F Rancière1, L Nikasinovic, J Bousquet, I Momas. 1. Univ. Paris Descartes, Sorbonne Paris Cité, EA 4064, Laboratoire Santé Publique et Environnement, Paris, France; Mairie de Paris, Direction de l'Action Sociale, de l'Enfance et de la Santé, Cellule Cohorte, Paris, France.
Abstract
BACKGROUND: The natural course of childhood asthma and allergy is complex and not fully understood. We aimed to identify phenotypes based upon the time course of respiratory/allergic symptoms throughout preschool years. METHODS: As part of the PARIS cohort, symptoms of wheezing, dry night cough, rhinitis and dermatitis were collected annually from birth to age 4 years. K-means clustering was used to group into phenotypes children with similar symptoms trajectories over the study period. Associations of phenotypes with IgE sensitization and risk factors were studied using multinomial logistic regression. RESULTS: Besides a group with low prevalence of symptoms considered as reference (n = 1236, 49.0%), four distinct respiratory/allergic phenotypes were identified: two transient [transient rhinitis phenotype (n = 295, 11.7%), transient wheeze phenotype (n = 399, 15.8%)], without any relation with IgE sensitization, and two persistent [cough/rhinitis phenotype (n = 284, 11.3%), dermatitis phenotype (n = 308, 12.2%)], associated with IgE sensitization. Transient rhinitis phenotype was only associated with tobacco smoke exposure, which could irritate the airways. Transient wheeze phenotype was related to male sex and contact with other children (older siblings, day care attendance). Lastly, risk factors for both IgE-associated phenotypes encompassed parental history of allergy, potential exposure to allergens and stress, known to be associated with the development of allergic diseases. CONCLUSION: This study provides evidence for the existence of different respiratory/allergic phenotypes before school age. The fact that they differ in terms of sensitization and risk factors reinforces the plausibility of distinct phenotypes, potentially linked to irritation and infections for the transient phenotypes and to allergy for the persistent phenotypes.
BACKGROUND: The natural course of childhood asthma and allergy is complex and not fully understood. We aimed to identify phenotypes based upon the time course of respiratory/allergic symptoms throughout preschool years. METHODS: As part of the PARIS cohort, symptoms of wheezing, dry night cough, rhinitis and dermatitis were collected annually from birth to age 4 years. K-means clustering was used to group into phenotypes children with similar symptoms trajectories over the study period. Associations of phenotypes with IgE sensitization and risk factors were studied using multinomial logistic regression. RESULTS: Besides a group with low prevalence of symptoms considered as reference (n = 1236, 49.0%), four distinct respiratory/allergic phenotypes were identified: two transient [transient rhinitis phenotype (n = 295, 11.7%), transient wheeze phenotype (n = 399, 15.8%)], without any relation with IgE sensitization, and two persistent [cough/rhinitis phenotype (n = 284, 11.3%), dermatitis phenotype (n = 308, 12.2%)], associated with IgE sensitization. Transient rhinitis phenotype was only associated with tobacco smoke exposure, which could irritate the airways. Transient wheeze phenotype was related to male sex and contact with other children (older siblings, day care attendance). Lastly, risk factors for both IgE-associated phenotypes encompassed parental history of allergy, potential exposure to allergens and stress, known to be associated with the development of allergic diseases. CONCLUSION: This study provides evidence for the existence of different respiratory/allergic phenotypes before school age. The fact that they differ in terms of sensitization and risk factors reinforces the plausibility of distinct phenotypes, potentially linked to irritation and infections for the transient phenotypes and to allergy for the persistent phenotypes.
Authors: Jean Bousquet; James E Gern; Fernando D Martinez; Josep M Anto; Christine C Johnson; Patrick G Holt; Robert F Lemanske; Peter N Le Souëf; Robert S Tepper; Erika R M von Mutius; S Hasan Arshad; Leonard B Bacharier; Allan Becker; Kathleen Belanger; Anna Bergström; David I Bernstein; Michael D Cabana; Kecia N Carroll; Mario Castro; Philip J Cooper; Matthew W Gillman; Diane R Gold; John Henderson; Joachim Heinrich; Soo-Jong Hong; Daniel J Jackson; Thomas Keil; Anita L Kozyrskyj; Karin C Lødrup Carlsen; Rachel L Miller; Isabelle Momas; Wayne J Morgan; Patricia Noel; Dennis R Ownby; Mariona Pinart; Patrick H Ryan; Julie M Schwaninger; Malcolm R Sears; Angela Simpson; Henriette A Smit; Debra A Stern; Padmaja Subbarao; Rudolf Valenta; Xiaobin Wang; Scott T Weiss; Robert Wood; Anne L Wright; Rosalind J Wright; Alkis Togias; Peter J Gergen Journal: J Allergy Clin Immunol Date: 2014-03-15 Impact factor: 10.793
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Authors: M A Calderon; P Demoly; T Casale; C A Akdis; C Bachert; M Bewick; B M Bilò; B Bohle; S Bonini; A Bush; D P Caimmi; G W Canonica; V Cardona; A M Chiriac; L Cox; A Custovic; F De Blay; P Devillier; A Didier; G Di Lorenzo; G Du Toit; S R Durham; P Eng; A Fiocchi; A T Fox; R Gerth van Wijk; R M Gomez; T Haathela; S Halken; P W Hellings; L Jacobsen; J Just; L K Tanno; J Kleine-Tebbe; L Klimek; E F Knol; P Kuna; D E Larenas-Linnemann; A Linneberg; M Matricardi; H J Malling; R Moesges; J Mullol; A Muraro; N Papadopoulos; G Passalacqua; E Pastorello; O Pfaar; D Price; P Rodriguez Del Rio; R Ruëff; B Samolinski; G K Scadding; G Senti; M H Shamji; A Sheikh; J C Sisul; D Sole; G J Sturm; A Tabar; R Van Ree; M T Ventura; C Vidal; E M Varga; M Worm; T Zuberbier; J Bousquet Journal: Clin Transl Allergy Date: 2016-11-23 Impact factor: 5.871
Authors: Magnus Wickman; Christian Lupinek; Niklas Andersson; Danielle Belgrave; Anna Asarnoj; Marta Benet; Mariona Pinart; Sandra Wieser; Judith Garcia-Aymerich; Alexandra Baar; Göran Pershagen; Angela Simpson; Inger Kull; Anna Bergström; Erik Melén; Carl Hamsten; Josep M Antó; Jean Bousquet; Adnan Custovic; Rudolf Valenta; Marianne van Hage Journal: EBioMedicine Date: 2017-11-14 Impact factor: 8.143