Prevalence of allergen sensitization among asthmatic patients with serum total IgE >1000 IU/mL

IF 4.6 2区 医学 Q2 ALLERGY
Wanjun Wang, Lulu Wu, Jing Li, Qiurong Hu
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Our previous article had demonstrated that house dust mite remained the most important allergen in Chinese individuals with asthma.<span><sup>1</sup></span> A raised serum IgE against Aspergillus antigens usually occurred in bronchial asthma, especially a value ≥1000 IU/mL was recommended as the serum total IgE (tIgE) cut-off to diagnose Allergic bronchopulmonary aspergillosis (ABPA).<span><sup>2</sup></span> Therefore, we aim to describe the prevalence of sensitization to common allergens among asthmatic patients with serum tIgE &gt;1000 IU/mL, the extent to which allergy accounts for these individuals is controversial.</p><p>We retrospectively analyzed the laboratory records of 1367 physician-diagnosed asthma patients at the Department of Allergy and Clinical Immunology and Respiratory Medicine, the First Affiliated Hospital of Guangzhou Medical University, who had serum IgE test with a battery of common allergens performed (ImmunoCAP, ThermoFisher) during a 5-year period from January, 2018 through October, 2024. 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Details about the baseline characteristics for patients are in Appendix S1. <i>Dermatophagoides pteronyssimus</i> (69.4%), <i>Aspergillus fumigatus</i> (29.7%), and cat (24.9%) were the three most common positive reactions in the tIgE &gt;1000 individuals. Sensitization to inhalant allergens was significantly common (97.8%) as compared with food allergens (2.2%). The respective proportions for grass pollen, dog, <i>A. alternata</i> and <i>P. notatum</i> were 7.3%, 10.3%, 17.6% and 4.9% (Figure 1). In addition, a graded effect was observed with the serum tIgE level in these patients increasing with the number of positive allergens (<i>r</i> = 0.34, <i>p</i> = 0.047), and the <i>D. pteronyssimus</i> sIgE level (<i>r</i> = 0.52, <i>p</i> = 0.036). However, there was no statistically significant correlation between serum tIgE and Aspergillus sIgE level (Appendix S2).</p><p>Our study focused on whether a fungal allergy must be present in asthma with elevated tIgE, and found that both house dust mites and cat dander were strong sensitizers. We observed that the <i>D. pteronyssimus</i> was still a major perennial allergen source and a significant cause of allergic asthma even in the high tIgE individuals. Some research found that asthmatics with atopic eczema and more allergic multimorbidities would preferentially develop strong Th2 responses against common allergens, such as mite proteases and Fel d1,<span><sup>3, 4</sup></span> then the Th2 response promotes massive IgE release by plasma cells. Our hospital was a tertiary center of Southern China, which had enriched population of asthmatic patients from nationwide. 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引用次数: 0

Abstract

To the Editor,

Allergen sensitization occurs in most patients with asthma. Our previous article had demonstrated that house dust mite remained the most important allergen in Chinese individuals with asthma.1 A raised serum IgE against Aspergillus antigens usually occurred in bronchial asthma, especially a value ≥1000 IU/mL was recommended as the serum total IgE (tIgE) cut-off to diagnose Allergic bronchopulmonary aspergillosis (ABPA).2 Therefore, we aim to describe the prevalence of sensitization to common allergens among asthmatic patients with serum tIgE >1000 IU/mL, the extent to which allergy accounts for these individuals is controversial.

We retrospectively analyzed the laboratory records of 1367 physician-diagnosed asthma patients at the Department of Allergy and Clinical Immunology and Respiratory Medicine, the First Affiliated Hospital of Guangzhou Medical University, who had serum IgE test with a battery of common allergens performed (ImmunoCAP, ThermoFisher) during a 5-year period from January, 2018 through October, 2024. All the patients analyzed had a blood tIgE level >1000 IU/mL. The allergens tested were house dust mite (Dermatophagoides pteronyssimus), grass pollen mix, food mix, cat, dog, Alternaria alternata, Aspergillus and Penicillium notatum. For patients who had multiple measurements performed during the study period, only the first time total serum IgE and specific IgE value were included for analysis. The criteria were excluded for patients with chronic obstructive pulmonary disease, helminth infection, rheumatic disease and tumors. This study was approved by the hospital ethics committee and the need for informed consent was waived.

Our study showed that all the patients were sensitized to at least two allergens and 734 (53.7%) individuals sensitized to more than 5 allergens. Allergic multimorbidities were very commonly found in nearly 98% of all patients’ allergies. Details about the baseline characteristics for patients are in Appendix S1. Dermatophagoides pteronyssimus (69.4%), Aspergillus fumigatus (29.7%), and cat (24.9%) were the three most common positive reactions in the tIgE >1000 individuals. Sensitization to inhalant allergens was significantly common (97.8%) as compared with food allergens (2.2%). The respective proportions for grass pollen, dog, A. alternata and P. notatum were 7.3%, 10.3%, 17.6% and 4.9% (Figure 1). In addition, a graded effect was observed with the serum tIgE level in these patients increasing with the number of positive allergens (r = 0.34, p = 0.047), and the D. pteronyssimus sIgE level (r = 0.52, p = 0.036). However, there was no statistically significant correlation between serum tIgE and Aspergillus sIgE level (Appendix S2).

Our study focused on whether a fungal allergy must be present in asthma with elevated tIgE, and found that both house dust mites and cat dander were strong sensitizers. We observed that the D. pteronyssimus was still a major perennial allergen source and a significant cause of allergic asthma even in the high tIgE individuals. Some research found that asthmatics with atopic eczema and more allergic multimorbidities would preferentially develop strong Th2 responses against common allergens, such as mite proteases and Fel d1,3, 4 then the Th2 response promotes massive IgE release by plasma cells. Our hospital was a tertiary center of Southern China, which had enriched population of asthmatic patients from nationwide. Though ABPA was well recognized in refractory asthma, the prevalence of ABPA among asthmatics with tIgE >1000 IU/mL was 29.7% in our cohort. This finding was consistent with a similar study demonstrating that compared to non-ABPA with a tIgE level >1000 IU/mL, the coexisting atopic diseases might influence the development of ABPA.5 Further large-scale studies across different geographic regions are warranted to validate our findings. In conclusion, the current study suggests that the possibility of other allergen cosensitization should be clinically considered besides Aspergillus sensitization in these patients.

Wanjun Wang: Writing—original draft; validation; data curation. Lulu Wu: Methodology; investigation; formal analysis. Jing Li: Funding acquisition; project administration; supervision. Qiurong Hu: Conceptualization; resources; writing—review and editing. Wanjun Wang and Lulu Wu shared first authorship. Jing Li and Qiurong Hu contributed equally as corresponding authors.

The authors declare no conflicts of interest.

Abstract Image

血清总IgE≥1000iu /mL的哮喘患者过敏原致敏率
致编辑,过敏原致敏发生在大多数哮喘患者中。我们之前的文章已经证明,尘螨仍然是中国哮喘患者中最重要的过敏原支气管哮喘患者血清抗曲霉抗原IgE升高,尤其推荐≥1000 IU/mL作为诊断变应性支气管肺曲霉病(ABPA)的血清总IgE (tIgE)临界值因此,我们的目的是描述对常见过敏原致敏的患病率哮喘患者血清tIgE >;1000 IU/mL,过敏在多大程度上占这些个体是有争议的。我们回顾性分析了广州医科大学第一附属医院变态反应与临床免疫学与呼吸内科1367例经医师诊断的哮喘患者的实验室记录,这些患者在2018年1月至2024年10月的5年间进行了血清IgE检测,检测的是一组常见的过敏原(ImmunoCAP, ThermoFisher)。所有分析的患者血液tIgE水平均为1000 IU/mL。检测的过敏原有尘螨、草花粉混合物、食物混合物、猫、狗、交替孢霉、曲霉和青霉。对于在研究期间进行多次测量的患者,仅首次血清总IgE和特异性IgE值被纳入分析。排除慢性阻塞性肺疾病、寄生虫感染、风湿病和肿瘤患者。本研究经医院伦理委员会批准,无需知情同意。我们的研究表明,所有患者至少对两种过敏原致敏,734例(53.7%)患者对5种以上过敏原致敏。过敏性多病在近98%的过敏患者中很常见。关于患者基线特征的详细信息见附录S1。阳性反应最多的3种是翼螨(69.4%)、烟曲霉(29.7%)和猫(24.9%)。与食物过敏原(2.2%)相比,吸入性过敏原的致敏性明显常见(97.8%)。草花粉、狗、麻草和棘草的比例分别为7.3%、10.3%、17.6%和4.9%(图1)。此外,随着阳性过敏原数量的增加,这些患者的血清tIgE水平(r = 0.34, p = 0.047)和pteronyssimus sIgE水平(r = 0.52, p = 0.036)呈分级效应。然而,血清tIgE与曲霉sIgE水平无统计学意义(附录S2)。我们的研究重点是真菌过敏是否一定存在于tIgE升高的哮喘中,并发现室内尘螨和猫皮屑都是强致敏物。我们观察到,即使在高tIgE个体中,翼龙线虫仍然是一个主要的常年性过敏原来源和过敏性哮喘的重要原因。有研究发现,患有特应性湿疹和多变应性疾病的哮喘患者,对常见的过敏原如螨蛋白酶和Fel d1, 3,4优先产生强烈的Th2反应,Th2反应促进浆细胞大量释放IgE。我院是华南地区三级中心医院,拥有丰富的全国哮喘患者人群。虽然ABPA在难治性哮喘中得到了广泛认可,但在我们的队列中,tIgE为1000 IU/mL的哮喘患者中ABPA的患病率为29.7%。这一发现与一项类似的研究一致,该研究表明,与tIgE水平为1000 IU/mL的非abpa相比,共存的特应性疾病可能会影响abpa的发展。5需要在不同地理区域进行进一步的大规模研究来验证我们的发现。综上所述,本研究提示除了曲霉致敏外,临床还应考虑其他过敏原共致敏的可能性。王万军:写作-原稿;验证;数据管理。吴璐璐:方法论;调查;正式的分析。李静:资金获取;项目管理;监督。胡秋荣:概念化;资源;写作-审查和编辑。王万军和吴璐璐共同为第一作者。李静和胡秋荣作为通讯作者作出了同样的贡献。作者声明无利益冲突。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Clinical and Translational Allergy
Clinical and Translational Allergy Immunology and Microbiology-Immunology
CiteScore
7.50
自引率
4.50%
发文量
117
审稿时长
12 weeks
期刊介绍: Clinical and Translational Allergy, one of several journals in the portfolio of the European Academy of Allergy and Clinical Immunology, provides a platform for the dissemination of allergy research and reviews, as well as EAACI position papers, task force reports and guidelines, amongst an international scientific audience. Clinical and Translational Allergy accepts clinical and translational research in the following areas and other related topics: asthma, rhinitis, rhinosinusitis, drug hypersensitivity, allergic conjunctivitis, allergic skin diseases, atopic eczema, urticaria, angioedema, venom hypersensitivity, anaphylaxis, food allergy, immunotherapy, immune modulators and biologics, animal models of allergic disease, immune mechanisms, or any other topic related to allergic disease.
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