Early Life Markers to Predict the Risk for Frequent Wheezing in Infants; Going on a Mysterious Road with an Old Friend, “The Eosinophil”

Ali Haydar Turhan
Tuğba Arıkoğlu
Özlem Tezol
Gönül Aslan
Semanur Kuyucu


Objective: In most cases of asthma, wheezing symptoms start in early childhood. Although there are studies evaluating the factors that play a role in the development of childhood asthma, the predictive markers for frequent wheezing in early childhood are still unclear. The aim of our study was to investigate the relation between the wheezing episodes and the familial, prenatal, and postnatal risk factors, and the sensitivity of serum eosinophilic cationic protein (ECP) and eosinophil levels for predicting frequent wheezing.

Materials and Methods: Fifty-seven children with acute wheezing and fifty healthy children aged between 1-36 months were included in the study. The children who had ≥ 3 episodes of wheezing in the next year after presentation were classified as the frequent wheezing group and those with fewer episodes were classified as the infrequent wheezing group. Administration of a comprehensive questionnaire about risk factors for wheezing; blood sampling for serum total IgE, ECP, eosinophil count, food and inhaled specific IgE levels and RSV/adenovirus serology; and skin prick tests were performed. Oral provocation tests were applied in cases of suspected food allergy.

Results: Male gender (p=0.024), low socioeconomic level (p=0.046), initiation of milk formula (p=0.009) and eggs (p=0.018) before the fourth month, the presence of mold / humidity at home (p=0.023), eczema (p<0.001), and atopy (p=0.017) rates were significantly higher in the frequent wheezing group. The children with serum ECP levels ≥7.9 μg/L at enrollment had higher risk of frequent wheezing than those with serum ECP<7.9 μg/L (p=0.008). The sensitivity of ECP ≥7.9 μg/L for frequent wheezing was 75.9% and the specificity was 68.7%. Similarly, serum total IgE (≥154 IU/ml) and total eosinophil count (≥390 /mm3) were found to be significantly higher in infants in the frequent wheezing group than the other groups (p=0.049, p=0.019). The multivariate analysis showed that the risk of frequent wheezing was 6.6 fold higher in children with a serum ECP level ≥7.9 μg /L and 5.3 fold higher in the presence of RSV / Adenovirus infection (p=0.026, p=0.038, respectively).

Conclusion: In conclusion, our study suggested that the increase in serum ECP levels and the presence of RSV / Adenovirus infection significantly increased the risk of frequent wheezing in children with acute wheezing attacks.


Eosinophilic cationic protein, wheezy infant, risk factors, eosinophil, total IgE
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