We wanted to test the hypothesis that the efficacy of systemic
corticosteroid is associated with atopic characteristics in
wheezing children. A randomized controlled trial comparing oral
prednisolone (2 mg/kg/day in 3 divided doses for 3 days) with placebo in hospitalized
wheezing children (n = 266, median 1.6 years, range 3 months to 15.2 years) was conducted. In this post-hoc analysis, we assessed the link between the efficacy of
prednisolone and several atopic characteristics, such as atopy, aeroallergen sensitization, total
IgE level, number of sensitizations,
eczema, atopic eczema, blood or nasal eosinophils, exhaled
nitric oxide, positive modified
asthma predictive index/
asthma, inhaled
corticosteroid medication and parental
asthma/
allergy. Virology was studied comprehensively. Our primary endpoint was the time until ready for discharge, and the most important secondary endpoint was the occurrence of relapses during the following 2 months. For statistics, we used interaction analyses in uni- and multivariate regression models. Overall,
prednisolone did not decrease any of our predefined clinical endpoints. Neither was the efficacy of
prednisolone associated with atopy. However,
prednisolone significantly decreased the time until ready for discharge in children with positive modified
asthma predictive index/
asthma, inhaled
corticosteroids, or rhinovirus
infection and/or in children without
azithromycin treatment.
Prednisolone significantly decreased relapses in children with
eczema, nasal
eosinophilia and rhinovirus
infection. The multiple clinical, inflammatory and
viral markers associating with the efficacy of
prednisolone should be confirmed in prospective trials. It is important that
corticosteroid intervention trials have strict design for these potentially confounding factors.