This study from Australia included 147 children at high atopic risk who were followed from birth to age 10 yrs. Atopy was measured by skin prick tests at 6 months, and 2 and 5 yrs. History of wheeze and doctor-diagnosed eczema and asthma was collected regularly until 10 yrs of age.
At 10 yrs, 60% of the cohort was atopic, 26% had eczema, 18% asthma and 20% persistent wheeze. 36% experienced at least one lower respiratory infection (LRI) associated with fever and/or wheeze in first year of life.
Children who had wheezy or, in particular, febrile LRI in infancy and were atopic by 2 yrs, were much more likely to have persistent wheeze (RR 3.51) and current asthma (RR 4.92) at 10 yrs.
Severe viral respiratory infections in infancy and early atopy are risk factors for persistent wheeze and asthma. The strongest marker of the asthmatogenic potential of early life infections was concurrent fever. The study conclusions are interesting especially in the light of the recent hypothesis that implicates acetaminophen (paracetamol) in the etiology of pediatric asthma. Many children with febrile respiratory illness receive acetaminophen (paracetamol) as symptomatic therapy which may aggravate or confound their risk profile.
Febrile respiratory illnesses in infancy and atopy are risk factors for persistent asthma and wheeze. M.M.H. Kusel et al. ERJ April 1, 2012 vol. 39 no. 4 876-882.
Image source: Molecular surface of a rhinovirus, Wikipedia, GNU Free Documentation License.