J Korean Med Sci.  2010 Mar;25(3):425-428. 10.3346/jkms.2010.25.3.425.

Relationship between Silent Gastroesophageal Reflux and Food Sensitization in Infants and Young Children with Recurrent Wheezing

• Kang SK
• Kim JK
• Ahn SH
• Oh JE
• Kim JH
• Lim DH
• Son BK

• KMID: 1778038
• DOI: http://doi.org/10.3346/jkms.2010.25.3.425

Abstract

It is known that early childhood wheezing associated with sensitization to allergens, including food, has an increased risk of developing asthma later during school age. Gastroesophageal reflux (GER) is well known to be associated with asthma. The purpose of this study was to determine whether there is an association between silent GER and food sensitization in infants and young children with recurrent wheezing. Eighty-five infants or young children with recurrent wheezing, and no gastrointestinal symptoms, underwent 24 hr esophageal pH monitoring, as well as total serum IgE and specific IgE testing for eggs and milk. Among the 85 subjects, 48.2% had significant GER. There was no significant difference in the GER between atopic and non-atopic recurrent wheezers (41.7% and 50.8%, respectively). The sensitization rate to food (eggs or milk) was 12.2% and 20.5% in the GER and non-GER groups, respectively and showed no statistically significant difference between the two groups (P=0.34). In conclusion, about half of infants and young children with recurrent wheezing and no gastrointestinal symptoms have silent GER. The silent GER may not contribute to food sensitization in infants and young children with recurrent wheezing.

Keyword

Recurrent Wheezer; Infant; Gastroesophageal Reflux; Food Antigen Sensitization

MeSH Terms

Allergens/immunology
Child, Preschool
Esophageal pH Monitoring
Female
*Food Hypersensitivity/etiology/immunology
*Gastroesophageal Reflux/complications/immunology
Humans
Infant
Male
*Respiratory Sounds/etiology/immunology
Allergens

Reference

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

2. Wennergren G, Amark M, Amark K, Oskarsdóttir S, Sten G, Redfors S. Wheezing bronchitis reinvestigated at the age of 10 years. Acta Paediatr. 1997. 86:351–355.

3. Payne DN, Rogers AV, Adelroth E, Bandi V, Guntupalli KK, Bush A, Jeffery PK. Early thickening of the reticular basement membrane in children with difficult asthma. Am J Respir Crit Care Med. 2003. 167:78–82.

4. Guilbert TW, Morgan WJ, Krawiec M, Lemanske RF, Sorkness C, Szefler SJ, Larsen G, Spahn JD, Zeiger RS, Heldt G, Strunk RC, Bacharier LB, Bloomberg GR, Chinchilli VM, Boehmer SJ, Mauger EA, Mauger DT, Taussig LM, Martinez FD. The prevention of early asthma in kids study: design, rationale and methods for the childhood asthma research and education network. Control Clin Trials. 2004. 25:286–310.

5. Illi S, von Mutius E, Lau S, Nickel R, Niggemann B, Sommerfeld C, Wahn U. Multicenter Allergy Study Group. The pattern of atopic sensitization is associated with the development of asthma in childhood. J Allergy Clin Immunol. 2001. 108:709–714.

6. Ay M, Sivasli E, Bayraktaroglu Z, Ceylan H, Coskun Y. Association of asthma with gastroesophageal reflux disease in children. J Chin Med Assoc. 2004. 67:63–66.

7. Cinquetti M, Micelli S, Voltolina C, Zoppi G. The pattern of gastroesophageal reflux in asthmatic children. J Asthma. 2002. 39:135–142.

8. Khoshoo V, Le T, Haydel RM Jr, Landry L, Nelson C. Role of gastroesophageal reflux in older children with persistent asthma. Chest. 2003. 123:1008–1013.

9. Salvatore S, Vandenplas Y. Gastroesophageal reflux and cow milk allergy: is there a link? Pediatrics. 2002. 110:972–984.

10. Meer S, Groothuis JR, Harbeck R, Liu S, Leung DY. The potential role of gastroesophageal reflux in the pathogenesis of food-induced wheezing. Pediatr Allergy Immunol. 1996. 7:167–170.

11. Kiljander TO, Salomaa ER, Hietanen EK, Terho EO. Gastroesophageal reflux in asthmatics: a double-blind, placebo-controlled crossover study with omeprazole. Chest. 1999. 116:1257–1264.

12. Yüksel H, Yilmaz O, Kirmaz C, Aydoğdu S, Kasirga E. Frequency of gastroesophageal reflux disease in nonatopic children with asthma-like airway disease. Respir Med. 2006. 100:393–398.

13. Harding SM, Guzzo MR, Richter JE. The prevalence of gastroesophageal reflux in asthma patients without reflux symptoms. Am J Respir Crit Care Med. 2000. 162:34–39.

14. Vandenplas Y, Goyvaerts H, Helven R, Sacre L. Gastroesophageal reflux, as measured by 24-hour pH monitoring, in 509 healthy infants screened for risk of sudden infant death syndrome. Pediatrics. 1991. 88:834–840.

15. Jain A, Patwari AK, Bajaj P, Kashyap R, Anand VK. Association of gastroesophageal reflux disease in young children with persistent respiratory symptoms. J Trop Pediatr. 2002. 48:39–42.

16. Kjellén G, Brundin A, Tibbling L, Wranne B. Oesophageal function in asthmatics. Eur J Respir Dis. 1981. 62:87–94.

17. Sheikh S, Stephen T, Howell L, Eid N. Gastroesophageal reflux in infants with wheezing. Pediatr Pulmonol. 1999. 28:181–186.

18. Hong CS, Shim JY, Kim BS, Park KY, Kim KM. Prevalence of gastroesophageal reflux in infants with recurrent wheezing. J Asthma Allergy Clin Immunol. 1999. 19:576–583.

19. Koh MS, Irving LB. The natural history of asthma from childhood to adulthood. Int J Clin Pract. 2007. 61:1371–1374.

20. Taussig LM, Wright AL, Holberg CJ, Halonen M, Morgan WJ, Martinez FD. Tucson Children's Respiratory Study: 1980 to present. J Allergy Clin Immunol. 2003. 111:661–675.