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  • Clinical Research Article
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Allergy and atopic phenotype are associated with earlier gestation and severity of respiratory symptoms in bronchopulmonary dysplasia

Pediatric Research (2025)Cite this article

Abstract

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.

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Data availability

The data supporting this study’s findings are available from the BPD Collaborative. However, restrictions apply to the availability of these data, and so they are not publicly available. Data are available from the authors upon reasonable request and with permission of the BPD Collaborative.

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Acknowledgements

No financial assistance was received in support of this study.

Author information

Authors and Affiliations

  1. Eudowood Division of Pediatric Respiratory Sciences, Johns Hopkins University, Baltimore, MD, USA

    Brianna C. Aoyama & Joseph M. Collaco

  2. Division of Pulmonary Medicine, Arkansas Children’s Hospital and University of Arkansas for Medical Sciences, Little Rock, AR, USA

    Amit Agarwal

  3. Division of Neonatology, Children’s Mercy-Kansas City and University of Missouri Kansas City School of Medicine, Kansas City, Missouri, USA

    Gangaram Akangire & Winston M. Manimtim

  4. Pulmonary Medicine, Vanderbilt University and Vanderbilt University Medical Center, Nashville, TN, USA

    Eric D. Austin & Paul E. Moore

  5. Pulmonology and Sleep Medicine, Children’s Hospital of Los Angeles, Los Angeles, CA, USA

    Manvi Bansal

  6. Division of Pulmonary Medicine, Children’s Hospital of Philadelphia and University of Pennsylvania, Philadelphia, PA, USA

    Anita Bhandari & Sharon A. McGrath-Morrow

  7. Division of Pediatric Pulmonology, Allergy and Sleep Medicine, Riley Children’s Hospital and Indiana University, Indianapolis, IN, USA

    A. Ioana Cristea

  8. Division of Pulmonary Medicine, Boston Children’s Hospital and Harvard Medical School, Boston, MA, USA

    Lystra P. Hayden, Jonathan C. Levin & Catherine A. Sheils

  9. Division of Newborn Medicine, Boston Children’s Hospital and Harvard Medical School, Boston, MA, USA

    Jonathan C. Levin

  10. Division of Neonatology, Nationwide Children’s Hospital and Ohio State University, Columbus, OH, USA

    Audrey N. Miller

  11. Pediatric Pulmonology, University of Michigan, Ann Arbor, MI, USA

    Antonia P. Popova

  12. Neonatal-Perinatal Medicine/Pediatric Pulmonology, University of Massachusetts, Worcester, MA, USA

    Lawrence M. Rhein

  13. Section of Pulmonary and Sleep Medicine, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA

    Steven H. Abman & Christopher D. Baker

  14. Department of Pediatrics, Medical College of Wisconsin Milwaukee, Milwaukee, Wisconsin, USA

    Sara K. Dawson, Jennifer K. Henningfeld & Joanne M. Lagatta

  15. Department of Pediatrics, Brown University School of Medicine, Providence, RI, USA

    Mehtap Haktanir Abul

  16. Pediatric Pulmonology, Penn State Health, Hershey, PA, USA

    Roopa Siddaiah

  17. Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Nicole Stephenson

  18. Division of Pediatric Pulmonary and Sleep Medicine, University of Washington, Seattle, WA, USA

    Demet Toprak

Authors
  1. Brianna C. Aoyama
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  2. Joseph M. Collaco
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  3. Amit Agarwal
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  4. Gangaram Akangire
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  5. Eric D. Austin
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  6. Manvi Bansal
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  7. Anita Bhandari
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  8. A. Ioana Cristea
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  9. Lystra P. Hayden
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  10. Jonathan C. Levin
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  11. Winston M. Manimtim
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  12. Audrey N. Miller
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  13. Paul E. Moore
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  14. Antonia P. Popova
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  15. Lawrence M. Rhein
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  16. Catherine A. Sheils
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  17. Steven H. Abman
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  18. Christopher D. Baker
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  19. Sara K. Dawson
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  20. Mehtap Haktanir Abul
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  21. Jennifer K. Henningfeld
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  22. Joanne M. Lagatta
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  23. Roopa Siddaiah
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  24. Nicole Stephenson
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  25. Demet Toprak
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  26. Sharon A. McGrath-Morrow
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Contributions

Contribution to conception and design, analysis, and interpretation of data: B.C. A., S.A.M.-M., J.M.C.; Acquisition of data: G.G.A., A.A., B.C.A., E.D.A., M.B., A.B., J.M.C., A. I.C., S.K.D., J.C.L., S.A.M.-M., P.E.M., C.A.S.; Drafting the manuscript: B.C.A., S.A.M.-M., J.M.C.; Revising the manuscript critically for intellectual content and final approval for version to be published: S.H.A., A.A., B.C.A., G.G.A., E.D.A., C.D.B., M.B., A.B., J.M. C., A. I.C., S.K.D., M.H.A., J.K.H., J.M.L., J.C.L., SA.M.-M., P.E.M., L.M.R., C.A.S., R.S., N. S., D.T..

Corresponding author

Correspondence to Brianna C. Aoyama.

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Aoyama, B.C., Collaco, J.M., Agarwal, A. et al. Allergy and atopic phenotype are associated with earlier gestation and severity of respiratory symptoms in bronchopulmonary dysplasia. Pediatr Res (2025). https://doi.org/10.1038/s41390-025-04277-6

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  • DOI: https://doi.org/10.1038/s41390-025-04277-6

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