The association of skin test reactivity, total serum IgE levels, and peripheral blood eosinophilia with asthma in Kuwait

Clinical characteristics, cytokine profiles and plasma IgE in adults with asthma

Asthma is a disease with complicated network of inflammatory responses of cytokines and ImmunoglobulinE (IgE). The aim of this study was to explore the clinical characteristics, cytokine profile and plasma IgE in the Malaysian population. This is a cross-sectional study involving physician-diagnosed asthma patients (n = 287) recruited from the Chest Clinic, University of Malaya Medical Centre (UMMC). Blood (8 mL) was taken after consent was obtained. The peripheral blood leucocytes (PBL) were cultured in presence of a mitogen for 72 h to quantify cytokines [Interleukin-5(IL-5), Interleukin-9 (IL-9), Interleukin-12 Beta (IL-12ꞵ) and granulocyte-macrophage colony-stimulating factor (GM-CSF)] and plasma was used to quantify IgE levels with commercial ELISA kits. Results were compared against the same biomarkers in healthy subjects (n = 203). In addition, the amount of the biomarkers in the asthma patients were compared with their disease severity and clinical characteristics. Statistical tests in the SPSS software (Mann-Whitney U test and the Kruskal Wallis) were used to compare cytokine production and plasma IgE levels. The mean plasma IgE level was markedly higher (p < 0.0001) in asthmatics compared to controls. There were higher levels of IL-5, IL-9, IL-12ꞵ and GM-CSF (p < 0.0001) produced by cultured PBL from asthma patients compared to controls. However, our results did not expose a significant association between these cytokine levels and severity and clinical symptoms of asthma. However, there was a marked association between asthma severity and blood lymphocyte count [ꭓ²(2) = 6.745, p < 0.05]. These findings support the roles played by cytokines and IgE in the airway inflammation in asthma. The findings of this study provide new information about inflammatory cytokines in Malaysian asthma patients.

Relationship between total serum immunoglobulin E levels, fractional exhaled breath nitric oxide levels and absolute blood eosinophil counts in atopic and non-atopic asthma: a controlled comparative study

OBJECTIVE

Asthma is a prevalent non-communicable disease both in low- and high-income countries, including Nepal. Total serum immunoglobulin E levels and peripheral blood absolute eosinophil counts are known inflammatory markers of asthma. Fractional exhaled nitric oxide measurement in breath has also been proposed as a non-invasive biomarker to assess eosinophilic airway inflammation. This study explores the correlation between these three variables with the intent that one may replace the other in resource-limited setups.

APPROACH

This prospective controlled trial evaluated 314 subjects with and without asthma, with the asthma group sub-divided into atopic and non-atopic categories. Total serum immunoglobulin E level, absolute eosinophil count in peripheral blood and fractional exhaled nitric oxide level were measured in all categories.

RESULTS

The geometric mean of immunoglobulin E levels, absolute eosinophil count and fractional exhaled nitric oxide were 221.07 ± 774.55 IU/mL, 214 ± 360/uL and 37 ± 49 ppb in the asthma group and 59.13 ± 174.32 IU/mL, 164 ± 137/uL and 12 ± 21 ppb in the control group, respectively. Significantly higher levels were seen in the asthma group for total serum immunoglobulin E (p < 0.001), AEC (p = 0.002) and F_ENO (p < 0.001) levels. Total serum immunoglobulin E levels, absolute eosinophil count and fractional exhaled nitric oxide were 436.79 ± 822.40 IU/mL, 269 ± 395/uL and 76 ± 52 ppb in atopic asthma group. Similarly, total serum immunoglobulin E levels, absolute eosinophil count and fractional exhaled nitric oxide were 131.17 ± 692.96 IU/mL, 182 ± 328/uL and 23 ± 22.5 ppb in non-atopic asthma group. Significantly higher levels were seen in all three variables: tIgE (p < 0.001), AEC (p =  0.008) and F_ENO (p < 0.001). A moderate degree of positive correlation was identified between tIgE and F_ENO₅₀ (Spearman's rho = 0.461) and tIgE and AEC (Spearman's rho = 0.315) with only small correlation between F_ENO₅₀ and AEC (Spearman's rho = 0.299).

SIGNIFICANCE

tIgE levels, F_ENO₅₀ and AEC levels are higher in asthma, specifically in the atopic phenotype, as compared to normal. Total serum IgE levels have moderate correlation with F_ENO₅₀ and AEC but F_ENO₅₀ and AEC are weakly correlated.

The expression of a novel anti-inflammatory cytokine IL-35 and its possible significance in childhood asthma

Interleukin-35 (IL-35) is a novel anti-inflammatory cytokine and has been shown to play an important role in maintaining immune homeostasis. However, the effect of IL-35 on human asthma remains unclear. The present study is to investigate the expression and significance of IL-35 in childhood asthma. Forty-one asthmatic children and forty-two healthy controls were recruited in Qilu Children's Hospital of Shandong University. Serum total immunoglobulin E level was measured by radioimmunosorbent test. Peripheral blood eosinophils were counted using BC-5800 Automatic Blood Cell Analyzer. IL-35 mRNA in peripheral blood mononuclear cells was detected by quantitative real-time polymerase chain reaction. Serum IL-35, IL-4 and interferon-γ levels were measured using enzyme-linked immunosorbent assay. The correlations among the above indexes were also analyzed using Pearson's method. Our results showed that serum total IgE, eosinophil count and serum IL-4 were significantly increased in asthmatic children compared with control children, and serum IFN-γ level in asthmatic patients was obviously lower than that in healthy controls. We also found that there was an obviously positive correlation between serum IgE and IL-4 levels in asthmatic patients. In addition, significantly negative correlation was found between serum total IgE and IFN-γ levels. More importantly, we found that the expression of IL-35 mRNA and protein was both down-regulated in asthmatic children, and serum IL-35 level was inversely related to serum IL-4 level. Moreover, significantly positive correlation was also found between serum IL-35 and IFN-γ levels. The results suggest that the decreased expression of IL-35 could be involved in the pathogenesis of childhood asthma.

Elevated serum IgE may be associated with development of ketamine cystitis

PURPOSE

Previous studies revealed bladder mast cell and eosinophil cell infiltration in patients with ketamine cystitis. Due to possible hypersensitivity in those with this condition we investigated the association of serum Ig, histology findings and symptoms in patients with ketamine cystitis.

MATERIALS AND METHODS

We evaluated patients with ketamine cystitis for maximal bladder capacity, serum IgE, IgG and IgM, and pain visual analog scale score. Bladder biopsies were assessed for mast cells and eosinophils. Patients with interstitial cystitis/bladder pain syndrome, acute bacterial cystitis and controls were also studied. We used the Mann-Whitney U test for nonparametric data to compare serum IgE among groups with p <0.017 considered significant.

RESULTS

Median serum IgE was significantly higher in the 20 patients with ketamine cystitis (205.5 IU/ml, IQR 36.9, 514.0) than in the 10 controls (33.4 IU/ml, IQR 13.5, 71.7, p = 0.015) and the 15 with acute bacterial cystitis (34.6 IU/ml, IQR 24.2, 101.9, p = 0.015). It was marginally higher than in the 13 patients with interstitial cystitis/bladder pain syndrome (65.8 IU/ml, IQR 11.9, 133.0, p = 0.029). Of patients with ketamine cystitis the median visual analog scale pain score was significantly higher in those with serum IgE greater than compared to less than 200 IU/ml. Maximal bladder capacity was significantly less in patients with ketamine cystitis who had higher IgE. Patients with severe or moderate bladder eosinophil infiltration had a greater visual analog scale score, higher serum IgE and smaller maximal bladder capacity than patients with no or mild eosinophil infiltration. Serum IgE and the visual analog scale score correlated significantly (r(2) = 0.318, p = 0.01).

CONCLUSIONS

Patients with ketamine cystitis had higher serum IgE than patients with interstitial cystitis/bladder pain syndrome or acute bacterial cystitis, or controls. Serum IgE and the severity of eosinophil infiltration were associated with bladder pain severity and small maximal bladder capacity.

Sensitization profile in differential diagnosis: allergic asthma vs. chronic (nonspecific) cough syndrome

BACKGROUND

In the subgroup of children with chronic cough, distinguishing children with allergic asthma from those with non-specific respiratory symptoms is difficult. We have focused on determination of diagnostic efficiency of serum total IgE, sIgE, and skin prick test in differentiation of asthmatic children from children with nonspecific respiratory symptoms.

MATERIAL AND METHODS

A total of 131 children with median age of 7.5 years were enrolled in study and divided into 2 groups; children with allergic asthma (N=71) and children with chronic cough (N=60). Participants underwent the standard allergological examination, including skin prick test and measurement of total IgE, and following 3 allergen-specific IgE antibodies against aeroallergens: Dermatophagoides pteronyssinus, Ambrosia artemisiifolia, and Phleum pratense.

RESULTS

The percentage of patients with elevated level of total and sIgE was higher in children with allergic asthma than in children with chronic cough syndrome (P=0.0001). In children with asthma, sIgE had a better diagnostic value than total IgE. The best diagnostic efficiency of cut-off values for sIgE was shown for Der p sIgE. Skin prick test to all allergens had 78.82% sensitivity and 91.3% specificity in differentiating the 2 tested groups. The highest sensitivity and specificity in skin prick test was proved for Dermatophagoides pteronyssinus.

CONCLUSIONS

The sensitization profile consisting of total IgE, sIgE levels, and SPT clearly distinguishes children with allergic asthma from children with chronic nonspecific cough, but still with overlap. Therefore, diagnosis should always be confirmed by a thorough allergy investigation.

To Evaluate Serum Eosinophil Cationic Protein and Total IgE Concomitantly May Predict the Persistence of Wheezing in Young Children

Background. We investigated the predictive value and the relative risk of the evaluation of serum eosinophilic cationic protein (sECP) and total IgE levels concomitantly in relation to the persistence of wheezing in young children. Methods. The study was conducted prospectively between January 2007 and December 2010. A hundred and eight children, aged between three months and four years, with three or more episodes of wheezing, were studied to evaluate the role of eosinophil inflammation and its relation to persistence of wheezing two years later. Results. A statistically significant difference in terms of total IgE and sECP values was observed between the groups (P < 0.05). When measurement of IgE and sECP was assessed concomitantly, the sensitivity was found to be 92.68%, the negative predictive value was found to be 71.43%, accuracy rate was found to be 84.26%, and the relative risk was found to be 3.06 in group 1. Conclusions. In this study, we aimed to emphasize the importance of the assessment of sECP and total IgE concomitantly, as being two noninvasive and easily applicable tests, useful in predicting persistent wheezing in early childhood.

Serum total IgE levels and total eosinophil counts: relationship with treatment response in patients with acute asthma

OBJECTIVE

To determine whether serum total IgE levels and total eosinophil counts have any relationship with the response to routine pharmacological treatment in patients with acute asthma.

METHODS

A cross-sectional study involving 162 patients with acute asthma. Serum total IgE levels, peripheral blood cell counts and eosinophil counts were determined. The treatment was adjusted for each patient according to the severity of asthma. Spirometry was performed at baseline and two weeks after the treatment. The patients were divided into two groups: high IgE (>100 IU/mL) and low IgE (<100 IU/mL). We compared the two groups in terms of the relationships between baseline values and final values (percentage change) for the following parameters: FEV1, FVC, FEF25-75%, peripheral white blood cell counts and eosinophil counts.

RESULTS

There were no significant differences between the groups regarding the percentage changes of the studied parameters. Nor were there significant differences between the groups regarding FEV1, FVC, and FEF25-75% (% of the predicted values) at baseline.

CONCLUSIONS

On the basis of these findings, we conclude that serum total IgE levels, peripheral white blood cell counts and eosinophil counts cannot predict the response to the pharmacological treatment of patients with acute asthma.

Asthma and sensitization in a community with low indoor allergen levels and low pet-keeping frequency

BACKGROUND

Little is known about causes of asthma and sensitization in desert countries.

OBJECTIVE

To investigate risk factors associated with asthma and sensitization in Kuwait.

METHODS

One hundred sixty children (9-16 years) with physician-diagnosed asthma were recruited and matched (age, sex) with 303 healthy controls. Risk factors were assessed by questionnaires, determination of sensitization status (skin tests and IgE), and home allergen exposure (mite, cat, dog, cockroach; ELISA).

RESULTS

Home allergen levels and frequency of pet ownership were very low (cat, 4.1%; dog, 1.5%). The risk of cat sensitization increased significantly among cat owners (odds ratio [OR], 3.53; 95% CI, 1.33-9.41; P = .01), and in children with reported contact with cats during the first year of life (OR, 2.60; 95% CI, 1.17-5.80; P = .019). In the multivariate analysis, maternal atopy (OR, 1.77; 95% CI, 1.13-2.75; P = .01) and cat ownership (OR, 3.32; 95% CI, 1.19-9.25; P = .02) remained significant associates of cat sensitization. Current dog ownership significantly increased the risk of sensitization to dog (OR, 6.05; 95% CI, 1.33-27.54; P = .02). In the multivariate analysis, dog ownership remained the only significant associate of dog sensitization (OR, 6.02; 95% CI, 1.30-27.96; P = .02). Sensitization to Alternaria was the strongest independent associate of the asthma group. Family history of asthma, history of whooping cough, current cat ownership, and breast-feeding <2 months were other significant and independent risk factors for asthma.

CONCLUSIONS

Pet ownership markedly increased the risk of sensitization to pets. Despite low allergen exposure, the pattern of childhood asthma in Kuwait follows that described in Western communities (strong association with sensitization).

Total and allergen-specific IgE levels in serum reflect blood eosinophilia and fractional exhaled nitric oxide concentrations but not pulmonary functions in allergic asthmatic children sensitized to house dust mites

Although elevated levels of serum immunoglobulin E (IgE) are considered the hallmark of atopic diseases, their clinical value in evaluating subjects with allergic disorders is under debate. To evaluate possible relationships between serum IgE levels and a variety of clinical parameters, 83 mild asthmatic children [10.98-year-old (2.95)], sensitized to house dust mites (HDM) Dermatophagoides pteronyssinus (Dp) or D. farinae (Df), were enrolled. As compared with normal control reference values detected in our laboratory, children with allergic asthma had higher blood eosinophil counts (expressed both as percentage and as absolute number) and higher fractional exhaled nitric oxide (FeNO) levels but similar values in pulmonary function parameters. In the allergic asthmatic population, serum levels of total, Dp-specific or Df-specific IgE correlated positively with eosinophil counts (Rho > or = 0.30, p < 0.01, each correlation) and FeNO levels (Rho > or = 0.33, p < 0.01, each correlation) but not with pulmonary function parameters (p > 0.1, each correlation). Finally, significant correlations, although moderate, were found in the allergic asthmatic population between eosinophil counts and FeNO levels (Rho > or = 0.42, p < 0.001, each correlation). Thus, in atopic children sensitized to HDM with mild intermittent asthma, IgE levels in blood appear to reflect systemic (blood eosinophils) and organ-specific (FeNO) markers of allergic inflammation but not pulmonary volumes or the degree of airflow limitation.