Association between pronounced IgA response in RSV bronchiolitis and development of allergic sensitization.

Forty-five children who had been hospitalized with bronchiolitis caused by respiratory syncytial virus (RSV) at a mean age of 4 months, and 90 matched control children, were tested for occurrence of RSV antibodies at one year of age. Of the children who had suffered from bronchiolitis, forty had demonstrable IgG antibodies, whereas the remaining five only had IgA antibodies against RSV. In the control group, 42% were RSV seropositive. The anti-RSV IgA antibody titres tended to be higher in patients with bronchiolitis than in controls and a larger proportion of the seropositive children in the former than in the latter group had demonstrable IgG antibodies. These findings suggest that RSV infections causing bronchiolitis are more often associated with a strong antibody response than are mild cases of the infection. Follow-up of the children at 3 years of age showed that allergic sensitization and development of asthma had occurred much more frequently in children with past RSV bronchiolitis than in controls. Children with past RSV bronchiolitis who later developed allergic sensitization had elevated RSV IgA antibody titres at one year of age more frequently than children with past RSV-bronchiolitis, who were not sensitized (p = 0.015). No significant differences regarding IgG antibody titres were observed. Since IgA, similarly as IgE, antibody formation is strongly Th2 cell dependent, the results are compatible with other findings suggesting that RSV has an unusual propensity to activate the Th2 cell system. This may contribute to the pathological picture of bronchiolitis in small children and at the same time render the infected child predisposed for later development of allergic sensitization. RSV bronchiolitis may thus be an important risk factor for later development of atopic disease although it cannot be excluded that the bronchiolitis simply serves as a marker that predict later development of atopy.