Palivizumab Exposure and the Risk of Atopic Dermatitis, Asthma and Allergic Rhinoconjunctivitis: A Cross-National, Population-Based Cohort Study

Hærskjold, Ann; Stokholm, Lonny; Linder, Marie; Thomsen, Simon Francis; Bergman, Gunnar; Berglind, Ingegärd Anveden; Kieler, Helle; Ravn, Henrik; Stensballe, Lone Graff

doi:10.1007/s40272-017-0215-7

Cited by 6 publications

(7 citation statements)

References 21 publications

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“… 18 In standard care, infants receiving RSV immunoprophylaxis tend to have poorer baseline health status than those who do not, even within groups at high risk. 20 , 21 Consequently, observational RSV immunoprophylaxis studies require particular care to limit confounding by indication, 22 in addition to other biases. 18 Properly done immunoprophylaxis randomised controlled trials (RCTs) eliminate confounding by indication.…”

Section: Introductionmentioning

confidence: 99%

Assessing the strength of evidence for a causal effect of respiratory syncytial virus lower respiratory tract infections on subsequent wheezing illness: a systematic review and meta-analysis

Brunwasser

Snyder

Driscoll

et al. 2020

The Lancet Respiratory Medicine

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Summary Background Although a positive association has been established, it is unclear whether lower respiratory tract infections (LRTIs) with respiratory syncytial virus (RSV) cause chronic wheezing illnesses. If RSV-LRTI were causal, we would expect RSV-LRTI prevention to reduce the incidence of chronic wheezing illnesses in addition to reducing acute disease. We aimed to evaluate the strength of evidence for a causal effect of RSV-LRTI on subsequent chronic wheezing illness to inform public health expectations for RSV vaccines. Methods We did a systematic review and meta-analysis of observational studies evaluating the association between RSV-LRTI and subsequent wheezing illness (exposure studies) and studies evaluating the association between RSV immunoprophylaxis and subsequent wheezing illness (immunoprophylaxis studies). Exposure studies were included if the exposure group members had an LRTI with laboratory-confirmed RSV and if the exposure ascertainment period began before 2 years of age and ended before 5 years of age. We required a wash-out period of more than 30 days between the index RSV-LRTI and the outcome measurement to allow for resolution of the acute illness. Comparisons between RSV-LRTI and non-RSV-LRTI were not included. Immunoprophylaxis studies were included if they measured the association with subsequent wheezing illness relative to a control group, either in a randomised controlled trial (RCT) or an observational design. For the immunoprophylaxis drugs in question, we required evidence of efficacy in targeting RSV-LRTI from at least one RCT to ensure biological plausibility. All variations of wheezing illness were combined into a single outcome that refers broadly to asthma or any other respiratory illness with wheezing symptoms. Ovid MEDLINE and Embase databases were searched from inception up to Aug 28, 2018. We evaluated whether data from exposure studies could provide evidence against the most viable non-causal theory that RSV-LRTI is a marker of respiratory illness susceptibility rather than a causal factor. Additionally, we tested whether RSV immunoprophylaxis reduces the odds of subsequent wheezing illnesses. We used a random-effects modelling framework and, to accommodate studies providing multiple correlated estimates, robust variance estimation meta-regressions. Meta-regression coefficients ( b ) quantify differences between exposure and comparator groups on the log e odds ratio (log e OR) scale. Findings From 14 235 records we identified 57 eligible articles that described 42 studies and provided 153 effect estimates. 35 studies estimated the direct effect of RSV-LRTI on wheezing illnesses (exposure studies) and eight evaluated the effect of RSV immunoprophylaxis (immunoprophylaxis studies). Exposure studies that adjusted for genetic influences yielded a smaller mean adjusted OR estimate (aOR + ...

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Section: Introductionmentioning

confidence: 99%

Assessing the strength of evidence for a causal effect of respiratory syncytial virus lower respiratory tract infections on subsequent wheezing illness: a systematic review and meta-analysis

Brunwasser

Snyder

Driscoll

et al. 2020

The Lancet Respiratory Medicine

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“…Various studies have also produced conflicting evidence regarding asthma development and RSV immunoprophylaxis 44–46 . In a Dutch RCT, Scheltema et al observed that, at 6 years of age, there was a 9.9% reduction in parentally reported current asthma (defined as parent‐reported wheeze or use of asthma medication) in children who had received palivizumab as immunoprophylaxis versus a placebo group, although no reduction in physician‐diagnosed current asthma and no impact on lung function were noted 46 .…”

Section: Long‐term Consequencesmentioning

confidence: 99%

“…In a Dutch RCT, Scheltema et al observed that, at 6 years of age, there was a 9.9% reduction in parentally reported current asthma (defined as parent‐reported wheeze or use of asthma medication) in children who had received palivizumab as immunoprophylaxis versus a placebo group, although no reduction in physician‐diagnosed current asthma and no impact on lung function were noted 46 . Conversely, cohort studies in the United States and Europe did not find any reduction in asthma associated with palivizumab treatment 44,45 …”

Section: Long‐term Consequencesmentioning

confidence: 99%

RSV through the COVID‐19 pandemic: Burden, shifting epidemiology, and implications for the future

Stein

Zar

2023

Pediatric Pulmonology

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Respiratory syncytial virus (RSV) represents a major global healthcare burden, particularly in those under 5 years of age. There is no available vaccine, with treatment limited to supportive care or palivizumab for high-risk children.Additionally, although a causal relationship has not been established, RSV has been associated with the development of asthma or wheezing in some children. The COVID-19 pandemic and the introduction of nonpharmaceutical interventions (NPIs) have caused substantial changes to RSV seasonality and epidemiology. Many countries have experienced an absence of RSV during the time of a typical season, followed by an out-of-season surge upon relaxation of NPI use. These dynamics have disrupted traditional RSV disease patterns and assumptions, but also provide a unique opportunity to learn more about the transmission of RSV and other respiratory viruses, as well as inform future approaches to RSV preventive strategies. Here, we review the RSV burden and epidemiology through the COVID-19 pandemic and discuss how new data may affect future decisions regarding RSV prevention.

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“…A third type of prospective observational study follows non-randomized infants who received RSV mAbs [100][101][102][103][104][105][106][107] or RSV immunoglobulin [102] based on clinical indications and compares RWEC and asthma outcomes in this group to children with similar clinical profiles who did not receive RSV immunoprophylaxis. Some of these studies showed a reduction in RWEC in preschool aged children but no effect on outcomes measured at older ages [100,101,105], one found a reduction in RWEC in nonatopic but not in atopic children [103], and others found no difference in asthma by treatment status [106,107].…”

Section: Observational Studiesmentioning

confidence: 99%

Respiratory syncytial virus vaccine research and development: World Health Organization technological roadmap and preferred product characteristics

Vekemans

Moorthy

Giersing

et al. 2019

Vaccine

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The respiratory syncytial virus causes a considerable respiratory disease burden globally, most markedly in young infants, in low and middle income countries. A diverse product pipeline illustrates the recent intensification of research and development activities for vaccines and monoclonal antibodies against RSV. With the aim to ensure that product development activities are directed to address the public health needs, the World Health Organization has developed a research and development technical roadmap and articulated product characteristics preferences.

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Palivizumab Exposure and the Risk of Atopic Dermatitis, Asthma and Allergic Rhinoconjunctivitis: A Cross-National, Population-Based Cohort Study

Abstract: Exposure to palivizumab neither increased the risk of atopic disease nor protected against asthma.

Cited by 6 publications

References 21 publications

Assessing the strength of evidence for a causal effect of respiratory syncytial virus lower respiratory tract infections on subsequent wheezing illness: a systematic review and meta-analysis

Assessing the strength of evidence for a causal effect of respiratory syncytial virus lower respiratory tract infections on subsequent wheezing illness: a systematic review and meta-analysis

RSV through the COVID‐19 pandemic: Burden, shifting epidemiology, and implications for the future

Respiratory syncytial virus vaccine research and development: World Health Organization technological roadmap and preferred product characteristics

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