Agache Ioana, Salazar Josefina, Rodriguez-Tanta Yesenia, Saenz Fiorella Karina Fernandez, Haahtela Tari, Traidl-Hoffmann Claudia, Damialis Athanasios, Vecillas Letizia, Giovannini Mattia, Nadeau Kari C, Pali-Schöll Isabella, Palomares Oscar, Renz Harald, Schwarze Jurgen, Sousa Pinto Bernardo, Urrutia-Pereira Marilyn, Venter Carina, Vercelli Donata, Winders Tonia, Sola-Arnau Ivan, Alonso-Coello Pablo, Canelo-Aybar Carlos, Jutel Marek, Akdis Cezmi A
Faculty of Medicine, Transylvania University, Brasov, Romania.
Iberoamerican Cochrane Centre, Barcelona, Spain.
Allergy. 2025 Jul;80(7):1878-1898. doi: 10.1111/all.16611. Epub 2025 Jun 10.
This systematic review evaluated the association between lower respiratory tract infections (LRTI) in infancy with respiratory syncytial virus (RSV), rhinovirus (RV) or infestation with helminths and the risk of developing asthma and allergic diseases. The risk of bias was assessed with ROBINS-E, and the certainty of evidence (CoE) with GRADE. Meta-analysis applied a random-effects model. RSV LRTI is likely associated with an increased risk of developing asthma by age 7 (OR 3.02, 95% CI 2.23-4.09; I = 98%; moderate CoE). The impact on wheezing, atopic dermatitis (AD), and allergic rhinitis is uncertain. RV LRTI may be associated with increased risk of developing asthma (OR 8.40, 95% CI 2.56-27.55; I = 43%; low CoE). The impact on wheezing and AD is uncertain. Trichuris trichiura infestation might be associated with reduced risk of new-onset wheezing (OR 0.57, 95% CI 0.35-0.94; very low CoE) or AD (HR: 0.35, 95% CI 0.18-0.67; very low CoE). The association between Ascaris lumbricoides and hookworm infestation and the risk of developing asthma or AD is uncertain. Infestation with any helminths might be associated with reduced risk of new-onset asthma by age 5 (OR: 0.60, 95% CI 0.38-0.95; very low CoE) and wheezing (OR 0.70, 95% CI 0.51-0.95; very low CoE). More high-quality studies are needed to confirm these findings.
本系统评价评估了婴儿期下呼吸道感染（LRTI）与呼吸道合胞病毒（RSV）、鼻病毒（RV）或蠕虫感染之间的关联以及发生哮喘和过敏性疾病的风险。使用ROBINS-E评估偏倚风险，使用GRADE评估证据确定性（CoE）。荟萃分析采用随机效应模型。RSV LRTI可能与7岁时患哮喘风险增加相关（比值比[OR]3.02，95%置信区间[CI]2.23 - 4.09；I² = 98%；中等CoE）。对喘息、特应性皮炎（AD）和过敏性鼻炎的影响尚不确定。RV LRTI可能与患哮喘风险增加相关（OR 8.40，95% CI 2.56 - 27.55；I² = 43%；低CoE）。对喘息和AD的影响尚不确定。鞭虫感染可能与新发喘息风险降低相关（OR 0.57，95% CI 0.35 - 0.94；极低CoE）或AD（风险比[HR]：0.35，95% CI 0.18 - 0.67；极低CoE）。蛔虫和钩虫感染与患哮喘或AD风险之间的关联尚不确定。任何蠕虫感染可能与5岁时新发哮喘风险降低相关（OR：0.60，95% CI 0.38 - 0.95；极低CoE）和喘息（OR 0.70，95% CI 0.51 - 0.95；极低CoE）。需要更多高质量研究来证实这些发现。
