Infant rhinitis and watery eyes predict school-age exercise-induced wheeze, emergency department visits and respiratory-related hospitalizations.

BACKGROUND: Rhinitis and conjunctivitis are often linked to asthma development through an allergic pathway. However, runny nose and watery eyes can result from nonallergic mechanisms. These mechanisms can also underlie exercise-induced wheeze (EIW), which has been associated with urgent medical visits for asthma, independent of other indicators of asthma severity or control. OBJECTIVE: To test the hypothesis that rhinitis or watery eyes without cold symptoms (RWWC) in infancy predict development of EIW and urgent respiratory-related medical visits at school age, independent of seroatopy. METHODS: Within a prospective birth cohort of low-income, urban children (n = 332), RWWC was queried during the first year of life. Relative risks (RRs) for EIW, emergency department (ED) visits, and hospitalizations for asthma and other breathing difficulties at 5 to 7 years of age were estimated with multivariable models. Seroatopy was determined at 7 years of age. RESULTS: Infant RWWC was common (49% of children) and predicted school-age EIW (RR, 2.8; P < .001), ED visits (RR, 1.8; P = .001), and hospitalizations (RR, 9.8; P = .002). These associations were independent of infant wheeze. They were also independent of birth order, an indicator of increased risk of exposure to viruses in infancy, and infant ear infections, an indicator of sequelae of upper airway infections. The association between infant RWWC and ED visits at 5 to 7 years of age was attenuated (RR, 1.2; P = .23) when EIW at 5 to 7 years of age was included in the model, suggesting EIW mediates the association. Adjustment for seroatopy did not diminish the magnitudes of any of these associations. CONCLUSION: These findings suggest a nonallergic connection between infant nonwheeze symptoms and important consequences of urban respiratory health by school age through EIW.

Increased Heart Rate Variability Response Among Infants with Reported Rhinorrhea and Watery Eyes: A Pilot Study.

INTRODUCTION: Previously, we found that reported infant rhinorrhea and watery eyes without a cold (RWWC) predicted school age exercise-induced wheeze, emergency department visits, and hospitalizations. These findings were independent of allergic sensitization, and we theorized that increased parasympathetic tone underlay the association. We also reported that increased heart-rate variability (HRV) in infants predicted wheeze in 2-3 year-olds. In a convenience sample of children participating in a birth cohort study, we tested the hypothesis that infants with RWWC would have elevated HRV, indicating increased parasympathetic tone. METHODS: RWWC symptoms since birth were queried for 3-month-old children. At 4-months, HRV was assessed (root mean square of successive differences [RMSSD]) during a standardized infant-mother still-face paradigm, which included 2 minutes of mother/child play immediately followed by 2 minutes of the mother maintaining a still-face. RESULTS: Among participants (n=38), RWWC was common for girls (32%) and boys (21%). The children with the greatest decrease in RMSSD between play and still-face challenge (lowest tertile) had a higher prevalence of RWWC as compared with children in the higher tertiles (50% vs 16%, P=0.045). In a logistic regression model controlling for sex, age and time between HRV and RWWC assessment, children with greater decrease in HRV between play and still-face (lowest tertile) had greater odds of having RWWC (odds ratio=6.0, P=0.029). CONCLUSION: In this relatively small study, we demonstrated greater decreases in HRV in response to a stressor among children with reported RWWC, suggesting that these children might have increased parasympathetic tone and/or overall greater vagal reactivity.

Post 9/11: high asthma rates among children in Chinatown, New York.

We reported increased rates of childhood asthma and worsening of preexisting asthma in Chinatown near the World Trade Center (WTC) after September 11, 2001. This conclusion was corroborated by the WTC Health Registry in 2003, which showed asthma prevalence in children <5 years old was higher than national estimates. In 2002, ethnic Chinese in New York City (NYC), based on 2000 U.S. Census addresses, were reported to have the lowest levels of asthma compared with other ethnic NYC neighborhoods. This study was designed to determine if Chinatown asthma rates are still higher than other ethnic neighborhoods and if rates decreased since 2003. We surveyed 353 parents of children at a Chinatown elementary school, conducted spirometry on 202 students, measured air pollution (PM2.5), and sampled dust from the floor of the school during 2008 for concentrations of dust-mite antigens, cat, rat, mouse, and cockroach. Asthma rates of 14.4% were reported in children who refused spirometry if they lived <1 mi from the WTC. The rate was 4.9% if they lived farther away. Twenty-nine percent of all students (4-12 years old) who had spirometry showed a forced expiratory volume at 1 second (FEV(1)) of <80% predicted normal. Among children who were alive in 2001, 17.4% had an FEV(1) of < or = 75% predicted. The concentration of PM2.5 reached a high level of 40 microg/m(3). Indoor aeroallergen concentrations were negligible. Chinatown asthma rates are still higher than among other groups (29% versus the NYC reference rate of 13%). High air pollution levels may account for increased asthma incidence. It is possible that exposure to toxins on September 11, 2001 accentuated the effect of subsequent exposure to air pollution.