Long-term risk of allergic disorders following Kawasaki disease: a population-based cohort study

Abstract

Background: Kawasaki disease (KD) is an acute systemic vasculitis primarily affecting children under five years old. While its etiology remains unclear, immune dysregulation has been implicated, suggesting a potential link between KD and allergic diseases. Previous epidemiological studies have reported inconsistent findings regarding this association across different countries. This study aims to investigate the association between KD and allergic diseases in Korea.

Methods: A nationwide population-based cohort study was conducted utilizing data from the Korean National Health Insurance database. KD cases were defined as admissions with a primary diagnosis of KD plus treatment records for immunoglobulin or aspirin. The control group had no KD diagnosis. Between 2008 and 2015, 41,806 KD cases were matched 1:4 with 163,548 controls using propensity score matching. The incidence and prevalence of asthma, rhinitis, atopic dermatitis, and urticaria from 2017 to 2021 were analyzed using hazard ratios (HRs) and odds ratios (ORs).

Results: Mean age was 2.63 ± 1.84 years for KD patients and 2.64 ± 1.85 years for controls (P = 0.119). The proportion of females was 42.20% in the KD group and 42.60% in the control group (P = 0.145). KD patients showed significantly higher risks for developing rhinitis (HR 1.045, 95%CI 1.013-1.078) and urticaria (HR 1.139, 95%CI 1.085-1.197). However, no significant association was found in the incidence of asthma or atopic dermatitis. KD diagnosis at age 5 or older was associated with decreased risk of all allergic disorders. The prevalence of all allergic disorders studied was significantly higher in the KD group, with the strongest associations observed for rhinitis (OR 1.178, 95%CI 1.151-1.205) and urticaria (OR 1.192, 95%CI 1.155-1.230). Gender and urban living also influenced the prevalence of allergic disorders. A sensitivity analysis conducted to account for the COVID-19 pandemic showed consistent results, confirming the association between KD and increased risk and prevalence of allergic disorders.

Conclusions: This study demonstrates a significant association between Kawasaki disease and increased risk of allergic disorders, particularly rhinitis and urticaria. These findings suggest potential shared pathogenesis between the two conditions and highlight the need for long-term monitoring of allergic conditions in KD patients.