Caruso Cristiano, Colantuono Stefania, Ciasca Gabriele, Basile Umberto, Di Santo Riccardo, Bagnasco Diego, Passalacqua Giovanni, Caminati Marco, Michele Schiappoli, Senna Gianenrico, Heffler Enrico, Canonica G Walter, Crimi Nunzio, Intravaia Rossella, De Corso Eugenio, Firinu Davide, Gasbarrini Antonio, Del Giacco Stefano R
Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Rome, Italy.
Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
Allergy. 2023 Jan;78(1):131-140. doi: 10.1111/all.15466. Epub 2022 Aug 10.
Asthma, with several phenotypes and endotypes, is considered particularly suited for precision medicine. The identification of different non-invasive biomarkers may facilitate diagnosis and treatment. Recently, Staphylococcus aureus and its enterotoxins (SE) have been found to have a role in inducing persistent type 2 airway inflammation in severe asthma, but also in such comorbidities as chronic rhinosinusitis with nasal polyposis (CRSwNP).
The aim of this retrospective study was to evaluate the prevalence of SE-IgE sensitization in a multicentric Italian cohort of severe asthmatic patients and correlate it with demographic and clinical characteristics.
A total of 249 patients were included in the analysis, out of which 25.3% were staphylococcal enterotoxin B (SEB)-IgE positive. We found a meaningful association between SEB-IgE and female gender, a positive association was also measured between CRS and CRSwNP. No significant association was found between SEB-IgE sensitization and atopy, the occurrence of exacerbations and corticosteroid dosages. In the SEB-IgE-positive patient, blood eosinophil count does not appear to be correlated with the severity of the disease. Patients with SEB-IgE sensitization are, on average, younger and with an earlier disease onset, thus confirming the possibility to consider SEB-IgE sensitization as an independent risk factor for developing asthma.
Our data confirm that the search for SE in the initial screening phase of these patients is helpful to better phenotype them, may predict the evolution of comorbidities and lead to a targeted therapeutic choice; in this point of view this represents a goal of precision medicine.
哮喘具有多种表型和内型，被认为特别适合精准医学。识别不同的非侵入性生物标志物可能有助于诊断和治疗。最近发现，金黄色葡萄球菌及其肠毒素（SE）在严重哮喘中可诱导持续性2型气道炎症，在慢性鼻窦炎伴鼻息肉（CRSwNP）等合并症中也有作用。
这项回顾性研究的目的是评估意大利多中心重症哮喘患者队列中SE-IgE致敏的患病率，并将其与人口统计学和临床特征相关联。
共有249例患者纳入分析，其中25.3%的患者葡萄球菌肠毒素B（SEB）-IgE呈阳性。我们发现SEB-IgE与女性性别之间存在显著关联，CRS和CRSwNP之间也存在正相关。未发现SEB-IgE致敏与特应性、加重发作的发生及皮质类固醇剂量之间存在显著关联。在SEB-IgE阳性患者中，血液嗜酸性粒细胞计数似乎与疾病严重程度无关。SEB-IgE致敏患者平均年龄较小，发病较早，从而证实了将SEB-IgE致敏视为哮喘发病独立危险因素的可能性。
我们的数据证实，在这些患者的初始筛查阶段寻找SE有助于更好地对其进行表型分析，可能预测合并症的演变并导致有针对性的治疗选择；从这个角度来看，这代表了精准医学的一个目标。
