Manise M, Bakayoko B, Schleich F, Corhay J-L, Louis R
Department of Respiratory Medicine, CHU Sart-Tilman, Liege, Belgium.
GIGA Research Group i3, Liege, Belgium.
Int J Clin Pract. 2016 Jul;70(7):596-605. doi: 10.1111/ijcp.12837. Epub 2016 Jun 28.
Atopy is known to play an important role in the asthmatic disease. The main objective of this study was to evaluate the frequency of sensitisation to common aeroallergens in a cohort of asthmatics with different inflammatory phenotypes and disease severity.
We have conducted a retrospective cross-sectional study including 772 asthmatics recruited between 2003 and 2014 in our Asthma Clinic. The patients were defined as asthmatics on the basis of respiratory symptoms together with a positive methacholine test (PC20M) < 16 mg/ml and/or a reversibility to short-acting β2-agonists (salbutamol) ≥ 12% and 200 ml. Sensitisation to house dust mites, grass and birch pollens, cats, dogs and moulds was assessed by RAST and a specific immunoglobulin E (IgE) > 0.35 kU/l was considered as significant. Inflammatory phenotypes were subdivided between pauci-granulocytic (n = 309) (40%), eosinophilic (n = 311) (40%), neutrophilic (N = 134) (17%) and mixed-granulocytic (N = 18) (3%) asthmatics. Severe asthmatics (n = 118) were defined according to the American Thoracic Society (ATS 2000) criteria and compared with mild-to-moderate asthmatics (N = 654).
The eosinophilic phenotype was associated with higher levels of total serum IgE compared with neutrophilic and pauci-granulocytic asthma (p < 0.001 for both). Sensitisation rate to dogs and cats was higher in eosinophilic asthmatics (31% and 37%, respectively, p < 0.01 both) compared with neutrophilic (18% and 23% respectively) and pauci-granulocytic asthmatics (20% and 24%, respectively), while sensitisation rate to house dust mites and moulds were rather similar between the groups (ranging from 33% to 40% and from 10% to 16%, respectively). Severe asthmatics had slightly increased total serum IgE compared with mild-to-moderate asthmatics (p < 0.05) without any difference in the sensitisation rate to common aeroallergens.
Eosinophilic asthma exhibits higher total serum IgE and sensitisation rate towards animal dander while clinical severity, though also associated with higher total IgE, did not preferentially relate to any type of common aeroallergens.
已知特应性在哮喘疾病中起重要作用。本研究的主要目的是评估一组具有不同炎症表型和疾病严重程度的哮喘患者对常见气传变应原的致敏频率。
我们进行了一项回顾性横断面研究，纳入了2003年至2014年期间在我们哮喘诊所招募的772例哮喘患者。根据呼吸道症状以及乙酰甲胆碱试验阳性（PC20M）<16mg/ml和/或对短效β2激动剂（沙丁胺醇）的可逆性≥12%且200ml，将患者定义为哮喘患者。通过放射变应原吸附试验（RAST）评估对屋尘螨、草和桦树花粉、猫、狗和霉菌的致敏情况，特异性免疫球蛋白E（IgE）>0.35kU/l被认为具有统计学意义。炎症表型分为少粒细胞性（n = 309）（40%）、嗜酸性粒细胞性（n = 311）（40%）、中性粒细胞性（n = 134）（17%）和混合粒细胞性（n = 18）（3%）哮喘患者。根据美国胸科学会（ATS 2000）标准定义重度哮喘患者（n = 118），并与轻至中度哮喘患者（n = 654）进行比较。
与中性粒细胞性和少粒细胞性哮喘相比，嗜酸性粒细胞性表型的总血清IgE水平更高（两者p < 0.001）。与中性粒细胞性哮喘患者（分别为18%和23%）和少粒细胞性哮喘患者（分别为20%和24%）相比，嗜酸性粒细胞性哮喘患者对狗和猫的致敏率更高（分别为31%和37%，两者p < 0.01），而各组对屋尘螨和霉菌的致敏率相当相似（分别为33%至40%和10%至16%）。与轻至中度哮喘患者相比，重度哮喘患者的总血清IgE略有升高（p < 0.05），但对常见气传变应原的致敏率无差异。
嗜酸性粒细胞性哮喘表现出更高的总血清IgE和对动物皮屑的致敏率，而临床严重程度虽然也与更高的总IgE相关，但与任何类型的常见气传变应原均无优先关联。
