Clinical Characteristics of 2009 Pandemic Influenza A (H1N1) Pneumonia in Atopic versus Non-atopic Children

Mi Ju; Jin Young Shin; Kye Hyang Lee; Hye Jin Park; Kyung Hoon Lee; Eun Jin Choi; Jin Kyung Kim; Woo Taek Kim; Hai Lee Chung

doi:10.7581/pard.2012.22.1.78

Journal List > Pediatr Allergy Respir Dis > v.22(1) > 1033213

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Ju, Shin, Lee, Park, Lee, Choi, Kim, Kim, and Chung: Clinical Characteristics of 2009 Pandemic Influenza A (H1N1) Pneumonia in Atopic versus Non-atopic Children

Original Article

Pediatric Allergy and Respiratory Disease

Pediatric Allergy and Respiratory Disease 2012; 22(1): 78-85.

Published online: 31 March 2012

DOI: https://doi.org/10.7581/pard.2012.22.1.78

Clinical Characteristics of 2009 Pandemic Influenza A (H1N1) Pneumonia in Atopic versus Non-atopic Children

Mi Ju, MD, Jin Young Shin, MD, Kye Hyang Lee, MD, Hye Jin Park, MD, Kyung Hoon Lee, MD, Eun Jin Choi, MD, Jin Kyung Kim, MD, Woo Taek Kim, MD, Hai Lee Chung, MD

Department of pediatrics, Catholic University of Daegu School of Medicine, Daegu, Korea.

Corresponding author (jyshin00@gmail.com)

Received 2 December 2011 Revised 4 January 2012 Accepted 6 February 2012

Abstract

Purpose

Bronchial asthma was reported to be an important risk factor of severe respiratory symptoms due to pandemic H1N1 influenza infection. In this study, we investigated if there was any difference in the clinical features of children with H1N1 pneumonia according to their atopic or asthma status.

Methods

Eighty-eight children admitted with pneumonia due to reverse transcriptase-polymerase chain reaction-confirmed H1N1 influenza infection during the period from September 2009 to January 2010 were enrolled. These patients were divided into atopic (n=42) and non-atopic (n=46) groups. The atopic group consisted of 23 asthmatic children and 19 non-asthmatic children with allergic rhinitis or atopic dermatitis. We retrospectively analyzed the medical records of the patients to investigate if there was any difference in the clinical features according to their atopic or asthma status.

Results

There was no age difference between atopic and non-atopic patients. Male preponderance was observed only in the atopic group.(P<0.05) The occurrence of wheezing, severity of respiratory symptoms, and number of emergency-room visits were significantly higher in atopic than non-atopic patients.(P<0.05) However, those variables showed no difference between asthmatic and non-asthmatic patients within the atopic group. Twelve patients in the atopic, non-asthmatic group were followed for 1 year after discharge, and 5 patients were diagnosed to have asthma with recurrence of wheezing and/or positive results to methacholine challenge tests.

Conclusion

Our study shows that H1N1 influenza infection may cause more severe respiratory symptoms in atopic patients than in non-atopic patients, regardless of their asthma status. allergic rhinitis.(R=0.195, P=0.002). About 17% of the parents who care the allergic rhinitis children experienced the work absence due to their child's illness.

Keywords: Influenza A (H1N1), Pneumonia, Children

Figures and Tables

Table 1

Clinical Characteristics of Atopic and Non-atopic Patients

Values are presented as mean±SD or number (%).

NS, not significant; GI, gastrointestinal.

Table 2

Respiratory Symptoms and Signs in Atopic versus Non-atopic Patients

Values are presented as number (%) or median (interquartile range).

NS, not significant.

Table 3

Respiratory Symptoms and Signs in the Patients with versus without Asthma

Values are presented as number (%), median (interquartile range) or mena±SD.

NS, not significant; IgE, immunoglobulin E

Table 4

Chest Radiographic Findings in Atopic and Non-atopic Patients

Values are presented as number (%)

NS, not significant.

Table 5

Laboratory Findings in Atopic and Non-atopic Patients

Values are presented as mena±SD or number (%).

WBC, white blood cell; NS, not significant; ASO, anti-streptolysin O.

References

1. Jain S, Kamimoto L, Bramley AM, Schmitz AM, Benoit SR, Louie J, et al. Hospitalized patients with 2009 H1N1 influenza in the United States, April-June 2009. N Engl J Med. 2009. 361:1935–1944.

2. O'Riordan S, Barton M, Yau Y, Read SE, Allen U, Tran D. Risk factors and outcomes among children admitted to hospital with pandemic H1N1 influenza. CMAJ. 2010. 182:39–44.

3. Plessa E, Diakakis P, Gardelis J, Thirios A, Koletsi P, Falagas ME. Clinical features, risk factors, and complications among pediatric patients with pandemic influenza A (H1N1). Clin Pediatr (Phila). 2010. 49:777–781.

4. Okada T, Morozumi M, Matsubara K, Komiyama O, Ubukata K, Takahashi T, et al. Characteristic findings of pediatric inpatients with pandemic (H1N1) 2009 virus infection among severe and nonsevere illnesses. J Infect Chemother. 2011. 17:238–245.

5. Mathisen M, Strand TA, Sharma BN, Chandyo RK, Valentiner-Branth P, Basnet S, et al. Clinical presentation and severity of viral community-acquired pneumonia in young Nepalese children. Pediatr Infect Dis J. 2010. 29:e1–e6.

6. Kin Key N, Araújo-Neto CA, Nascimento-Carvalho CM. Severity of childhood community-acquired pneumonia and chest radiographic findings. Pediatr Pulmonol. 2009. 44:249–252.

7. Pagana KD. Mosby's manual of diagnostic and laboratory test. 2010. 4th ed. St. Louis: Mosby;74–101.

8. Kaneko H, Matsui E, Asano T, Kato Z, Teramoto T, Aoki M, et al. Suppression of IFN-gamma production in atopic group at the acute phase of RSV infection. Pediatr Allergy Immunol. 2006. 17:370–375.

9. Papadopoulos NG, Stanciu LA, Papi A, Holgate ST, Johnston SL. A defective type 1 response to rhinovirus in atopic asthma. Thorax. 2002. 57:328–332.

10. Corne JM, Marshall C, Smith S, Schreiber J, Sanderson G, Holgate ST, et al. Frequency, severity, and duration of rhinovirus infections in asthmatic and non-asthmatic individuals: a longitudinal cohort study. Lancet. 2002. 359:831–834.

11. Wark PA, Johnston SL, Bucchieri F, Powell R, Puddicombe S, Laza-Stanca V, et al. Asthmatic bronchial epithelial cells have a deficient innate immune response to infection with rhinovirus. J Exp Med. 2005. 201:937–947.

12. Iikura K, Katsunuma T, Saika S, Saito S, Ichinohe S, Ida H, et al. Peripheral blood mononuclear cells from patients with bronchial asthma show impaired innate immune responses to rhinovirus in vitro. Int Arch Allergy Immunol. 2011. 155:Suppl 1. 27–33.

13. Choi BG, Lee DW, Kim YH, Hyun MC, Lee HJ. Clinical aspects of pneumonia with tachypnea in pediatric patients with influenza H1N1. Pediatr Allergy Respir Dis. 2010. 20:114–121. (Korea).

14. Lee HJ, Min SJ, Choi JH, Kang EK. Clinical characteristics of hospitalized pediatric patients with 2009 novel influenza A infection. Pediatr Allergy Respir Dis. 2010. 20:130–137. (Korea).

15. Martinez FD, Wright AL, Taussig LM, Holberg CJ, Halonen M, Morgan WJ. The Group Health Medical Associates. Asthma and wheezing in the first six years of life. N Engl J Med. 1995. 332:133–138.

16. Henderson J, Granell R, Heron J, Sherriff A, Simpson A, Woodcock A, et al. Associations of wheezing phenotypes in the first 6 years of life with atopy, lung function and airway responsiveness in mid-childhood. Thorax. 2008. 63:974–980.

17. Hasegawa S, Hirano R, Hashimoto K, Haneda Y, Shirabe K, Ichiyama T. Characteristics of atopic children with pandemic H1N1 influenza viral infection: pandemic H1N1 influenza reveals 'occult' asthma of childhood. Pediatr Allergy Immunol. 2011. 22(1 Pt 2):e119–e123.

18. Hasegawa M, Hashimoto K, Morozumi M, Ubukata K, Takahashi T, Inamo Y. Spontaneous pneumomediastinum complicating pneumonia in children infected with the 2009 pandemic influenza A (H1N1) virus. Clin Microbiol Infect. 2010. 16:195–199.

TOOLS

Similar articles