Home Environment Risk Factors in Toddlers With Recurrent Wheeze: The Windows Study

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Abstract Rationale: Environmental exposures may play an important role in recurrent wheeze progression to persistent asthma in the early-childhood period. WINDOWS is a longitudinal cohort study of toddlers with a history of ≥3 wheezing episodes aimed at differentiating molecular, clinical, and environmental features in asthma development. The objective of this cross-sectional sub-study is to define home environment risk factors and determine their associations with type 2 inflammation (T2) biomarkers. Methods: WINDOWS participants were recruited from the Denver region and aged 18-36 months at time of enrollment. In addition to history of recurrent wheeze, inclusion required public insurance or home address in high-poverty census tracts, and gestational age >32 weeks. Caregivers completed a survey to assess the presence of 10 home environment risk factors for asthma (Figure). We developed a composite home environment risk score (HErisk) on a 0-1 scale by averaging the total number of present risk factors. T2 biomarkers (eosinophils, total and aeroallergen-specific IgE) were measured from participant blood samples. Median (IQR) and proportions are reported. Univariate generalized linear regression models were fit to evaluate relationships between HErisk, dog, cat, and mold home exposures and T2 outcomes. Results: Of the 119 participants in the cohort, 110 had paired home environment survey and biomarker results. These children were 2.64 (2.07-2.99) years old, 63% male, and 44% Hispanic. HErisk was 0.40 (0.30-0.56). Of T2 biomarkers, 47% had abnormally elevated eosinophils ≥0.24 103/mcl [0.22 (0.15-0.41)103/mcl], 44% had total IgE >45 kUA/L [31.60 (12.10-105.50)kUA/L], and 40% were sensitized to ≥1 aeroallergen (sIgE≥0.35kUA/L). The top three sensitizations were to dog (30%), cat (24%), and Alternaria alternata (11%). Cat or mold exposure and HErisk were not predictive of elevated T2 markers. Dog exposure was not associated with eosinophils. However, having a dog in the home was associated with an average 5.14 kUA/L [95%CI 0.92,9.35] increase in dog allergen IgE (p=0.017) and an average 77.48 kUA/L [95% CI 14.69,140.28] increase in total IgE (p=0.016). Conclusions: More than half of the toddler-aged participants were exposed to six of the ten home environment risk factors, and almost half exhibited elevated T2 biomarkers. Exposure to dog dander at home in 47% of participants had a measurable impact on IgE levels, emphasizing the early role of aeroallergen exposure in emerging atopy that contributes to developing asthma. Further investigation of non-T2 inflammatory responses is warranted to understand the impact of other home environment risk factors on developing asthma in high-risk toddlers.

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