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

BACKGROUND: Childhood wheezing is a highly heterogeneous condition with incomplete understanding of the characteristics of wheeze trajectories, particularly for persistent wheeze.

OBJECTIVE: To characterise predictors and allergic comorbidities of distinct wheeze trajectories in a multi-ethnic Asian cohort.

METHODS: A total of 974 mother-child pairs from the prospective XXX cohort were included in this study. Wheeze and allergic comorbidities in the first eight years of life were assessed using the modified ISAAC questionnaires and skin prick tests. Group-based trajectory modelling was used to derive wheeze trajectories and regression was used to assess associations with predictive risk factors and allergic comorbidities.

RESULTS: Four wheeze trajectories were derived: early onset with rapid remission from age 3 years (4.5%), late onset peaking at age 3 years and rapidly remitting from 4 years (8.1%), persistent with steady increase to age 5 years and high wheeze occurrence until 8 years (4.0%) and no/low wheeze (83.4%). Early onset wheezing was associated with respiratory infections during infancy and linked to subsequent non-allergic rhinitis throughout childhood. Late onset and persistent wheeze shared similar origins characterized by parent-reported viral infections in later childhood. However, persistent wheeze was generally more strongly associated with a family history of allergy, parent-reported viral infections in later childhood and allergic comorbidities as compared to late onset wheeze.

CONCLUSION: The timing of viral infection occurrence may determine the type of wheeze trajectory development in children. Children with family history of allergy and viral infections in early life may be predisposed to persistent wheeze development and the associated comorbidities early allergic sensitization and eczema.