Kawasaki Disease Associated With Elevated Risk of Developing Asthma

Children with Kawasaki disease (KD) are more likely to develop asthma and allergic rhinitis compared with individuals without KD, according to a meta-analysis published in Frontiers in Pediatrics.

Studies suggest that children with KD have an elevated prevalence of asthma before or after KD, and there is evidence that KD is the result of an “exaggerated immune response similar to asthma with type 2 inflammation,” the authors noted.

They conducted a meta-analysis using an electronic systematic literature search to investigate the long-term risks of KD patients with allergic disease. A total of 4 studies reporting asthma among patients with KD were included in the meta-analysis. The studies were from 4 countries—Israel, Singapore, Japan, and Taiwan—and represented 8474 patients.

The studies were published between 1997 and 2016 and the sample sizes ranged from 93 to 7072. The assessment methods used were interview via telephone, questionnaire, code in database, or medical records. All 4 studies included asthma and allergic rhinitis, while only 3 studies evaluated atopic dermatitis.

Of the 8474 children with KD, 773 were also diagnosed with asthma. Based on the pooled estimated odds ratio of children having KD compared with those who did not, the authors found a statistically significant difference (P = .017) and an association between KD and asthma.

They also found that children with KD had more atopic dermatitis and were more likely to have allergic rhinitis than those in the control groups. For atopic dermatitis, it did not reach statistical significance.

Although the meta-analysis identified an association between previous KD and asthma and allergic rhinitis, the researchers noted that factors such as family history or environment were not taken into account.

They conjectured that the reason there was no association between atopic dermatitis and KD was because “children with atopic dermatitis are younger, even younger than KD patients.” In fact, they determined that the results of the meta-analysis would show significantly higher comorbidity rates of atopic dermatitis in patients with KD if they replaced the search in the Taiwan Health Insurance Database with atopic dermatitis comorbid with KD.

Among the limitations of the study were the fact that the meta-analysis only included case-control/cross-section designs with no cohort studies, which meant the authors could not “investigate the relationship between the gender, ethnicity, and age differences at the time of KD diagnosis and the subsequent development of allergic diseases or the increasing risk per year following KD for each disease.”

Another limitation of the study was the different methods for determining KD.

“In conclusion, the results of this meta-analysis provided consistent evidence of an association between KD and subsequent asthma and allergic rhinitis,” the authors concluded. “Physicians should be aware of the distinct clinical presentations of allergic diseases and set up a tracking plan of KD even to adulthood.”

Reference

Lei W-T, Hsu C-W, Chen P-C, et al. Increased risk of asthma and allergic rhinitis in patients with a past history of Kawasaki disease: a systematic review and meta-analyses. Front Pediatr. Published online December 20, 2021. doi:10.3389/fped.2021.746856