Atopic asthma as a potentially significant but unrecognized risk factor for Kawasaki disease in children

Abstract

Objectives

Childhood asthma is known to be associated with risks of both respiratory and non-respiratory infections. Little is known about the relationship between asthma and the risk of Kawasaki disease (KD). We assessed associations of asthma status and asthma phenotype (e.g. atopic asthma) with KD.

Methods

We performed a population-based retrospective case-control study, using KD cases between January 1, 1979, and December 31, 2016, and two matched controls per case. KD cases were defined by the American Heart Association diagnostic criteria. Asthma status prior to KD (or control) index dates was ascertained by the two asthma criteria, Predetermined Asthma Criteria (PAC) and Asthma Predictive Index (API, a surrogate phenotype of atopic asthma). We assessed whether 4 phenotypes (both PAC + and API+; PAC + only; API + only, and non-asthmatics) were associated with KD.

Results

There were 124 KD cases during the study period. The group having both PAC + and API + was significantly associated with the increased odds of KD, compared to non-asthmatics (odds ratio [OR] 4.3; 95% CI: 1.3 − 14.3). While asthma defined by PAC was not associated with KD, asthma defined by PAC positive with eosinophilia (≥4%) was significantly associated with the increased odds of KD (OR: 6.7; 95% CI: 1.6 − 28.6) compared to non-asthmatics. Asthma status defined by API was associated with KD (OR = 4.7; 95% CI: 1.4–15.1).

Conclusions

Atopic asthma may be associated with increased odds of KD. Further prospective studies are needed to determine biological mechanisms underlying the association between atopic asthma and increased odds of KD.

Keywords:

• Epidemiology
• pediatrics
• phenotypes

Acknowledgements

We would like to thank Ms. Kelly Okeson for her administrative assistance whom has no financial relationships or conflicts of interest relevant to this article to disclose. This work was supported by National Institutes of Health grants R01 HL126667 and the Mayo Foundation.

Author contributions

Contributors Dr. Choi conceptualized and designed the study, drafted the article, and contributed to the acquisition of data, or analysis, and interpretation of data. Drs. Wi, Ryu, Boyce, Johnson, Taslakian, and Juhn conceptualized and designed the study, contributed to the acquisition of data, or analysis, and interpretation of data, and critically reviewed and revised the manuscript. Drs. Shin, Seol, Kwon and Ms. King contributed to the acquisition of data, or analysis, and interpretation of data and critically reviewed and revised the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.

Additional information

Funding

This work was supported by National Institutes of Health grants R01 HL126667 and the Mayo Foundation. The funding sources had no involvement in study design, in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the article for publication.