Atopic Phenotype In Children Under 6 Years with Persistent Wheezing In El Salvador

Background: Asthma is the most common chronic disease of childhood and the leading cause of childhood morbidity¹. Even if an early intervention could improve their symptoms, the diagnosis of asthma in the first years of age is difficult.  This study is the first effort to describe the atopic profile and the risk of developing asthma in a group of children from El Salvador with recurrent wheezing.

Methods: A questionnaire was designed for parents to determine the atopic background, while skin tests were performed in children. We used the modified Asthma Predictive Index (APIm)² to assess the risk of developing asthma.

Results: 65 children under 6 years were evaluated, with an average age of 3.5 years. The average age of onset of wheezing was at 11 months of age. Family history of asthma, chronic rhinitis and eczema were presented respectively at 25%, 19% and 8% of the population. 42% of our population presents allergic rhinitis and 37% eczema. Among the factors related to wheezing risk, we found that one third of the population was born via caesarean section with a breastfeeding average of 3.76 months; also we found the presence of pets in 26% of households, a passive smoking and exposure to wood smoke in 17% and 35% of the studied population respectively. 23 children were sensitized to respiratory allergens. Dust mites were found in 73% of children sensitized. The APIm was positive in 66% of the population.

Conclusions: This is the first cohort of children described under 6 years with recurrent wheezing in El Salvador. We found an early presentation of wheezing, caused not only by viral conditions. These children had strong personal and family atopic background with a high rate of sensitization to respiratory allergens, especially dust mites. Most of the children studied are at risk of presenting asthma in later ages.

References:

1. Masoli, Fabian, Holt, Beasley. The global burden of asthma: executive summary of the GINA. Dissemination Committee report. Allergy 2004;59:469-78.
2. Guilbert et al. Atopic characteristics of children with recurrent wheezing at high risk for the development of childhood asthma. J Allergy Clin Immunol. 2004. Dec;114(6):1282-7.