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The Role of IgE in Upper and Lower Airway Disease: More Than Just Allergy! Clin Rev Allergy Immunol 2021; 62:200-215. [PMID: 34536215 PMCID: PMC8818003 DOI: 10.1007/s12016-021-08901-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2021] [Indexed: 12/25/2022]
Abstract
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.
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Crespo-Lessmann A, Curto E, Mateus E, Soto L, García-Moral A, Torrejón M, Belda A, Giner J, Ramos-Barbón D, Plaza V. Total and specific immunoglobulin E in induced sputum in allergic and non-allergic asthma. PLoS One 2020; 15:e0228045. [PMID: 31995587 PMCID: PMC6988954 DOI: 10.1371/journal.pone.0228045] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 01/06/2020] [Indexed: 11/26/2022] Open
Abstract
Background Most patients with nonallergic asthma have normal serum immunoglobulin E (IgE) levels. Recent reports suggest that total and aeroallergen-specific IgE levels in induced sputum may be higher in nonallergic asthmatics than in healthy controls. Our objective is to compare total and dust-mite specific (Der p 1) IgE levels in induced sputum in allergic and nonallergic asthmatics and healthy controls. Methods Total and Der p 1-specific IgE were measured in induced sputum (ImmunoCAP immunoassay) from 56 age- and sex-matched asthmatics (21 allergic, 35 nonallergic) and 9 healthy controls. Allergic asthma was defined as asthma with a positive prick test and/or clinically-significant Der p 1-specific serum IgE levels. Results Patients with allergic asthma presented significantly higher total and Der p 1-specific serum IgE levels. There were no significant between-group differences in total sputum IgE. However, Der p 1-specific sputum IgE levels were significantly higher (p = 0.000) in the allergic asthmatics, but without differences between the controls and nonallergic asthmatics. Serum and sputum IgE levels were significantly correlated, both for total IgE (rho = 0.498; p = 0.000) and Der p 1-specific IgE (rho, 0.621; p = 0001). Conclusions Total IgE levels measured in serum and induced sputum are significantly correlated. No significant differences were found between the differents groups in total sputum IgE. Nevertheless, the levels of Der p 1-specific sputum IgE levels were significantly higher in the allergic asthmatics, but without differences between the controls and nonallergic asthmatics. Probably due to the lack of sensitivity of the test used, but with the growing evidence for local allergic reactions better methods are need to explore its presence. The Clinical Trials Identifier for this project is NCT03640936.
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Affiliation(s)
- Astrid Crespo-Lessmann
- Department of Respiratory Medicine and Allergology, Hospital de la Santa Creu i Sant Pau, Institute of Sant Pau Biomedical Research (IBB Sant Pau), Department of Medicine of Universitat Autònoma de Barcelona (UAB), CIBER of Respiratory Diseases (CIBERES), Barcelona, Spain
- * E-mail:
| | - Elena Curto
- Department of Respiratory Medicine and Allergology, Hospital de la Santa Creu i Sant Pau, Institute of Sant Pau Biomedical Research (IBB Sant Pau), Department of Medicine of Universitat Autònoma de Barcelona (UAB), CIBER of Respiratory Diseases (CIBERES), Barcelona, Spain
| | - Eder Mateus
- Department of Respiratory Medicine and Allergology, Hospital de la Santa Creu i Sant Pau, Institute of Sant Pau Biomedical Research (IBB Sant Pau), Department of Medicine of Universitat Autònoma de Barcelona (UAB), CIBER of Respiratory Diseases (CIBERES), Barcelona, Spain
| | - Lorena Soto
- Department of Respiratory Medicine and Allergology, Hospital de la Santa Creu i Sant Pau, Institute of Sant Pau Biomedical Research (IBB Sant Pau), Department of Medicine of Universitat Autònoma de Barcelona (UAB), CIBER of Respiratory Diseases (CIBERES), Barcelona, Spain
| | - Alba García-Moral
- Department of Respiratory Medicine and Allergology, Hospital de la Santa Creu i Sant Pau, Institute of Sant Pau Biomedical Research (IBB Sant Pau), Department of Medicine of Universitat Autònoma de Barcelona (UAB), CIBER of Respiratory Diseases (CIBERES), Barcelona, Spain
| | - Montserrat Torrejón
- Department of Respiratory Medicine and Allergology, Hospital de la Santa Creu i Sant Pau, Institute of Sant Pau Biomedical Research (IBB Sant Pau), Department of Medicine of Universitat Autònoma de Barcelona (UAB), CIBER of Respiratory Diseases (CIBERES), Barcelona, Spain
| | - Alicia Belda
- Department of Respiratory Medicine and Allergology, Hospital de la Santa Creu i Sant Pau, Institute of Sant Pau Biomedical Research (IBB Sant Pau), Department of Medicine of Universitat Autònoma de Barcelona (UAB), CIBER of Respiratory Diseases (CIBERES), Barcelona, Spain
| | - Jordi Giner
- Department of Respiratory Medicine and Allergology, Hospital de la Santa Creu i Sant Pau, Institute of Sant Pau Biomedical Research (IBB Sant Pau), Department of Medicine of Universitat Autònoma de Barcelona (UAB), CIBER of Respiratory Diseases (CIBERES), Barcelona, Spain
| | - David Ramos-Barbón
- Department of Respiratory Medicine and Allergology, Hospital de la Santa Creu i Sant Pau, Institute of Sant Pau Biomedical Research (IBB Sant Pau), Department of Medicine of Universitat Autònoma de Barcelona (UAB), CIBER of Respiratory Diseases (CIBERES), Barcelona, Spain
| | - Vicente Plaza
- Department of Respiratory Medicine and Allergology, Hospital de la Santa Creu i Sant Pau, Institute of Sant Pau Biomedical Research (IBB Sant Pau), Department of Medicine of Universitat Autònoma de Barcelona (UAB), CIBER of Respiratory Diseases (CIBERES), Barcelona, Spain
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Atosuo J, Karhuvaara O, Suominen E, Vilén L, Nuutila J, Putus T. Indoor exposure to Streptomyces albus and Aspergillus versicolor elevates the levels of spore-specific IgG, IgG1 and IgG3 serum antibodies in building users - A new ELISA-based assay for exposure assessment. THE SCIENCE OF THE TOTAL ENVIRONMENT 2020; 698:134335. [PMID: 31518785 DOI: 10.1016/j.scitotenv.2019.134335] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 09/05/2019] [Accepted: 09/05/2019] [Indexed: 06/10/2023]
Abstract
Moisture-indicative microbes in buildings are associated with a variety of symptoms, ranging from mild irritation to severe clinical illnesses. These symptoms are caused principally by dried, dormant and dead microbe material like spores, mycelium and microbe metabolites, leading to the activation of the immune system and formation of the antigen-specific immunoglobulins. This activation presumably takes place through the respiratory track and is a normal immune reaction against pathogenic invaders. During continuous exposure, a prolonged state of inflammation will follow, and this forms a considerable health risk for a building's occupant. A new ELISA system utilizing spores from two species Streptomyces albus and Aspergillus versicolor as an antigen was developed to reveal the related immunological processes. In 159 persons, microbial exposure was observed to increase the levels of spore-specific IgG, IgG1 and IgG3 serum antibody levels of individuals residing in microbe-dense buildings compared with the control reference buildings. No differences were detected in the levels of S. albus- and A. versicolor-specific serum IgA or IgM levels.
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Affiliation(s)
- Janne Atosuo
- The Laboratory of Immunochemistry, Department of Biochemistry, Faculty of Science and Engineering, University of Turku, Turku, Finland; Environmental Medicine and Occupational Health, Department of Clinical Medicine, Faculty of Medicine, University of Turku, Turku, Finland.
| | - Outi Karhuvaara
- The Laboratory of Immunochemistry, Department of Biochemistry, Faculty of Science and Engineering, University of Turku, Turku, Finland; Environmental Medicine and Occupational Health, Department of Clinical Medicine, Faculty of Medicine, University of Turku, Turku, Finland
| | - Eetu Suominen
- The Laboratory of Immunochemistry, Department of Biochemistry, Faculty of Science and Engineering, University of Turku, Turku, Finland; Environmental Medicine and Occupational Health, Department of Clinical Medicine, Faculty of Medicine, University of Turku, Turku, Finland
| | - Liisa Vilén
- Environmental Medicine and Occupational Health, Department of Clinical Medicine, Faculty of Medicine, University of Turku, Turku, Finland
| | - Jari Nuutila
- The Laboratory of Immunochemistry, Department of Biochemistry, Faculty of Science and Engineering, University of Turku, Turku, Finland
| | - Tuula Putus
- Environmental Medicine and Occupational Health, Department of Clinical Medicine, Faculty of Medicine, University of Turku, Turku, Finland
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Maio S, Baldacci S, Bresciani M, Simoni M, Latorre M, Murgia N, Spinozzi F, Braschi M, Antonicelli L, Brunetto B, Iacovacci P, Roazzi P, Pini C, Pata M, La Grasta L, Paggiaro P, Viegi G. RItA: The Italian severe/uncontrolled asthma registry. Allergy 2018; 73:683-695. [PMID: 29072882 DOI: 10.1111/all.13342] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2017] [Indexed: 12/28/2022]
Abstract
BACKGROUND The Italian severe/uncontrolled asthma (SUA) web-based registry encompasses demographic, clinical, functional, and inflammatory data; it aims to raise SUA awareness, identifying specific phenotypes and promoting optimal care. METHODS Four hundred and ninety three adult patients from 27 Italian centers (recruited in 2011-2014) were analyzed. RESULTS Mean age was 53.8 years. SUA patients were more frequently female (60.6%), with allergic asthma (83.1%). About 30% showed late onset of asthma diagnosis/symptoms (>40 years); the mean age for asthma symptoms onset was 30.2 years and for asthma diagnosis 34.4 years. 97.1% used ICS (dose 2000 BDP), 93.6% LABA in association with ICS, 53.3% LTRAs, 64.1% anti-IgE, 10.7% theophylline, and 16.0% oral corticosteroids. Mean FEV1 % pred of 75.1%, median values of 300/mm3 of blood eosinophil count, 323 kU/L of serum total IgE, and 24 ppb of FENO were shown. Most common comorbidities were allergic rhinitis (62.4%), gastroesophageal reflux (42.1%), sinusitis (37.9%), nasal polyposis (30.2%), and allergic conjunctivitis (30.2%). 55.7% of SUA patients had exacerbations in the last 12 months, 9.7% emergency department visits, and 7.3% hospitalizations. Factors associated with exacerbation risk were obesity (OR, 95% CI 2.46, 1.11-5.41), psychic disorders (2.87, 0.89-9.30-borderline), nasal polyps (1.86, 0.88-3.89-borderline), partial/poor asthma treatment adherence (2.54, 0.97-6.67-borderline), and anti-IgE use in a protective way (0.26, 0.12-0.53). Comparisons to severe asthma multicenter studies and available registries showed data consistency across European and American populations. CONCLUSIONS An international effort in the implementation of SUA patients' registries could help to better understand the clinical features and to manage severe asthma, representing a non-negligible socioeconomic burden for health services.
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Affiliation(s)
- S. Maio
- Pulmonary Environmental Epidemiology Unit; CNR Institute of Clinical Physiology; Pisa Italy
| | - S. Baldacci
- Pulmonary Environmental Epidemiology Unit; CNR Institute of Clinical Physiology; Pisa Italy
| | - M. Bresciani
- Pulmonary Environmental Epidemiology Unit; CNR Institute of Clinical Physiology; Pisa Italy
| | - M. Simoni
- Pulmonary Environmental Epidemiology Unit; CNR Institute of Clinical Physiology; Pisa Italy
| | - M. Latorre
- Cardio-Thoracic and Vascular Department; University of Pisa; Pisa Italy
| | - N. Murgia
- Clinical and Experimental Medicine; University of Perugia; Perugia Italy
| | - F. Spinozzi
- Clinical and Experimental Medicine; University of Perugia; Perugia Italy
| | - M. Braschi
- Allergy Unit; Internal Medicine Department; AOU Ospedali Riuniti; Ancona Italy
| | - L. Antonicelli
- Allergy Unit; Internal Medicine Department; AOU Ospedali Riuniti; Ancona Italy
| | - B. Brunetto
- Immunology Department; Italian National Health Institute (ISS); Roma Italy
| | - P. Iacovacci
- Immunology Department; Italian National Health Institute (ISS); Roma Italy
| | - P. Roazzi
- Immunology Department; Italian National Health Institute (ISS); Roma Italy
| | - C. Pini
- Immunology Department; Italian National Health Institute (ISS); Roma Italy
| | - M. Pata
- Roche S.p.A.; Monza Milano Italy
| | | | - P. Paggiaro
- Cardio-Thoracic and Vascular Department; University of Pisa; Pisa Italy
| | - G. Viegi
- Pulmonary Environmental Epidemiology Unit; CNR Institute of Clinical Physiology; Pisa Italy
- Institute of Biomedicine and Molecular Immunology (IBIM) “A. Monroy”; CNR; Palermo Italy
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Abstract
The off-label use of medicines is a common and extensive clinical practice. Omalizumab has been licensed for use in severe allergic asthma and chronic urticaria. Omalizumab dosing was based on body weight and baseline serum IgE concentration. All patients are required to have a baseline IgE between 30 and 700 IU/ml and body weight not more than 150 kg. The use of off-label drugs may lead to several problems including adverse effects and an increased risk/benefit balance. In this article, there are summarized off-label uses of omalizumab in the last recent years in diseases in which IgE maybe or certainly has a corner role such as allergic rhinitis, allergic bronchopulmonary aspergillosis, anaphylaxis, keratoconjunctivitis, food allergy, drug allergy, urticaria, angioedema, non-atopic asthma, atopic dermatitis, nasal polyps, Churg-Strauss syndrome, eosinophilic otitis media, chronic rhinosinusitis, bullous pemphigoid, contact dermatitis, and others. Use in pregnancy asthmatic women and pre-co-administration with specific immunotherapy will also be revised.
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Affiliation(s)
- David El-Qutob
- Unit of Allergy, University Hospital of La Plana in Vila-Real, Carretera Vila-Real-Burriana Km. 0.5, Vila-Real, Castellon, 12540, Spain.
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Morin Attenuates Ovalbumin-Induced Airway Inflammation by Modulating Oxidative Stress-Responsive MAPK Signaling. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2015; 2016:5843672. [PMID: 26783416 PMCID: PMC4691473 DOI: 10.1155/2016/5843672] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 09/12/2015] [Accepted: 09/13/2015] [Indexed: 02/07/2023]
Abstract
Asthma is one of the most common inflammatory diseases characterized by airway hyperresponsiveness, inflammation, and remodeling. Morin, an active ingredient obtained from Moraceae plants, has been demonstrated to have promising anti-inflammatory activities in a range of disorders. However, its impacts on pulmonary diseases, particularly on asthma, have not been clarified. This study was designed to investigate whether morin alleviates airway inflammation in chronic asthma with an emphasis on oxidative stress modulation. In vivo, ovalbumin- (OVA-) sensitized mice were administered with morin or dexamethasone before challenge. Bronchoalveolar lavage fluid (BALF) and lung tissues were obtained to perform cell counts, histological analysis, and enzyme-linked immunosorbent assay. In vitro, human bronchial epithelial cells (BECs) were challenged by tumor necrosis factor alpha (TNF-α). The supernatant was collected for the detection of the proinflammatory proteins, and the cells were collected for reactive oxygen species (ROS)/mitogen-activated protein kinase (MAPK) evaluations. Severe inflammatory responses and remodeling were observed in the airways of the OVA-sensitized mice. Treatment with morin dramatically attenuated the extensive trafficking of inflammatory cells into the BALF and inhibited their infiltration around the respiratory tracts and vessels. Morin administration also significantly suppressed goblet cell hyperplasia and collagen deposition/fibrosis and dose-dependently inhibited the OVA-induced increases in IgE, TNF-α, interleukin- (IL-) 4, IL-13, matrix metalloproteinase-9, and malondialdehyde. In human BECs challenged by TNF-α, the levels of proteins such as eotaxin-1, monocyte chemoattractant protein-1, IL-8 and intercellular adhesion molecule-1, were consistently significantly decreased by morin. Western blotting and the 2',7'-dichlorofluorescein assay revealed that the increases in intracellular ROS and MAPK phosphorylation were abolished by morin, implying that ROS/MAPK signaling contributes to the relief of airway inflammation. Our findings indicate for the first time that morin alleviates airway inflammation in chronic asthma, which probably occurs via the oxidative stress-responsive MAPK pathway, highlighting a novel profile of morin as a potent agent for asthma management.
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