Infants with rhinovirus C infection at increased risk of asthma: JAMA

USA: A multicenter cohort study of infants hospitalized for bronchiolitis found that infants with rhinovirus C infection, along with IgE sensitization had the highest risk of developing recurrent wheeze by age 3 years. The risk was lower among infants who had bronchiolitis caused by other viruses.

These are the findings of a recent study published in the journal JAMA Pediatrics.

Rhinovirus infection in early life, particularly with allergic sensitization can lead to recurrent wheeze and asthma. While some studies have established an association between different rhinovirus species (eg, rhinovirus C) with higher severity of infection and asthma exacerbation, not much is known about longitudinal associations of rhinovirus C infection during infancy with subsequent morbidities. Kohei Hasegawa, an attending physician at Massachusetts General Hospital and an associate professor of emergency medicine at Harvard Medical School, and colleagues conducted the study to examine the association of different viruses (respiratory syncytial virus [RSV], rhinovirus species) in bronchiolitis with risks of developing recurrent wheeze.

“Rhinovirus is the second most common pathogen following a respiratory syncytial virus, and it contributes to 20% to 40% of severe bronchiolitis,” wrote the authors. “Epidemiological studies have reported that rhinovirus infection in early life, particularly with allergic sensitization, is associated with a higher risk of developing recurrent wheeze and childhood asthma.”

This multicenter prospective cohort study involved 716 infants aged younger than 1 year. The infants were hospitalized for either RSV-only bronchiolitis or rhinovirus bronchiolitis in 17 hospitals in 14 states during the fall and winter seasons between 2011 and 2014.

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Key findings of the study include:

• Bronchiolitis was most often caused by RSV only (76%; n = 541), followed by rhinovirus A (12%; n = 85), rhinovirus C (11%; n = 78) and rhinovirus B (2%; n = 12).


• Recurrent wheeze was diagnosed in 32% of the children by age 3 years.


• The risk for developing recurrent wheeze was similar among infants with RSV-only infection compared with those infected with rhinovirus A or rhinovirus B.


• A significantly higher risk for recurrent wheeze was observed in children who were infected with rhinovirus C.


• A correlation between rhinovirus C infection and immunoglobulin E (IgE) sensitization in relation to the future development of recurrent wheeze was found. For example, the only infants with a significantly higher risk for recurrent wheeze were those who were infected with rhinovirus C and who had IgE sensitization to food or aeroallergens during infancy.


• These infants were also at increased risk for developing recurrent wheeze and asthma at age 4 years compared with infants infected with RSV only.

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“Our data facilitate further investigations into the mechanisms underlying the association between distinct respiratory viruses, host immunity and respiratory health in children,” the researchers wrote. “Furthermore, the study identifies infants at higher risk for developing recurrent wheeze and asthma and informs strategies to develop targeted preventive therapies.”

For detailed research log on to 10.1001/jamapediatrics.2019.0384