Association of asthma with serum IgE levels and skin-test reactivity to allergens

Exhaled and Systemic Biomarkers to Aid the Diagnosis of Bronchial Asthma in Elite Water Sports Athletes

PURPOSE

Our aim was to evaluate the accuracy of a combined airway inflammatory biomarker assessment in diagnosing asthma in elite water sports athletes.

METHODS

Members of the Hungarian Olympic and Junior Swim Team and elite athletes from other aquatic disciplines were assessed for asthma by objective lung function measurements, and blood eosinophil count (BEC), serum total immunoglobulin E (IgE), fractional exhaled nitric oxide (F ENO ) measurements, and skin prick testing were performed. A scoring system from BEC, F ENO , serum IgE, and skin test positivity was constructed by dichotomizing the variables and assigning a score of 1 if the variable is elevated. These scores were summed to produce a final composite score ranging from 0 to 4.

RESULTS

A total of 48 participants were enrolled (age 21 ± 4 yr, 42% male), of which 22 were diagnosed with asthma. Serum total IgE and F ENO levels were higher in asthmatic individuals (68 [27-176] vs 24 [1-43], P = 0.01; 20 [17-26] vs 15 [11-22], P = 0.02), and positive prick test was also more frequent (55% vs 8%, P < 0.01). Asthmatic participants had higher composite variable scores (2 [1-3] vs 1 [0-1], P = 0.02). Receiver operating characteristic analysis showed that total IgE, F ENO , and composite variable were suitablefor identifying asthmatic participants (area under the curve = 0.72, P = 0.01; 0.70, P = 0.02, and 0.69, P = 0.03). A composite score of >2 reached a specificity of 96.2%, a sensitivity of 36.4%, and a likelihood ratio of 9.5. Logistic regression model revealed a strong association between the composite variable and the asthma diagnosis (OR = 2.71, 95% confidence interval = 1.17-6.23, P = 0.02).

CONCLUSIONS

Our data highlight the diagnostic value of combined assessment of Th2-type inflammation in elite water sports athletes. The proposed scoring system may be helpful in ruling in asthma in this population upon clinical suspicion.

Biomarkers in asthma, potential for therapeutic intervention

Asthma is a heterogeneous disease characterized by multiple phenotypes with varying risk factors and therapeutic responses. This Commentary describes research on biomarkers for T2-"high" and T2-"low" inflammation, a hallmark of the disease. Patients with asthma who exhibit an increase in airway T2 inflammation are classified as having T2-high asthma. In this endotype, Type 2 cytokines interleukins (IL)-4, IL-5, and IL-13, plus other inflammatory mediators, lead to increased eosinophilic inflammation and elevated fractional exhaled nitric oxide (FeNO). In contrast, T2-low asthma has no clear definition. Biomarkers are considered valuable tools as they can help identify various phenotypes and endotypes, as well as treatment response to standard treatment or potential therapeutic targets, particularly for biologics. As our knowledge of phenotypes and endotypes expands, biologics are increasingly integrated into treatment strategies for severe asthma. These treatments block specific inflammatory pathways or single mediators. While single or composite biomarkers may help to identify subsets of patients who might benefit from these treatments, only a few inflammatory biomarkers have been validated for clinical application. One example is sputum eosinophilia, a particularly useful biomarker, as it may suggest corticosteroid responsiveness or reflect non-compliance to inhaled corticosteroids. As knowledge develops, a meaningful goal would be to provide individualized care to patients with asthma.

Towards personalized medicine for the treatment of equine asthma

Although horses with asthma share similar clinical signs, the heterogeneity of the disease in terms of severity, triggering factors, inflammatory profile, and pathological features has hindered our ability to define biologically distinct subgroups. The recognition of phenotypes and endotypes could enable the development of precision medicine, including personalized, targeted therapy, to benefit affected horses. While in its infancy in horses, this review outlines the phenotypes of equine asthma and discusses how knowledge gained from targeted therapy in human medicine can be applied to evaluate the potential opportunities for personalized medicine in equine asthma and to suggest avenues for research to advance this emerging field.

Allergen skin test responses in broad U.S. asthma population in those with and without rhinitis

Background: Asthma and allergic rhinitis are pathologically interlinked conditions. Despite skin testing (ST) being pivotal for evaluating allergic sensitization, U.S. data that date back to 1960s on ST reactivity patterns in subjects with asthma remain sparse. Objective: The purpose of this study was to elucidate seasonal, perennial ST responses, and their relationship with asthma severity, early versus late onset disease, and immunoglobulin E (IgE) levels. Methods: Five hundred patients with asthma were randomly selected from the National Jewish Health electronic medical record over a 3-year span. Demographic, clinical, and allergen ST reactivity data for a battery of seasonal and perennial allergens were procured, including total IgE levels, asthma onset, and severity, by using t-tests, χ² tests, and Analysis of Variance (ANOVA), patterns of reactivity were assessed for overall, seasonal, and perennial allergens in relation to IgE levels, asthma onset, and severity. Results: Of the 500 patients, 398 were analyzed. 63.3% were women, 50.1% had adult-onset asthma, and 86.1% had rhinitis; 75.3% tested positive to one or more allergens, with men demonstrating higher overall (p = 0.039) and perennial (p = 0.035) sensitization. ST reactivity varied based on the presence of rhinitis for seasonal (p = 0.028) but not perennial (p = 0.733) allergens. Asthma severity was not significantly associated with ST reactivity (p > 0.10). ST positivity for perennial (p < 0.001) but not seasonal (p = 0.128) allergens was higher in childhood-onset asthma versus adult-onset asthma despite both groups having a large percentage of reactors. Elevated IgE levels correlated with ST reactivity (p < 0.01). Conclusion: Our study represents a unique comprehensive evaluation of ST reactivity in a U.S. asthma population, which is lacking in the literature, when factoring in asthma onset, severity, and IgE levels. Our findings underscore the importance of allergen sensitization in asthma, regardless of severity, concurrent rhinitis symptoms, or asthma onset, which challenge some of the prevailing assumptions about the relationship between allergen sensitization and asthma onset.

Association between interleukin-6-174G/C gene polymorphism and asthma severity: exploring the role of total serum IgE, blood eosinophils, and FeNO as markers of type 2 inflammation

BACKGROUND

While a connection has been established between serum interleukin-6 (IL-6) levels and the IL-6 gene (- 174G/C) polymorphism in allergic diseases such as asthma, its specific association with severe asthma remains unexplored. This study examined the relationship between the IL-6 (- 174G/C) gene polymorphism and mild and severe asthma, focusing on its influence on type 2 inflammation.

METHODS

Our study comprised 98 patients with mild asthma and 116 with severe asthma. Additionally, we recruited 121 healthy participants to serve as controls for comparative analyses. The IL-6 gene (- 174G/C) polymorphism was assessed utilizing the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method.

RESULTS

In our study, the risk of mild asthma exhibited a significant fourfold increase in individuals with the GG genotype pattern compared to healthy controls, yielding an odds ratio (OR) of 4.4 (p < 0.001). Conversely, we found no significant correlation between the IL-6 - 174G/C gene polymorphism and severe asthma when compared to the healthy control group. However, a noteworthy pattern emerged when we compared subgroups of mild and severe asthma. The risk of severe asthma increased fivefold in individuals with the GC polymorphism pattern, with an OR of 4.99 (p < 0.001), while the likelihood of mild asthma showed a similar fourfold increase with the GG polymorphism pattern, OR = 4.4 (p < 0.001). Consequently, we observed a significantly higher frequency of the C allele in patients with severe asthma, whereas the G allele was more prevalent in individuals with mild asthma (p = 0.05). Additionally, the correlation between markers of type 2 inflammation and the dominant model of the IL-6 gene -174G/C polymorphism (CC + CG vs GG) revealed a significant increase in total serum immunoglobulin E (IgE), Blood Eosinophil Counts (BEC), and Fractional Exhaled Nitric Oxide (FeNO) levels in asthmatic patients with the CC + CG gene pattern compared to those with GG, with p-values of 0.04, 0.03, and 0.04, respectively. Furthermore, after adjusting for other risk factors, the likelihood of developing severe asthma increased from fourfold to eightfold, with an OR of 8.12 (p = 0.01) with (CC + CG) gene pattern. Other predictors for severe asthma included older age and childhood-onset disease (OR = 1.13 and 19.19, p < 0.001). Allergic rhinitis (AR) and nasal polyps (NP) also demonstrated a substantial association with an increased risk of severe asthma, with odds ratios of 5 and 32.29 (p = 0.01 and < 0.001), respectively. Additionally, elevated Body Mass Index (BMI), BEC, and FeNO were linked to severe asthma, with ORs of 1.11, 1.00, and 1.04, respectively (p = 0.04, 0.05, and 0.001).

CONCLUSION

This study illuminated the intricate relationship between the IL-6 gene polymorphism, type 2 inflammation markers, and diverse risk factors in shaping asthma severity. As a significant association between the GG polymorphism of the IL-6 gene (- 174G/C) and mild asthma was found, while possessing at least one C allele, whether in a homozygous (CC) or heterozygous (CG) combination, independently predicts the likelihood of severe asthma.

Correlation Between Nasal Allergy and the Number of Eosinophils in Adenoid Tissue

To study adenoid tissue eosinophilia in allergic rhinitis. A single-centre clinical case-control prospective study with 66 subjects enrolled for the study after taking written informed consent from all the participants. All patients underwent adenoidectomy with histopathological evaluation of adenoid tissue samples for eosinophils. 36 patients (cases) with Symptoms for Allergic Rhinitis (SFAR) score indicative of allergic rhinitis. 30 patients (control) with SFAR scores not indicative of allergic rhinitis. All patients were evaluated for serum absolute eosinophil count and total serum immunoglobulin E (Ig-E). There was a significant relationship between allergic rhinitis and serum Ig-E levels using the Kruskal-Wallis rank sum test amongst case and control groups with a p-value of 0.031. Pathologically examined slides of adenoid tissue eosinophil count per 10 random high power fields in these patients showed significant results with a p-value of 0.002432, via the Kruskal-Wallis rank sum test. Statistical analysis, shows that adenoid tissue eosinophil count and serum Ig-E levels can somewhat predict the presence of clinical features of allergic rhinitis. Based on several similar studies with similar results, allergic rhinitis can be gauged with adenoid tissue histopathology and routine evaluation should be considered as a standard of care.

Allergic rhinitis and other comorbidities associated with asthma control in Thailand

Background

Asthma and allergic rhinitis (AR) can coexist and cause disabilities. This study aimed to assess the association between AR, asthma control, asthma-related quality of life, and other comorbidities.

Methods

A cross-sectional study was conducted in adults with asthma in six hospitals in Thailand. The outcomes were association of asthma control assessed by the asthma control test (ACT), AR, and asthma comorbidities. Not-well-controlled asthma was defined as ACT scores ≤22. The severity of AR was determined by visual analog scale (VAS). Severe AR was defined as VAS ≥5. Asthma-related quality of life (AQLQ), comorbidities, and total IgE were recorded.

Results

A total of 682 asthmatic patients were included. Median (IQR) age was 58.0 (47.0-64.0) years. 69.9% were female. Not-well-controlled asthma was present in 44.7%. The prevalence of AR was 86.1%. Moderate/severe persistent AR was diagnosed in 21.7% and severe AR was diagnosed in 30.2% of the patients. Inhaled corticosteroid-containing regimens were prescribed in 97.7% of patients. Intranasal corticosteroid and antihistamine were prescribed in 65.7 and 31.7%, respectively. Patients with not-well-controlled asthma had higher body mass index, VAS scores, proportions of pollution exposure, aeroallergen sensitization, severe AR, nasal polyp, urticaria, food allergy, gastroesophageal reflux disease, depression and anxiety, peptic ulcer, and asthma exacerbations, but younger age, lower AQLQ scores, and lower FEV1. Correlation was found between AR severity and ACT (r = -0.461, p < 0.001), AQLQ (r = -0.512, p < 0.001), and total IgE (r = 0.246, p < 0.023). Multiple regression analysis revealed that ACT, AQLQ, and percentage of FEV1/FVC were significantly associated with severe AR.

Conclusion

Allergic rhinitis is prevalent in Thai asthmatic patients. AR severity is associated with asthma control, quality of life, and pulmonary function. Comprehensive care is essential for patients with uncontrolled asthma, particularly when coexisting with conditions.

The B Cell Response and Formation of Allergenic and Anti-Allergenic Antibodies in Food Allergy

Food allergies are a growing public health concern worldwide, especially in children and young adults. Allergen-specific IgE plays a central role in the pathogenesis of food allergies, but their titers poorly correlate with allergy development. Host immune systems yield allergen-specific immunoglobulin (Ig)A, IgE and IgG subclasses with low or high affinities and differential Fc N-glycosylation patterns that can affect the allergic reaction to food in multiple ways. High-affinity IgE is required to induce strong mast cell activation eventually leading to allergic anaphylaxis, while low-affinity IgE can even inhibit the development of clinically relevant allergic symptoms. IgA and IgG antibodies can inhibit IgE-mediated mast cell activation through various mechanisms, thereby protecting IgE-positive individuals from allergy development. The production of IgE and IgG with differential allergenic potential seems to be affected by the signaling strength of individual B cell receptors, and by cytokines from T cells. This review provides an overview of the diversity of the B cell response and the diverse roles of antibodies in food allergy.

Investigating Forkhead Box O Transcription Factor 1 Gene's Relation to Immunoglobulin E in House Dust Mite-Allergic Asthma Patients

House dust mite (HDM)-allergic asthma is an abnormal immune response to extrinsic aeroallergens found in human vicinities. Studying the role of the associated immunity biomarkers and their interplay helps in discovering novel therapeutic strategies that can be used in adjunct with effective long-term immunotherapy. This study investigates the total serum IgE, FoxO1, and Sirtuin 1 (SIRT1) gene expressions in HDM-allergic asthma patients. We enrolled 40 patients for each of the following three groups: an HV group of healthy volunteers and HDM/AA and HDM/SCIT groups of HDM-allergic asthma patients who did not and who did receive immunotherapy before recruitment in this study, respectively. The results elucidated that total IgE was strikingly elevated in the HDM/AA group and showed little decline in the HDM/SCIT group. Both FoxO1 and SIRT1 gene expressions showed the highest levels in the HDM/SCIT group. There was a negative correlation between total IgE and both FoxO1 and SIRT1 in the HDM/AA group while there was a positive correlation with SIRT1 in the HDM/SCIT group. In conclusion, the interplay of the three immunity biomarkers related to HDM-allergic asthma after the course of immunotherapy treatment suggests further, broader studies on the feasibility of their role as immunity biomarkers in the control and remission of HDM-allergic asthma.

Gene Therapy for Immunoglobulin E, Complement-Mediated, and Eosinophilic Disorders

Immunoglobulin E, complement, and eosinophils play an important role in host defense, but dysfunction of each of these components can lead to a variety of human disorders. In this review, we summarize how investigators have adapted gene therapy and antisense technology to modulate immunoglobulin E, complement, and/or eosinophil levels to treat these disorders.

Personalized and Precision Medicine in Asthma and Eosinophilic Esophagitis: The Role of T2 Target Therapy

The role of type 2 inflammation has been progressively associated with many diseases, including severe asthma, atopic dermatitis, nasal polyposis, eosinophilic granulomatosis with polyangiitis, and, recently, eosinophilic esophagitis. Despite this, the association between asthma and esophagitis is still poorly known, and this is probably because of the low prevalence of each disease and the even lower association between them. Nonetheless, observations in clinical trials and, subsequently, in real life, have allowed researchers to observe how drugs acting on type 2 inflammation, initially developed and marketed for severe asthma, could be effective also in treating eosinophilic esophagitis. For this reason, clinical trials specifically designed for the use of drugs targeted to type 2 inflammation were also developed for eosinophilic esophagitis. The results of clinical trials are presently promising and envisage the use of biologicals that are also likely to be employed in the field of gastroenterology in the near future. This review focuses on the use of biologicals for type 2 inflammation in cases of combined severe asthma and eosinophilic esophagitis.

Exposure to farm environment and its correlations with total IgE, IL-13, and IL-33 serum levels in patients with atopy and asthma

BACKGROUND

The aim of the study was to evaluate total immunoglobulin E (IgE), IL-13, and IL-33 serum level in people with bronchial asthma and atopy, and in healthy control group depending on their exposure to farm animals currently and in the first year of life.

METHODS

The study included 174 individuals living in rural areas and in a small town. Standardized questions from the International Study of Asthma and Allergy in Childhood and The European Community Respiratory Health Survey (ECRHS) questionnaires were used to define asthma. Atopic status was verified by skin prick tests. Rural exposure including contact with livestock was verified by adequate questionnaire. Total serum IgE, IL-13, and IL-33 levels were assessed by ELISA (enzyme-linked immunosorbent assay) tests.

RESULTS

Participants with atopy and bronchial asthma were characterized by high level of immunoglobulin E. Tendency to lower serum IgE level was observed among people reporting present contact with farm animals. Also, among those having contact with livestock in their first year of life, the analogous tendency was noticed. No difference in serum IL-13 levels in participants with asthma and atopy, and controls was observed, and there was no effect of exposure on farm animals on the concentration of IL-13. The highest IL-33 level was found in the atopic group, and the lowest in the control group. Participants currently exposed to farm animals were predisposed to have lower IL-33 serum level.

CONCLUSION

Exposure of farm animals currently and in first year of life may result in a lower level of total IgE. Correlation between IL-13 and IL-33 serum levels and contact with livestock was not confirmed.

[Diagnosis and treatment of asthma: a guideline for respiratory specialists 2023 - published by the German Respiratory Society (DGP) e. V.]

The management of asthma has fundamentally changed during the past decades. The present guideline for the diagnosis and treatment of asthma was developed for respiratory specialists who need detailed and evidence-based information on the new diagnostic and therapeutic options in asthma. The guideline shows the new role of biomarkers, especially blood eosinophils and fractional exhaled NO (FeNO), in diagnostic algorithms of asthma. Of note, this guideline is the first worldwide to announce symptom prevention and asthma remission as the ultimate goals of asthma treatment, which can be achieved by using individually tailored, disease-modifying anti-asthmatic drugs such as inhaled steroids, allergen immunotherapy or biologics. In addition, the central role of the treatment of comorbidities is emphasized. Finally, the document addresses several challenges in asthma management, including asthma treatment during pregnancy, treatment of severe asthma or the diagnosis and treatment of work-related asthma.

K-means cluster analysis of characteristic patterns of allergen in different ages: Real life study

BACKGROUND

Atopy varies in people of different ages owing to different physical conditions and exposure to allergens. We aimed to cluster ages based on atopic severity using K-means cluster analysis and identify atopic incidence, severity, as well as the association among peripheral eosinophils, IgE and sensitisation.

METHODS

Consecutive patients (n = 7654) with allergic symptoms and undergoing allergen-specific IgE tests were included from 2013 to 2017. Age, sex, specific-IgE, peripheral eosinophil counts and total-IgE were collected.

RESULTS

Five age categories were identified: 1-17, 18-36, 37-52, 53-69 and 70-100 years. The incidences of atopy and poly-sensitisation decreased with increasing age. Similar trend was observed for aeroallergens, egg and milk but not for peanuts, soy or seafood. Dust mites remain the crucial factor bothering patients with allergic symptoms, especially for children and adolescents. In patients aged <52 years, sensitisation to aeroallergens was more prevalent than food. In group 37-52 years, incidence of females' atopy was higher than that of males. The overlap of atopy, high eosinophils, and high total-IgE was found in only 19.18% of patients. The trend of allergen-test positivity is not parallel to total IgE and peripheral eosinophil counts.

CONCLUSION

Age-grouping based on cluster analysis helps to find the changes in atopic status and distribution of sensitised allergens with age. Allergen tests are still necessary in the clinical diagnosis and treatment. An innovative exploration of the influence of age and allergens on total-IgE and eosinophil counts is helpful for the development of bio-targeted precision therapy.

CLINICAL TRIAL REGISTRATION

ChiCTR2300067700.

Association of Maternal Asthma and Total Serum Immunoglobulin E levels with Obstetric Complications: The Japan Environment and Children's Study

OBJECTIVE

To evaluate the association between maternal asthma (MA) and obstetric complications, while considering subdivided total serum immunoglobulin E (IgE) levels.

METHODS

Data of the participants enrolled in the Japan Environment and Children's Study between 2011 and 2014 were analyzed. In total, 77,131 women with singleton live births at and after 22 weeks of gestation were included. MA was defined based on a self-administered questionnaire. Women with MA were stratified based on the quartile of total serum IgE levels during pregnancy as follows: low IgE levels (< 52.40 IU/mL), moderate IgE levels (52.40-331.00 IU/mL), and high IgE levels (> 331.00 IU/mL). The adjusted odds ratios (aORs) for preterm births (PTB), small for gestational age (SGA) infants, gestational diabetes mellitus, and hypertensive disorders of pregnancy (HDP) were calculated using multivariable logistic regression, while considering women without MA as reference and maternal socioeconomic factors as confounders.

RESULTS

The aORs for SGA infants and HDP in women with MA and high total serum IgE levels were 1.26 (95% confidence interval [CI], 1.05-1.50) and 1.33 (95% CI, 1.06-1.66), respectively. The aOR for SGA infants among women with MA and moderate total serum IgE levels was 0.85 (95% CI, 0.73-0.99). The aOR for PTB among women with MA and low total serum IgE levels was 1.26 (95% CI, 1.04-1.52).

CONCLUSIONS FOR PRACTICE

MA with subdivided total serum IgE levels was associated with obstetric complications. Total serum IgE level may be a potential prognostic marker to predict obstetric complications in pregnancies with MA.

Toxocariasis: potential association with bronchial asthma, and pneumonia among pediatric children

Toxocariasis is an underestimated geohelminthic infection which shows respiratory changes concurrent with larval migration. The purpose of the present study was to detect Toxocara seropositivity in asthmatic and pneumonic children, and in turn to evaluate its association with the children clinical manifestations, laboratory test results, and sociodemographic risk factors. A total of 50 asthmatic, 50 pneumonic children and 50 healthy controls were subjected to stool analysis by direct wet mount and concentration techniques to exclude possible cross reactivity. Blood samples were collected for complete blood count and assessment of eosinophil count. Sera were examined for anti-Toxocara IgG antibodies, and measurement of total IgE level. Anti Toxocara IgG was detected in 27.3% (41/150) of the studied children. It was significantly higher in asthmatic group compared to controls (26%. p value = 0.033) and significantly highest in pneumonia group compared to both bronchial asthma group (46%. p value = 0.030) and control group (10%. p value = 0.001). There was a significant association between anti Toxocara IgG seroprevalence and each of eosinophilia, total IgE and both combined. Anti Toxocara IgG showed significant higher percentage in asthmatic children who recorded history of soil contact and pets contact as compared to control and pneumonic groups. Toxocara IgG seropositivity was highly associated with fever, cough, wheezes and dyspnea with statistical significance. Toxocara seropositivity has to be considered as a vital associated factor for asthmatic and pneumonic children, and eventually better to be considered in differential diagnosis by pediatricians. Further studies are still needed to explore the correlation between toxocariasis and different patient categories.

Influence of genetic variants and mRNA expression of interleukin IL17A gene in asthma susceptibility

Asthma is a chronic respiratory disease characterized by coughing, wheezing, shortness of breath, chest tightness, overproduction of mucus, and expiratory airflow limitation, which affects >300 million people worldwide. It is triggered by the dynamic interplay of genetic factors and environmental exposure. Th17 cells are an emerging subset of CD4+ T cells, which secrete IL-17A. This proinflammatory cytokine has recently been associated with asthma, autoimmune diseases, and inflammatory disorders. The present case-control study was focused on identifying the involvement of the IL-17A gene in asthma pathogenesis among 150 clinically diagnosed asthma patients and 150 healthy controls (HCs) of South Indian origin. To carry out the study, we aimed to screen the genetic variants of rs2275913G/A and rs8193036C/T and also estimated the serum cytokine levels of the IL-17A cytokine of recruited subjects. Further, we evaluated mRNA expression in selected subjects to correlate with the genetic variants. The results revealed that the mean IL-17A serum levels (161.6 ± 380.1 pg/ml vs. 86.75 ± 90.01 pg/ml) and IgE levels (257.7 ± 133.3 pg/ml vs. 311.2 ± 160.5 pg/ml) in asthma patients were significantly high as compared to healthy controls (p < 0.05). The ROC curves were constructed to compare the cytokine levels of asthma patients and HC, and the area under the curve (AUC) for IL-17A cytokine was 0.64, indicating that the test was satisfactory and significant (95 % CI: 0.575-0.709; p < 0.001). Genotyping of rs2275913G/A polymorphism indicated a 1.6-fold risk (95 % CI-1.02-2.56; p = 0.04) for asthma patients compared to healthy controls, whereas no significant association was observed for rs8193036C/T polymorphism with asthma susceptibility. Under genetic models, GA and AA models showed a protective effect against the disease for rs2275913G/A. In contrast, no statistically significant result was observed among the models of rs8193036C/T when adjusted with age and sex. The mRNA expression levels of the gene were statistically high in patients compared to the HCs, with a 1.8-fold change (p < 0.0001). We conclude that the results indicate IL-17A rs2275913G/A is likely to contribute to protection against the disease, while IL-17A rs8193036C/T shows no association with the disease. However, no correlation was identified in serum cytokine levels concerning genotypes. This comprehensive information in the present study might contribute to developing novel therapeutic strategies for treating inflammatory diseases like asthma. Further studies are warranted to understand the diverse functions of IL-17A concerning its longitudinal stability and its response to clinical interventions with large sample sizes in various ethnicities.

Association between Socioeconomic Status and Healthcare Utilization for Children with Allergic Diseases: Korean National Health and Nutritional Examination Survey (2015-2019)

This study aimed to investigate the association between socioeconomic status (SES) and healthcare utilization by children with allergic diseases. We determined SES based on parental occupation and household income. A cross-sectional study was conducted using the Korean National Health and Nutritional Examination Survey (KNHANES) between 2015 and 2019 with participants who were under 18 years of age. The presence of allergic conditions was determined by a self-reported survey of parental response and healthcare utilization data (such as inpatient and outpatient visits). Moreover, we categorized SES into four quantiles (Q1-Q4) based on household income per annum. Then, the data were analyzed using chi-square tests and multivariate logistic regression analysis with confidence intervals (CIs) of 95%, and p < 0.05 was considered significant. A total of 3250 participants were involved in this study. The percentage of allergic diseases was 67.9% for allergic asthma and 32.1% for atopic dermatitis. It was found that the participants who were over 13 years old had atopic dermatitis and were more likely to visit the hospital than younger children. Additionally, the highest SES group in Q4 demonstrated higher healthcare utilization (OR = 1.58; 95% CI, 1.14-1.76) than other SES groups. Our study reveals that parental socioeconomic characteristics are related to the use of healthcare services for children with allergic disorders in Korea. These results highlight the need for public health actions and research to overcome the SES gap among children with allergic diseases.

Effects of different levels of egg protein replacement in weaned diets on hematology, kidney functions, and immunity biomarkers

Eggs are good sources of nutrients essential for the growth and development of infants. Introducing eggs as a weaning food can improve dietary adequacy in infants at risk for protein energy malnutrition (PEM). To evaluate the current objective, 72 pups (36 males and 36 females) were used to calculate the impact of various egg protein levels on blood parameters. Nonisonitrogenous and isocaloric pellet diets were offered to pups for 28 days using nine pups with three replicates according to a completely randomized design (CRD). The water intake and ad libitum diet were offered to weaned pups. The pups were randomly assigned to different concentrations of diet, which contained WF₀, control diet, 14% of soybean protein; WF₁, 14% of egg protein; WF₂, 16% of egg protein; and WF₃, 18% of egg protein, respectively. After weaning, the intraperitoneal injection with the drug (xylazine with ketamine) was used to anesthetize before killing on the 28th day. Blood samples were used to measure the blood metabolites. The results indicated that the concentration of red blood cells, white blood cells, serum triglycerides, and serum protein was significantly (p ≤ .05) increased in pups fed with high egg protein levels compared to the control. The highest platelet count was observed in the pups fed WF₃ diet. In contrast, the amount of alanine aminotransferase and aspartate aminotransferase was significantly (p ≤ .05) reduced with increasing the level of egg protein in the diets of weaned pups. Immunity biomarkers (immunoglobulin A, immunoglobulin G, and immunoglobulin M) and kidney functions (creatinine and blood urine nitrogen) were nonsignificantly (p ≤ .05) increased in the pups fed a high level of protein due to a high biological value of soybean protein. Moreover, the concentration of immunoglobulin E in all pups remained unchanged. Egg protein in infant formula feed can be used for the growth and development of infants.

Algorithmic lifestyle optimization

OBJECTIVE

A hallmark of personalized medicine and nutrition is to identify effective treatment plans at the individual level. Lifestyle interventions (LIs), from diet to exercise, can have a significant effect over time, especially in the case of food intolerances and allergies. The large set of candidate interventions, make it difficult to evaluate which intervention plan would be more favorable for any given individual. In this study, we aimed to develop a method for rapid identification of favorable LIs for a given individual.

MATERIALS AND METHODS

We have developed a method, algorithmic lifestyle optimization (ALO), for rapid identification of effective LIs. At its core, a group testing algorithm identifies the effectiveness of each intervention efficiently, within the context of its pertinent group.

RESULTS

Evaluations on synthetic and real data show that ALO is robust to noise, data size, and data heterogeneity. Compared to the standard of practice techniques, such as the standard elimination diet (SED), it identifies the effective LIs 58.9%-68.4% faster when used to discover an individual's food intolerances and allergies to 19-56 foods.

DISCUSSION

ALO achieves its superior performance by: (1) grouping multiple LIs together optimally from prior statistics, and (2) adapting the groupings of LIs from the individual's subsequent responses. Future extensions to ALO should enable incorporating nutritional constraints.

CONCLUSION

ALO provides a new approach for the discovery of effective interventions in nutrition and medicine, leading to better intervention plans faster and with less inconvenience to the patient compared to SED.

Current Understanding of Asthma Pathogenesis and Biomarkers

Asthma is a heterogeneous lung disease with variable phenotypes (clinical presentations) and distinctive endotypes (mechanisms). Over the last decade, considerable efforts have been made to dissect the cellular and molecular mechanisms of asthma. Aberrant T helper type 2 (Th2) inflammation is the most important pathological process for asthma, which is mediated by Th2 cytokines, such as interleukin (IL)-5, IL-4, and IL-13. Approximately 50% of mild-to-moderate asthma and a large portion of severe asthma is induced by Th2-dependent inflammation. Th2-low asthma can be mediated by non-Th2 cytokines, including IL-17 and tumor necrosis factor-α. There is emerging evidence to demonstrate that inflammation-independent processes also contribute to asthma pathogenesis. Protein kinases, adapter protein, microRNAs, ORMDL3, and gasdermin B are newly identified molecules that drive asthma progression, independent of inflammation. Eosinophils, IgE, fractional exhaled nitric oxide, and periostin are practical biomarkers for Th2-high asthma. Sputum neutrophils are easily used to diagnose Th2-low asthma. Despite progress, more studies are needed to delineate complex endotypes of asthma and to identify new and practical biomarkers for better diagnosis, classification, and treatment.

The Mediating Effect of Cytokines on the Association between Fungal Sensitization and Poor Clinical Outcome in Asthma

Sensitization to fungal allergens is one of the proposed phenotypes in asthma. An association between fungal sensitization and worse clinical outcomes is apparent. Moreover, fungal sensitization in asthma that is associated with different type of immunological mechanism has been reported. How the role of cytokines mediates the association between fungal sensitization and poorer asthmatic outcomes remains unclear. We aimed to determine role of cytokines in the relationship between fungal sensitization and worse clinical outcomes in asthma.

METHOD

We conducted a prospective study to recruit adult patients with asthma. Data including age, sex, height, weight, smoking history, medication, emergency visit and admission, pulmonary function testing result, and Asthma Control Test (ACT) scores were collected. We used the automated BioIC method to measure fungal allergen sIgE in sera. Serum levels of Interleukin (IL) -4, IL-13, IL-6, IL-9, IL-10, IL-17 A, IL-22, Interferon (IFN) -γ, Immunoglobulin E (IgE), Tumor necrosis factor-α (TNF-α), and Transforming growth factor-β (TGF-β) were measured using ELISA.

RESULT

IL-6 and IL-17A had a significant positive correlation between sensitization and most fungi species compared to IgE. Sensitization to Candida albicans had strongly positive association both with IL-6 and IL-17A. However, only IL-17A had significant relationship with ED visit times. The mediation analysis result indicates that IL-17A had a significant positively mediating effect (ME) on the association between Candida albicans and ED visit times.

CONCLUSION

IL-17A is a potential mediator to link Candida albicans sensitization and ED visits for asthma. We suggest that patients with fungal sensitization, such as Candida albicans, have poorer outcomes associated with Th17-mediated immune response rather than Th2.

Title-Inflammatory Signaling Pathways in Allergic and Infection-Associated Lung Diseases

Lung inflammation can be caused by pathogen infection alone or by allergic disease, leading to pneumonitis. Most of the allergens (antigens) that cause allergic lung diseases, including asthma and hypersensitivity pneumonitis (HP), are derived from microorganisms, such as bacteria, viruses, and fungi, but some inorganic materials, such as mercury, can also cause pneumonitis. Certain allergens, including food and pollen, can also cause acute allergic reactions and lead to lung inflammation in individuals predisposed to such reactions. Pattern recognition-associated and damage-associated signaling by these allergens can be critical in determining the type of hypersensitization and allergic disease, as well as the potential for fibrosis and irreversible lung damage. This review discusses the signs, symptoms, and etiology of allergic asthma, and HP. Furthermore, we review the immune response and signaling pathways involved in pneumonitis due to both microbial infection and allergic processes. We also discuss current and potential therapeutic interventions for infection-associated and allergic lung inflammation.

Pharmacogenomics for the efficacy and side effects of antihistamines

Antihistamines, especially H1 antihistamines, are widely used in the treatment of allergic diseases such as urticaria and allergic rhinitis, mainly for reversing elevated histamine and anti-allergic effects. Antihistamines are generally safe, but some patients experience adverse reactions, such as cardiotoxicity, central inhibition, and anticholinergic effects. There are also individual differences in antihistamine efficacy in clinical practice. The concept of individualized medicine has been deeply rooted in people's minds since it was put forward. Pharmacogenomics is the study of the role of inheritance in individual variations in drug response. In recent decades, pharmacogenomics has been developing rapidly, which provides new ideas for individualized medicine. Polymorphisms in the genes encoding metabolic enzymes, transporters, and target receptors have been shown to affect the efficacy of antihistamines. In addition, recent evidence suggests that gene polymorphisms influence urticaria susceptibility and antihistamine therapy. Here, we summarize current reports in this area, aiming to contribute to future research in antihistamines and clinical guidance for antihistamines use in individualized medicine.

PlexinD1 Deficiency in Lung Interstitial Macrophages Exacerbates House Dust Mite-Induced Allergic Asthma

Interstitial macrophages (IMs) are key regulators of allergic inflammation. We previously showed that the absence of semaphorin 3E (Sema3E) exacerbates asthma features in both acute and chronic asthma models. However, it has not been studied whether Sema3E, via its receptor plexinD1, regulates IM function in allergic asthma. Therefore, we investigated the role of plexinD1 deficiency on IMs in allergic asthma. We found that the absence of plexinD1 in IMs increased airway hyperresponsiveness, airway leukocyte numbers, allergen-specific IgE, goblet cell hyperplasia, and Th2/Th17 cytokine response in the house dust mite (HDM)-induced allergic asthma model. Muc5ac, Muc5b, and α-SMA genes were increased in mice with Plxnd1-deficient IMs compared with wild-type mice. Furthermore, plexinD1-deficient bone marrow-derived macrophages displayed reduced IL-10 mRNA expression, at both the baseline and following HDM challenge, compared with their wild-type counterpart mice. Our data suggest that Sema3E/plexinD1 signaling in IMs is a critical pathway that modulates airway inflammation, airway resistance, and tissue remodeling in the HDM murine model of allergic asthma. Reduced IL-10 expression by plexinD1-deficient macrophages may account for these enhanced allergic asthma features.

Profiles of sensitization and comorbidity in asthma patients with markedly increased serum total IgE (>1000kU/L)

Background: Immunoglobulin E (IgE) plays an important role in asthma, but a few patients exhibit extremely high levels of serum total IgE. Objective: This study aimed to investigate the profiles of comorbidity and/or complications, severity, and sensitizations in patients with asthma and with a total IgE level > 1000 kU/L. Methods: We retrospectively analyzed 170 patients with asthma and with total IgE levels of >1000 kU/L from the inpatient data base. Available information, including age, gender, body mass index, diagnosis, results of routine blood tests, pulmonary function, fractional exhaled nitric oxide, induced sputum (if any), IgE (both total and specific) tests and medication records were analyzed. Results: In the study subjects, >80% were adults, and the average total IgE level was median (interquartile range) 1438 kU/L (1181-2255 kU/L). Approximately 15% of the subjects had at least one comorbidity and/or complication, and 78.82% of the subjects were positive for at least one allergen. Airway infections (44.71%) and rhinosinusitis (41.18%) accounted for the two most common conditions despite age groups. Total IgE levels did not differ among the subjects with different conditions. Overall, mites had the highest positive rate (59.4%). Serum total IgE levels were positively correlated with house-dust mite specific IgE (sIgE) levels (r = 0.23; p < 0.05), peripheral blood eosinophil counts (r = 0.21; p < 0.01), and the number of confirmed sIgE positivity (r = 0.19; p < 0.01), and optimal scaling analysis showed that asthma severity was associated with Aspergillus fumigatus sIgE levels. Conclusion: In the subjects with asthma and with a total IgE level of >1000 kU/L, the two most common conditions were airway infections and rhinosinusitis, despite sensitization. A. fumigatus sIgE levels were closely associated with total IgE levels and asthma severity.

Trajectories of IgE sensitization to allergen molecules from childhood to adulthood and respiratory health in the EGEA cohort

BACKGROUND

Longitudinal studies assessing the association of profiles of allergen-specific IgE (sIgE) sensitization to a large range of allergen molecules and respiratory health are rare. We aimed to assess trajectories of molecular sIgE sensitization profiles from childhood to adulthood and their associations with respiratory health.

METHODS

IgE reactivity to microarrayed allergen molecules were measured in childhood (EGEA1) and 12 years later in adult life (EGEA2) among 291 EGEA participants (152 with asthma). At each time point, sIgE sensitization profiles were identified by latent class analysis (LCA) by considering IgE-reactivity to the 38 most prevalent respiratory allergens. The LCA-defined profiles were then studied in association with respiratory health.

RESULTS

At baseline, the mean (min-max) age of the population was 11 (4.5-16) years. The LCA identified four sIgE sensitization profiles which were very similar at both time points (% at EGEA1 and EGEA2); A: "no/few allergen(s)" (48%, 39%), B: "pollen/animal allergens" (18%, 21%), C: "most prevalent house dust mite allergens" (22%, 27%) and D: "many allergens" (12%, 13%). Overall, 73% of the participants remained in the same profile from childhood to adulthood. The profiles were associated with asthma and rhinitis phenotypes. Participants of profiles C and D had lower FEV₁ % and FEF_25-75 % as compared to profile A. Similar patterns of associations were observed for participants with asthma. There was no association with change in lung function.

CONCLUSION

Using high-resolution sIgE longitudinal data, the LCA identified four molecular sensitization profiles, mainly stable from childhood to adulthood, that were associated with respiratory health.

Regulation of Trafficking and Signaling of the High Affinity IgE Receptor by FcεRIβ and the Potential Impact of FcεRIβ Splicing in Allergic Inflammation

Mast cells are tissue-resident immune cells that function in both innate and adaptive immunity through the release of both preformed granule-stored mediators, and newly generated proinflammatory mediators that contribute to the generation of both the early and late phases of the allergic inflammatory response. Although mast cells can be activated by a vast array of mediators to contribute to homeostasis and pathophysiology in diverse settings and contexts, in this review, we will focus on the canonical setting of IgE-mediated activation and allergic inflammation. IgE-dependent activation of mast cells occurs through the high affinity IgE receptor, FcεRI, which is a multimeric receptor complex that, once crosslinked by antigen, triggers a cascade of signaling to generate a robust response in mast cells. Here, we discuss FcεRI structure and function, and describe established and emerging roles of the β subunit of FcεRI (FcεRIβ) in regulating mast cell function and FcεRI trafficking and signaling. We discuss current approaches to target IgE and FcεRI signaling and emerging approaches that could target FcεRIβ specifically. We examine how alternative splicing of FcεRIβ alters protein function and how manipulation of splicing could be employed as a therapeutic approach. Targeting FcεRI directly and/or IgE binding to FcεRI are promising approaches to therapeutics for allergic inflammation. The characteristic role of FcεRIβ in both trafficking and signaling of the FcεRI receptor complex, the specificity to IgE-mediated activation pathways, and the preferential expression in mast cells and basophils, makes FcεRIβ an excellent, but challenging, candidate for therapeutic strategies in allergy and asthma, if targeting can be realized.

IgE is associated with exacerbations and lung function decline in COPD

Background

Both allergen-specific IgE and total IgE in serum play a major role in asthma. However, the role of IgE in chronic obstructive pulmonary disease (COPD) is poorly understood. It was the aim of this study to systematically analyze the relationship between serum IgE levels and disease characteristics in large COPD cohorts.

Methods

COSYCONET is a comprehensively characterized cohort of patients with COPD: total IgE and IgE specific to common aeroallergens were measured in serum of 2280 patients, and related to clinical characteristics of the patients. WISDOM is another large COPD population (2477 patients): this database contains the information whether total IgE in serum was elevated (≥ 100 IU/l) or normal in patients with COPD.

Results

Both in COSYCONET and WISDOM, total IgE was elevated (≥ 100 IU/l) in > 30% of the patients, higher in men than in women, and higher in currently than in not currently smoking men. In COSYCONET, total IgE was elevated in patients with a history of asthma and/or allergies. Men with at least one exacerbation in the last 12 months (50.6% of all men in COSYCONET) had higher median total IgE (71.3 IU/l) than men without exacerbations (48.3 IU/l): this difference was also observed in the subgroups of not currently smoking men and of men without a history of asthma. Surprisingly, a history of exacerbations did not impact on total IgE in women with COPD. Patients in the highest tertiles of total IgE (> 91.5 IU/ml, adjusted OR: 1.62, 95% CI 1.12–2.34) or allergen-specific IgE (> 0.19 IU/ml, adjusted OR: 2.15, 95% CI 1.32–3.51) were at risk of lung function decline (adjusted by: age, gender, body mass index, initial lung function, smoking status, history of asthma, history of allergy).

Conclusion

These data suggest that IgE may play a role in specific COPD subgroups. Clinical trials using antibodies targeting the IgE pathway (such as omalizumab), especially in men with recurrent exacerbations and elevated serum IgE, could elucidate potential therapeutic implications of our observations.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12931-021-01847-0.

Investigation of Allergic Sensitizations in Children With Allergic Rhinitis and/or Asthma

OBJECTIVE

Allergic rhinitis (AR) and asthma are becoming one of the most prevalent diseases in children. Identifying sensitization to aeroallergens is seemed to be valuable for diagnosing allergic disease and guiding its treatment. This study aimed to analyze the profiles of sensitization to aeroallergen in children with AR and/or asthma by skin prick test (SPT) and explore the differences of sensitization between different kinds of allergic diseases, different sexes, and different ages.

METHODS

A total of 230 children with AR and/or asthma who were hospitalized in our hospital from June 2017 to September 2019 were eligible in this retrospective study. All patients completed standardized questionnaires and SPT. Based on the sex, age, or classification of allergic disease, the sensitizations to 13 aeroallergens were compared.

RESULTS

Of the 230 patients, 67.4% of enrolled were positive for SPT; the top 5 allergens were Dermatophagoides pteronyssinus (Der.p) (59.3%), Dermatophagoides farina (Der.f ) (58.7%), Blomia tropicalis (Blot.) (40.3%), dog hair (36.1%), and Blattella germanica (20.4%). More than 90% of patients were sensitized to two or more allergens. As to the effect of age on aeroallergens, we found that the sensitizations of Blot., dog fur, and multiple sensitizations (≥5 allergens) were more common in adolescence (P < 0.01, P < 0.05). Regarding sex, we found that the positive rate of SPT and the percentages of double-allergen sensitizations in boys were much higher than girls (P < 0.01, P < 0.01), and the positive rate to Der.p, Der.f , and ragweed were also significantly higher in boys (P < 0.01, P < 0.05, and P < 0.05, respectively). Furthermore, we found that asthma-rhinitis multimorbidity increased the incidences of sensitizations; patients with AR and asthma had significantly higher positive rates to Der.p and Der.f when compared with the AR or asthma group (P < 0.05, P < 0.05).

CONCLUSION

Allergic sensitizations were common in children with AR and/or asthma; sex, age, and asthma-rhinitis multimorbidity might affect the prevalence of sensitizations to aeroallergens.

Selective IgA Deficiency a Probable Risk of Recurrent Chest Infections in Asthmatics

BACKGROUND

Selective immunoglobulin A (IgA) deficiency is characterized by a high incidence of both recurrent infections and atopic diseases. Asthma is one of the most common lung diseases affecting around 300 million people worldwide and is associated with risk of serious pneumococcal disease and microbial infections. Multiple studies have attributed this to impaired innate and adaptive immunity in asthmatics. An additional probable hypothesis is the existence of an underlying primary immunodeficiency (PID), such as selective IgA deficiency (sIgAD).

AIM

To assess the prevalence of selective IgA deficiency and its correlation to recurrent infections in asthmatic patients.

METHODS

A case-control study was conducted on 80 subjects who were divided into 3 groups: 20 Asthmatic patients with recurrent chest infections (Group A), 20 asthmatic patients without recurrent chest infections (Group B) and 40 healthy controls (Group C).

RESULTS

On comparing the 3 studied groups, there was a statistically significant difference between the three groups (p = ˂0.001) concerning serum IgA. The mean serum IgA was statistically significantly lower in Group A&B than in Group C. Furthermore, it was significantly lower in Group A than in Group B and C (p1,2 <0.002 and <0.001*, respectively). The percentage of selective IgA deficiency or partial IgA deficiency in asthmatic patients was 56% (26 patients). Group A showed a statistically significant higher percentage of selective/partial IgA deficiency.

Housing and asthma disparities

The burden of asthma disproportionately affects minority and low-income communities, resulting in racial and socioeconomic disparities in asthma prevalence, asthma exacerbations, and asthma-related death. Social determinants of health are increasingly implicated as root causes of disparities, and healthy housing is perhaps the most critical social determinant in asthma health disparities. In many minority communities, poor housing conditions and value are a legacy of historical policies and practices imbued with structural racism, including redlining, displacement, and exclusionary zoning. As a result, poor-quality, substandard housing is a characteristic feature of many underrepresented minority communities. Consequently, structurally deficient housing stock cultivates home environments rife with indoor asthma triggers. In this review we consider the historical context of urban housing policies and practices and how these policies and practices have contributed to the substandard housing conditions for many minoritized children in the present day. We describe the impact of poor housing quality on asthma and interventions that have attempted to mitigate its influence on asthma symptoms and health care utilization. We discuss the need to promote asthma health equity by reinvesting in these neighborhoods and communities to provide healthy housing.

Anxiety, depression, and asthma: New perspectives and approaches for psychoneuroimmunology research

The field of psychoneuroimmunology has advanced the understanding of the relationship between immunology and mental health. More work can be done to advance the field by investigating the connection between internalizing disorders and persistent airway inflammation from asthma and air pollution exposure. Asthma is a prominent airway condition that affects about 10% of developing youth and 7.7% of adults in the United States. People who develop with asthma are at three times increased risk to develop internalizing disorders, namely anxiety and depression, compared to people who do not have asthma while developing. Interestingly, sex differences also exist in asthma prevalence and internalizing disorder development that differ based on age. Exposure to air pollution also is associated with increased asthma and internalizing disorder diagnoses. New perspectives of how chronic inflammation affects the brain could provide more understanding into internalizing disorder development. This review on how asthma and air pollution cause chronic airway inflammation details recent preclinical and clinical research that begins to highlight potential mechanisms that drive comorbidity with internalizing disorder symptoms. These findings provide a foundation for future studies to identify therapies that can simultaneously treat asthma and internalizing disorders, thus potentially decreasing mental health diagnoses in asthma patients.

The Role of IgE in Upper and Lower Airway Disease: More Than Just Allergy!

Immunoglobulin E (IgE) is a well-known key factor in allergic airway disease; however, its central role in non-allergic airway inflammation is often underestimated. In some airway diseases, IgE is produced as a result of allergic sensitization. However, in others, IgE production occurs despite the lack of a specific allergen. Although multiple pathways contribute to the production of IgE in airway disease, it is its activity in mediating the inflammatory response that is associated with disease. Therefore, an understanding of IgE as the unifying component of upper and lower airway diseases has important implications for both diagnosis and treatment. Understanding the role of IgE in each upper and lower airway disease highlights its potential utility as a diagnostic marker and therapeutic target. Further classification of these diseases by whether they are IgE mediated or non–IgE mediated, rather than by the existence of an underlying allergic component, accounts for both systemic and localized IgE activity. Improvements in diagnostic methodologies and standardization of clinical practices with this classification in mind can help identify patients with IgE-mediated diseases. In doing so, this group of patients can receive optimal care through targeted anti-IgE therapeutics, which have already demonstrated efficacy across numerous IgE-mediated upper and lower airway diseases.

Allergic diseases attributable to atopy in a population sample of Asian children

The proportion of allergic diseases attributable to atopy remains a subject of controversy. This study aimed to estimate the population risk of physician-diagnosed asthma, rhinitis and eczema attributed to atopy among a population sample of Asian school-age children. Asian children aged 5–18 years (n = 1321) in the Prediction of Allergies in Taiwanese CHildren (PATCH) study were tested for serum allergen-specific immunoglobulin E. Physician-diagnosed asthma, rhinitis and eczema were assessed by a modified International Study of Asthma and Allergies in Childhood questionnaire. Atopy was defined as the presence of serum allergen-specific immunoglobulin E. In this population-based study, 50.4% of the subjects with asthma, 46.3% with rhinitis, and 46.7% with eczema were attributable to atopy. The population attributable risk (PAR) of atopy for three allergic diseases was higher in adolescents (asthma, 54.4%; rhinitis, 59.6%; eczema, 49.5%) than younger children aged less than 10 years (asthma, 46.9%; rhinitis, 39.5%; eczema, 41.9%). Among the seven allergen categories, sensitization to mites had the highest PARs for all three allergic diseases (51.3 to 64.1%), followed by sensitization to foods (asthma, 7.1%; rhinitis, 10.4%; eczema 27.7%). In conclusion, approximately half (46.3 to 50.4%) of Asian children in Taiwan with allergic diseases are attributable to atopy.

Interaction between antibiotic use and MS4A2 gene polymorphism on childhood eczema: a prospective birth cohort study

Background

Eczema is usually the first allergic manifestation to appear in life attributed to gene–environment interactions. IL13, IL4, MS4A2 and ILR4A are four key inflammatory genes associated with atopy. This study aimed to explore gene-environment interactions on eczema in early life among the above four genes and environmental factors in Chinese Han children.

Methods

Five hundred ninety-seven children from a birth cohort who completed two-year follow-up were enrolled and their cord blood was collected. Subjects were genotyped for six polymorphisms in the aforementioned four genes. The children were followed at 6, 12 and 24 months, with epidemiologic information and medical history of eczema collected by questionnaire and eczema assessed by dermatologists.

Results

Among the 597 children, 168 were diagnosed with eczema and the others were not after 2 years of follow-up. MS4A2 rs569108 GG genotype (P = 1.68E-02, odds ratio (OR) = 4.66) and antibiotic use (P = 3.75E-4, OR = 2.02) were found independently associated with development of childhood eczema. Children with both antibiotic use and MS4A2 rs569108 GG genotype were more likely to develop eczema than those with only antibiotic use or GG homozygote (OR = 6.24 VS. 2.04 or 4.68).

Conclusions

MS4A2 rs569108 polymorphism and antibiotic use were solely associated with eczema, and they interacted with each other to increase the risk of developing the disease in Chinese Han toddlers. Long-term follow-up along with functional and replication studies are still needed.

Gene-gene and gene-environment interactions on cord blood total IgE in Chinese Han children

Background

IL13, IL4, IL4RA, FCER1B and ADRB2 are susceptible genes of asthma and atopy. Our previous study has found gene–gene interactions on asthma between these genes in Chinese Han children. Whether the interactions begin in fetal stage, and whether these genes interact with prenatal environment to enhance cord blood IgE (CBIgE) levels and then cause subsequent allergic diseases have yet to be determined. This study aimed to determine whether there are gene–gene and gene-environment interactions on CBIgE elevation among the aforementioned five genes and prenatal environmental factors in Chinese Han population.

Methods

989 cord blood samples from a Chinese birth cohort were genotyped for nine single-nucleotide polymorphisms (SNPs) in the five genes, and measured for CBIgE levels. Prenatal environmental factors were collected using a questionnaire. Gene–gene and gene-environment interactions were analyzed with generalized multifactor dimensionality methods.

Results

A four-way gene–gene interaction model (IL13 rs20541, IL13 rs1800925, IL4 rs2243250 and ADRB2 rs1042713) was regarded as the optimal one for CBIgE elevation (testing balanced accuracy = 0.5805, P = 9.03 × 10^–4). Among the four SNPs, only IL13 rs20541 was identified to have an independent effect on elevated CBIgE (odds ratio (OR) = 1.36, P = 3.57 × 10^–3), while the other three had small but synergistic effects. Carriers of IL13 rs20541 TT, IL13 rs1800925 CT/TT, IL4 rs2243250 TT and ADRB2 rs1042713 AA were estimated to be at more than fourfold higher risk for CBIgE elevation (OR = 4.14, P = 2.69 × 10^–2). Gene-environment interaction on elevated CBIgE was found between IL4 rs2243250 and maternal atopy (OR = 1.41, P = 2.65 × 10^–2).

Conclusions

Gene–gene interaction between IL13 rs20541, IL13 rs1800925, IL4 rs2243250 and ADRB2 rs1042713, and gene-environment interaction between IL4 rs2243250 and maternal atopy begin in prenatal stage to augment IgE production in Chinese Han children.

A novel site-specific chemical conjugation of IgG antibodies by affinity peptide for immunoassays

Recently, there has been an increasing interest in site-specific modifications of antibodies used in immunoassays for disease diagnosis and as antibody therapeutics, such as antibody-drug conjugates. Previously, we established a site-specific chemical conjugation system using an IgG-Fc binding chemical conjugation affinity peptide (CCAP). CCAP could be used only for the modification of human IgG owing to the lack of affinity of CCAP to rodent IgG molecules. In this study, novel CCAP reagents are proposed, which can be used for both human and mouse IgG, based on the Staphylococcus aureus protein A domain-derived affinity peptides Z34C and Z33. Compared with the activity of a conventional randomly modified antibody, mouse IgG modified using this method had favourable features in two immunoassays, demonstrating the advantages of the proposed CCAP method in preserving antibody functionality during conjugation.

Evolution of our view on the IgE molecule role in bronchial asthma and the clinical effect of its modulation by omalizumab: Where do we stand today?

Bronchial asthma is a heterogeneous disease whose definition and treatment are based on evidence of variable airway obstruction and airway inflammation. Despite the enormous increase in the amount of information on the pathogenesis of this disease, diagnosis is still an unresolved problem, as we still lack sensitive and specific biomarkers. On the other hand, at the turn of the 20th and 21st century, there was a rapid development of therapeutic modalities based on the principle of biological therapy. The first authorized drug matching these characteristics was omalizumab – a monoclonal antibody directed against immunoglobulin E (IgE). It has been used for the treatment of severe forms of bronchial asthma for more than 15 years, which is a sufficient time to acquire ways of its effective use and to assess whether the treatment with omalizumab has met our expectations. However, we continue to discover new and surprising facts about the effects of omalizumab treatment which leads to widening of therapeutic indications. In this work, a basic overview of the very complex role of the IgE molecule in the organism (with a special emphasis on allergic asthma) is discussed, and the most important practical and clinical consequences resulting from its modulation by targeted therapy with omalizumab are summarized.

Prevalence of Allergic Sensitization in Childhood Asthma

Introduction

The allergic sensitization in childhood asthma is common and the prevalence varies in different geographical locations. The data on allergen sensitization to guide clinicians on allergy avoidance is limited.

Method

This prospective observational study was conducted between October 2019 and April 2020 on children aged two to 14 years attending an outpatient clinic. Those with recurrent wheezing or physician-diagnosed asthma were interviewed; eosinophil count, total serum immunoglobulin E (IgE) was measured; and skin prick test (SPT) was done using standardized reagents. Wheal size of ≥3mm was considered positive.

Results

A total of 80 children were enrolled. The mean age was 71.15 ± 33.52 months (M:F ratio =1.96:1). Allergic rhinitis, conjunctivitis, and dermatosis were seen in 76 (95.0%), 33 (41.3%), and 22 (27.5%) cases, respectively. The mean absolute eosinophil count was 576 ± 427per cmm. The mean total IgE was 800.9 ± 883.2IU/ml. Seasonal and diurnal variations were found in 34 (42.5%) and 79 (98.8%) cases. Out of 1753 skin pricks using 27 reagents, 355 (20.25%) were positive. Increasing age was significantly associated with increasing SPT positivity (P = 0.0001). The most common sensitive aeroallergens were Kentucky bluegrass (25%), Dermatophagoides pteronyssinus (22.5%), Dermatophagoides farinae (21.3%), Timothy grass, and Alternaria alternans (20% each). The most common sensitive food allergens were spinach (25%), banana (22.5%), carp (20%), shrimp and hen’s egg (18.8% each), and cow’s milk (17.5%).

Conclusion

Increasing age was associated with increasing SPT positivity in childhood asthma. The most common sensitive aeroallergens were Kentucky bluegrass and Dermatophagoides pteronyssinus; spinach and banana were the most common food allergen.

Chlamydia pneumoniae and chronic asthma: Updated systematic review and meta-analysis of population attributable risk

Background

Chlamydia pneumoniae (Cp) is an obligate intracellular human respiratory pathogen producing persisting lung infection with a plausible link to asthma pathogenesis. The population attributable risk of potentially treatable Cp infection in asthma has not been reported.

Methods

The author searched from 2000 to 2020 inclusive for previously un-reviewed and new cross sectional and prospective controlled studies of Cp biomarkers and chronic asthma in both children and adults. Qualitative descriptive results and quantitative estimates of population attributable risk for selected biomarkers (specific IgG, IgA and IgE) are presented.

Findings

No large, long-term prospective population-based studies of Cp infection and asthma were identified. About half of case-control studies reported one or more significant associations of Cp biomarkers and chronic asthma. Heterogeneity of results by age group (pediatric v adult asthma), severity category (severe/uncontrolled, moderate/partly controlled, mild/controlled) and antibody isotype (specific IgG, IgA, IgE) were suggested by the qualitative results and confirmed by meta-analyses. The population attributable risks for Cp-specific IgG and IgA were nul in children and were 6% (95% confidence interval 2%-10%, p = 0.002) and 13% (9%-18%, p<0.00001) respectively in adults. In contrast to the nul or small population attributable risks for Cp-specific IgG and IgA, the population attributable risk for C. pneumoniae-specific IgE (children and adults combined) was 47% (39%-55%, p<0.00001). In the subset of studies that reported on asthma severity categories, Cp biomarkers were positively and significantly (P<0.00001) associated with asthma severity.

Interpretation

C. pneumoniae-specific IgE is strongly associated with asthma and asthma severity, suggesting a possible mechanism linking chronic Cp infection with asthma in a subset of individuals with asthma. Infection biomarkers should be included in future macrolide treatment trials for severe and uncontrolled asthma.

Impact of Haemophilus influenzae type b combination vaccination on asthma symptoms and pneumonia in 5-year-old children in rural Bangladesh: a longitudinal study and comparison with a previous cross-sectional study

BACKGROUND

Although the prevalence of bronchial asthma has been increasing worldwide since the 1970's, the prevalence among 5-year-old children was significantly lower in 2016 than in 2001 in rural Bangladesh. We aimed to determine whether the Haemophilus influenzae type b (Hib) combination vaccination (without booster) started in 2009 contributed to this decrease.

METHODS

A case-control study was conducted among 1658 randomly selected 5-year-old children from Matlab, Bangladesh. Data on wheezing were collected using the International Study of Asthma and Allergies in Childhood questionnaire. The vaccination data were collected from the records of the Matlab Health and Demographic Surveillance System, while data on pneumonia were obtained from the clinical records of Matlab Hospital. Adjusted odds ratios (aORs) were calculated for the risk for wheezing. The reduction rate was calculated to determine the impact of the vaccination on pneumonia history between the present study and our previous study conducted in 2001 by using the following formula: (percentage of pneumonia cases in 2001 - percentage of pneumonia cases in 2016)/(percentage of pneumonia cases in 2001) times 100 (%).

RESULTS

Hib combination vaccination was a protecting factor against wheezing (aOR: 0.50; p = 0.010), while pneumonia at 1, 2, 3-4 years of age were risk factors for wheezing (aOR: 2.86, 3.19, 2.86; p = 0.046, 0.030, 0.030, respectively). The history of pneumonia was significantly lower in the 2016 study participants than those in 2001 both in the overall cohort and the wheezing group (paired t-test: p = 0.012, p < 0.001, respectively). Whereas the history of pneumonia decreased when the children grew older in the 2001 overall cohort, it peaked at the age of 2 years in 2016 wheezing group. The reduction rate decreased when children grew older in both the overall cohort and the wheezing group, however, it decreased faster in the wheezing group.

CONCLUSIONS

Hib combination vaccination was a protective factor against wheezing in 0-year-old children. However, the effects of vaccination might have attenuated at the ages of 1-4 years, because no booster dose was administered. The addition of a booster dose might further decrease the prevalence of asthma and wheezing.

ORMDL3/GSDMB genotype as a risk factor for early-onset adult asthma is linked to total serum IgE levels but not to allergic sensitization

BACKGROUND

An orosomucoid-like 3 (ORMDL3)/gasdermin B (GSDMB) gene locus on chromosome 17q is consistently associated with childhood-onset asthma, which is highly atopic. As some evidence suggests the relationship between asthma and allergic sensitization reflects asthma patient susceptibility to augmented IgE responses driven by common environmental allergens rather than an increased asthma risk after allergen exposure, we aimed to determine any relationships between this locus region and childhood-onset adult asthma with regard to serum total IgE levels or allergic sensitization.

METHODS

We conducted a case-control association study using three independent Japanese populations (3869 total adults) and analyzed the ORs for association of rs7216389, an expression quantitative trait locus for ORMDL3/GSDMB, with adult asthma according to onset age. Additionally, associations between the rs7216389 genotype and total serum IgE levels or allergic sensitization was examined.

RESULTS

Rs7216389 was associated with both childhood-onset adult asthma (OR for asthmatic patients afflicted at the age of 10 years or younger = 1.61, p = 0.00021) and asthmatic patients with higher levels of total serum IgE (OR for asthmatic patients with IgE ≥1000IU/mL = 1.55, p = 0.0033). In both healthy controls and in the combined healthy and asthmatic individuals, rs7216389 was correlated with increased total serum IgE levels (p < 0.0005), but not allergic sensitization (p > 0.1).

CONCLUSIONS

ORMDL3/GSDMB is an important susceptibility gene for childhood-onset adult asthma in Japanese populations and this association is linked to elevated total serum IgE levels but not to allergic sensitization.

Association of a four-gene model with allergic diseases: Two-year follow-up of a birth cohort study

Background

Our previous study has developed a four‐gene model involving IL13 rs20541, IL4 rs2243250, ADRB2 rs1042713, and FCER1B rs569108 associated with asthma and atopy in Chinese Han children. However, whether the gene model is associated with allergies in early life has yet to be determined. This study aimed to apply the gene model in a birth cohort to investigate its associations with the development of allergic diseases in Chinese Han toddlers.

Methods

Five hundred and ninety‐seven children from a birth cohort completing 2‐year follow‐up were included. Epidemiologic information and cord blood were collected. Children were genotyped for the above polymorphisms and divided into high or low genetic risk groups based on the genotypes. Subjects were followed at 6, 12, and 24 months, with information on allergic diseases collected via standard questionnaires and assessed by specialists.

Results

Two hundred and eighty‐four children were divided into a high‐risk group and 313 into a low‐risk group. Between the two groups, a significant difference was only found in delivery mode among all the subject characteristics (p = .025). After stratification for delivery mode, children at high risk were more likely to develop eczema (relative risk [RR] = 1.46, p = .040) over 2 years of follow‐up compared with those at low risk. No significant associations were found between genetic risk and food allergy, wheezing and allergic rhinitis (p > .05).

Conclusion

The gene model was significantly associated with the development of eczema in Chinese Han toddlers. Long‐term follow‐up along with functional and replication studies on the gene model are still needed in future.