Wi Chung-Il, Kim Bong-Seong, Mehra Sonia, Yawn Barbara P, Park Miguel A, Juhn Young J
Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Allergy Asthma Proc. 2015 Sep-Oct;36(5):372-8. doi: 10.2500/aap.2015.36.3864.
There is literature that indicates the association of asthma with an increased risk of common and serious microbial infections. We recently reported an increased risk of vaccine-preventable diseases, e.g., herpes zoster (HZ) among children with asthma, defined by predetermined asthma criteria. Little is known about whether this association is persistent if the asthma status is defined by different asthma criteria, e.g., the Asthma Predictive Index, given the heterogeneity of asthma.
To assess the consistency of the association between asthma and the risk of HZ in children.
This is a population-based case-control study based on all pediatric patients with HZ between 1996 and 2001 in Olmsted County, Minnesota, and 1:1 age- and sex-matched controls without a history of HZ who were enrolled in our previous study. The original Asthma Predictive Index criteria was operationalized by two or more wheezing episodes in a year for the first 3 years of life plus one of the major (physician-diagnosed asthma for a parent or physician-diagnosed eczema for a patient) or two of the minor criteria (physician-diagnosed allergic rhinitis for a patient, wheezing apart from cold, or eosinophilia [≥4%]). Data were fit to traditional logistic regression models to calculate odds ratios and 95% confident intervals.
Of the original cohort (n = 554), 95 (17%) did not meet the enrollment criteria for this study, which left 459. Of the 221 patients, 53% were female, with a mean (standard deviation) age of 9.7 ± 4.2 years. The risk of HZ was increased in children with asthma defined by the API controlling for a varicella vaccine history and atopic status (adjusted odds ratio 2.56 [95% confidence interval, 1.08-6.56]).
The association between asthma and increased risk of HZ in children and adolescents is consistent, independent of asthma definitions. Asthma might be an important clinical condition to be considered in HZ vaccine studies.
有文献表明哮喘与常见及严重微生物感染风险增加有关。我们最近报告了根据预定哮喘标准定义的哮喘儿童中疫苗可预防疾病的风险增加，例如带状疱疹（HZ）。鉴于哮喘的异质性，如果哮喘状态由不同的哮喘标准（如哮喘预测指数）定义，这种关联是否持续尚不清楚。
评估儿童哮喘与HZ风险之间关联的一致性。
这是一项基于人群的病例对照研究，研究对象为1996年至2001年明尼苏达州奥尔姆斯特德县所有患HZ的儿科患者，以及在我们之前的研究中纳入的1:1年龄和性别匹配的无HZ病史对照。最初的哮喘预测指数标准是在生命的前3年中每年出现两次或更多次喘息发作，加上一项主要标准（父母经医生诊断为哮喘或患者经医生诊断为湿疹）或两项次要标准（患者经医生诊断为过敏性鼻炎、非感冒引起的喘息或嗜酸性粒细胞增多[≥4%]）。数据采用传统逻辑回归模型进行拟合，以计算比值比和95%置信区间。
在最初的队列（n = 554）中，95名（17%）不符合本研究的纳入标准，剩余459名。在221名患者中，53%为女性，平均（标准差）年龄为9.7±4.2岁。根据API定义的哮喘儿童中，控制水痘疫苗接种史和特应性状态后，HZ风险增加（调整后的比值比为2.56[95%置信区间，1.08 - 6.56]）。
儿童和青少年哮喘与HZ风险增加之间的关联是一致的，与哮喘定义无关。在HZ疫苗研究中，哮喘可能是一个需要考虑的重要临床情况。
