Low Allergic Sensitisation in Wheezing Children With Down Syndrome: A Case–Control Study

BACKGROUND: Respiratory disorders are frequent in children with Down syndrome (DS), causing prolonged hospitalisations and increased healthcare system costs. Among these, recurrent wheezing is common in these children despite indications of lower rates of allergic sensitisation and asthma. This discrepancy is concerning because wheezing is often misinterpreted as asthma, leading to inappropriate treatment. Therefore, this study compared the profiles of allergic sensitisation among children with wheezing with and without DS. METHODS: This case-control study retrospectively reviewed medical records of children (2-12 years) with recurrent wheezing, comparing 98 with DS (cases) and 96 without DS (controls). Clinical variables (pneumonia episodes, respiratory hospitalisations), biological markers (serum total IgE, eosinophil counts) and aeroallergen sensitisation (skin prick tests and/or specific IgE) were analysed. Multivariate logistic regression was used to calculate adjusted odds ratios (OR). We analysed 194 children aged 2-12 years with recurrent wheezing, including 98 with DS (cases) and 96 without (controls). RESULTS: Allergic sensitisation was less prevalent in children with DS (7.1%) than in the control group (59.3%). Analysis revealed that DS was a protective factor, indicating that children with DS were 95% less likely to be sensitised than those without DS. Additionally, children with DS had significantly lower eosinophil counts and total IgE levels. Among sensitised children, allergic profiles were similar between groups, with Dermatophagoides farinae as the most common allergen. CONCLUSION: The findings support the hypothesis of a non-allergic wheezing phenotype in children with DS, highlighting the need for individualised, precision-based management to optimise respiratory care in this population.