Juan C. Celedón

Background Little is known about the determinants of asthma among youth with high T helper 2 (Th2) immunity. We hypothesized that exposure to violence (ETV) and violence‐related distress are associated with asthma in children and adolescents with high Th2 immunity. Methods We analyzed data from Puerto Ricans with high Th2 immunity aged 9−20 years in the Puerto Rico Genetics of Asthma and Lifestyle (PR‐GOAL) and the Epigenetic Variation of Childhood Asthma in Puerto Ricans (EVA‐PR) studies, and in a prospective study (PROPRA). High Th2‐immunity was defined as ≥1 positive allergen‐specific IgE and/or a total IgE ≥ 100 IU/mL and/or an eosinophil count ≥ 150 cells/μL. Asthma was defined as physician‐diagnosed asthma and current wheeze. ETV and violence‐related distress were assessed with the validated ETV Scale and Checklist of Children's Distress Symptoms (CCDS) questionnaires, respectively. Results In multivariable analyses, each 1‐point increment in ETV score was significantly associated with 1.13−1.17 times increased odds of asthma in PR‐GOAL and in EVA‐PR (both at p ≤ 0.01), and each 1‐point increment in CCDS score was significantly associated with 1.53‐1.54 increased odds of asthma in PR‐GOAL and in EVA‐PR (both at p ≤ 0.03). Further, a persistently high ETV score was significantly associated with asthma in PROPRA (odds ratio [OR] = 2.83, 95% confidence interval [CI] = 1.10−7.29). Similar results were obtained in a sensitivity analysis using an eosinophil count ≥ 300 cells/μL instead of ≥150 cells/μL to define high Th2 immunity. Conclusions ETV during childhood is associated with increased risk of persistent or new‐onset asthma in youth with high Th2 immunity.