Infants with severe bronchiolitis from the rhinovirus C infection have the highest risk of developing recurrent wheeze by age 3, particularly with immunoglobulin E (IgE) sensitization during infancy. Furthermore, these infants have a significantly higher risk of developing asthma by age 4, according to a study published in JAMA Pediatrics.

Early rhinovirus infection, particularly when accompanied by allergic sensitization, is associated with a higher risk for recurrent wheeze and asthma. This multicenter prospective cohort study of infants younger than age 1 (N=716) hospitalized for respiratory syncytial virus (RSV)-only or rhinovirus bronchiolitis was designed to examine the association of bronchiolitis from RSV and different rhinovirus species (rhinovirus A, B, and C) with developing recurrent wheeze by age 3 (primary outcome) and subsequent asthma by age 4 (secondary outcome). Data were taken from 17 hospitals in 14 states from 2011 to 2014 during the fall and winter seasons. A multivariable Cox model was used to estimate the risk of recurrent wheeze between different species of virus.

Overall, 32% (n=231) of participants developed a recurrent wheeze by age 3. Of the whole study population, 76% (n=541) had bronchiolitis with RSV only, 12% (n=85) had rhinovirus A infection, 2% (n=12) had rhinovirus B, and 11% (n=78) had rhinovirus C. The risk for recurrent wheeze by age 3 was not significantly different between rhinovirus A or B infection (hazard ratio [HR], 1.27; 95% CI, 0.86-1.88; and HR, 1.39; 95% CI, 0.51-3.77, respectively; both P >.10) compared with RSV-only infection, whereas rhinovirus C was associated with significantly higher risk (HR, 1.58; 95% CI, 1.08-2.32) compared with RSV-only.

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Researchers found a significant interaction between IgE sensitization and virus groups on the risk of recurrent wheeze (P for interaction <.01). Only infants with the combination of both IgE sensitization (to food or aeroallergens) and rhinovirus C infection during infancy showed significantly higher risks for recurrent wheeze by age 3 (HR, 3.03; 95% CI, 1.20-7.61). When compared with RSV-only infections, the combination of IgE sensitization and rhinovirus C infection was associated with significantly higher risks for wheeze with subsequent asthma development by age 4 (HR, 4.06; 95% CI, 1.17-14.1).

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The investigators concluded that the study identified infants with rhinovirus C infection combined with IgE sensitization as having the highest risk for recurrent wheeze, and these findings may aid in the development of targeted preventive therapies.

Disclosures: Study authors report receiving grants/fees/royalties from the National Institutes of Health, Novartis, MedImmune, Meissa Vaccines, PREP Biopharm Inc, Regeneron, and Teva. Dr Gern reports having a patent to Rhinovirus production pending.


Hasegawa K, Mansbach JM, Bochkov YA, et al. Association of Rhinovirus C bronchiolitis and immunoglobulin E sensitization during infancy with development of recurrent wheeze [published online April 1, 2019]. JAMA Pediatr. doi:10.1001/jamapediatrics.2019.0384