The influence of respiratory syncytial virus immunoprophylaxis on allergic sensitisation in children with respiratory allergy.

Background: Respiratory syncytial virus (RSV) infection may induce asthma and allergic sensitisation. RSV immunoprophylaxis can reduce the severity of RSV infections. However, the effects of RSV immunoprophylaxis on allergic sensitisation remains unclear. We aimed to explore effects of palivizumab, an anti-RSV monoclonal antibody on subsequent IgE sensitisation in preterm children aged ≤18 years with asthma or allergic rhinitis.

Methods: This retrospective study included 854 preterm children who were followed up and diagnosed with asthma or allergic rhinitis before 18 years old from January 1999 to December 2020. Binary logistic regression was used to investigate effects of palivizumab on the development of IgE sensitisation to aeroallergens or food allergens; the model was adjusted for birth weight, gestational age, foetal growth, sex, and delivery method.

Results: Palivizumab could decrease risks of aeroallergen sensitisation until 18 years of age, (adjusted odds ratio (aOR) 0.34, 95 % CI 0.17-0.67, p = 0.002) and as well as in those 7 and 12 years of age. Children receiving palivizumab prophylaxis had lower total sIgE levels (p < 0.001) and eosinophil counts (p = 0.038) than those without prophylaxis. Among asthmatic children, those receiving palivizumab had a shorter duration of active asthma (p < 0.001). In allergic rhinitis population, palivizumab prophylaxis required fewer intranasal corticosteroid (p < 0.001).

Conclusion: In preterm children with asthma or allergic rhinitis, early palivizumab prophylaxis may protect against future aeroallergen sensitisation before adulthood. Palivizumab prophylaxis could also decrease the duration of active asthma in asthmatic children and intranasal corticosteroid prescriptions in allergic rhinitis population.