Van Bever
Author:
Elizabeth Huiwen Tham
Author:
Yiong Huak Chan
Author:
Qai Ven Yap
Author:
Anne Eng Neo Goh
Author:
Oon Hoe Teoh
Author:
Kok Hian Tan
Author:
Fabian Yap
Author:
Johan G. Eriksson
Author:
Yap-Seng Chong
Author:
Bee Wah Lee
Author:
Lynette P. Shek
Author:
Evelyn Xiu-Ling Loo
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