Allergy and atopic phenotype are associated with earlier gestation and severity of respiratory symptoms in bronchopulmonary dysplasia.

Background: A history of atopy is associated with respiratory morbidities in term-born children; however, little is known about how allergies/atopy affect respiratory outcomes in children with bronchopulmonary dysplasia (BPD). This study aims to describe the prevalence of reported allergies/atopy in young children with BPD and assess whether allergies/atopy are associated with outpatient outcomes.

Methods: A retrospective longitudinal cohort study of children between 0 and 36 months of age followed at outpatient BPD clinics was performed using data from questionnaires administered during routine clinical encounters. The presence of allergy/atopy was defined by caregiver questionnaires. Generalized estimating equations were used to adjust associations between allergy/atopy and respiratory outcomes.

Results: Rates of reported allergy/atopy in a cohort of infants and children with BPD (21.6%) were similar to previously published rates in healthy children. Children with atopy/allergy were more likely to be born at earlier gestational ages, have pulmonary hypertension, and be non-white and non-Hispanic compared to their non-atopic peers and to experience trouble breathing, nighttime symptoms, activity limitations, and rescue medication use during the first three years of life.

Conclusions: In children with BPD, allergy/atopy was more common among those born at earlier gestational ages and was significantly associated with increased respiratory symptoms during the first 3 years of life. Further studies are needed to assess whether the association between allergy/atopy and increased respiratory morbidity persists throughout childhood and affects later lung function and whether potential interventions, including inhaled steroids, may modify this risk.

Impact: There is limited data on the prevalence of atopy/allergy in children with bronchopulmonary dysplasia (BPD) and the association between allergy/atopy and respiratory outcomes in this population. Our findings demonstrate that in children with BPD, allergy/atopy was more common among those born at earlier gestational ages and was associated with increased respiratory symptoms and rescue medication use during the first 3 years of life. Further studies are needed to determine whether this association persists throughout childhood and affects later lung function and whether potential interventions may modify this risk.