TY - JOUR

T1 - Bronchiolitis needs a revisit

T2 - Distinguishing between virus entities and their treatments

AU - Jartti, Tuomas

AU - Smits, Hermelijn H

AU - Bønnelykke, Klaus

AU - Bircan, Ozlem

AU - Elenius, Varpu

AU - Konradsen, Jon R

AU - Maggina, Paraskevi

AU - Makrinioti, Heidi

AU - Stokholm, Jakob

AU - Hedlin, Gunilla

AU - Papadopoulos, Nikolaos

AU - Ruszczynski, Marek

AU - Ryczaj, Klaudia

AU - Schaub, Bianca

AU - Schwarze, Jürgen

AU - Skevaki, Chrysanthi

AU - Stenberg-Hammar, Katarina

AU - Feleszko, Wojciech

AU - EAACI Task Force on Clinical Practice Recommendations on Preschool Wheeze

N1 - © 2018 The Authors. Allergy Published by John Wiley & Sons Ltd.

PY - 2019/1

Y1 - 2019/1

N2 - Current data indicate that the "bronchiolitis" diagnosis comprises more than one condition. Clinically, pathophysiologically, and even genetically three main clusters of patients can be identified among children suffering from severe bronchiolitis (or first wheezing episode): (a) respiratory syncytial virus (RSV)-induced bronchiolitis, characterized by young age of the patient, mechanical obstruction of the airways due to mucus and cell debris, and increased risk of recurrent wheezing. For this illness, an effective prophylactic RSV-specific monoclonal antibody is available; (b) rhinovirus-induced wheezing, associated with atopic predisposition of the patient and high risk of subsequent asthma development, which may, however, be reversed with systemic corticosteroids in those with severe illness; and (c) wheeze due to other viruses, characteristically likely to be less frequent and severe. Clinically, it is important to distinguish between these partially overlapping patient groups as they are likely to respond to different treatments. It appears that the first episode of severe bronchiolitis in under 2-year-old children is a critical event and an important opportunity for designing secondary prevention strategies for asthma. As data have shown bronchiolitis cannot simply be diagnosed using a certain cutoff age, but instead, as we suggest, using the viral etiology as the differentiating factor.

AB - Current data indicate that the "bronchiolitis" diagnosis comprises more than one condition. Clinically, pathophysiologically, and even genetically three main clusters of patients can be identified among children suffering from severe bronchiolitis (or first wheezing episode): (a) respiratory syncytial virus (RSV)-induced bronchiolitis, characterized by young age of the patient, mechanical obstruction of the airways due to mucus and cell debris, and increased risk of recurrent wheezing. For this illness, an effective prophylactic RSV-specific monoclonal antibody is available; (b) rhinovirus-induced wheezing, associated with atopic predisposition of the patient and high risk of subsequent asthma development, which may, however, be reversed with systemic corticosteroids in those with severe illness; and (c) wheeze due to other viruses, characteristically likely to be less frequent and severe. Clinically, it is important to distinguish between these partially overlapping patient groups as they are likely to respond to different treatments. It appears that the first episode of severe bronchiolitis in under 2-year-old children is a critical event and an important opportunity for designing secondary prevention strategies for asthma. As data have shown bronchiolitis cannot simply be diagnosed using a certain cutoff age, but instead, as we suggest, using the viral etiology as the differentiating factor.

KW - Adrenal Cortex Hormones/therapeutic use

KW - Antibodies, Monoclonal/therapeutic use

KW - Bronchiolitis/diagnosis

KW - Child

KW - Child, Preschool

KW - Humans

KW - Respiratory Sounds/etiology

KW - Respiratory Syncytial Viruses

KW - Rhinovirus

U2 - 10.1111/all.13624

DO - 10.1111/all.13624

M3 - Review

C2 - 30276826

VL - 74

SP - 40

EP - 52

JO - Allergy: European Journal of Allergy and Clinical Immunology

JF - Allergy: European Journal of Allergy and Clinical Immunology

SN - 0105-4538

IS - 1

ER -