Mansur Adel H, Marsh Julie, Bahron Ali, Thomas Maximillian, Walters Gareth, Busby John, Heaney Liam G, Krishna Mamidipudi Thirumala
Birmingham Regional Severe Asthma Service, Birmingham Heartland Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK.
Clin Transl Allergy. 2023 Oct;13(10):e12303. doi: 10.1002/clt2.12303.
House dust mite (HDM) is the most common sensitising allergen in asthma. Ethnic minority groups (EMGs) in the UK are more likely to live in deprived conditionings with a greater exposure to HDM and other aero-allergens.
To compare the ethnicity-based patterns of sensitisation to aero-allergens and the impact of ethnicity on clinical outcomes in patients with difficult-to-treat asthma (DTA).
Data of patients with DTA were extracted from the registry of the Birmingham Regional Severe Asthma Service (BRSAS), which have a catchment population of 7.3million from Central England. Patients from White and EMG backgrounds were compared in terms of the prevalence of atopy, total serum immunoglobulin E (IgE), specific serum IgE (ssIgE) and asthma related clinical outcomes. Logistic regression analysis was conducted to explore ethnicity-based risk factors for HDM sensitisation.
A total of 1272 patients [White 1016 (79.9%), EMG 256 (20.1%) EMG] with a median age of 51 years (range 16-97) were included in the analysis. Patients from EMG were more likely (64%) to reside in the worst scale of index of multiple deprivation (IMD) than the White patients (25.5%), p < 0.0001. Positive HDM sensitisation was more prevalent in the EMG than in the White group [142/216 (66%) versus 375/842 (45%), p < 0.0001]. The median HDM ssIgE level was higher in the EMG than in the White group [3.0 KUA/L (IQR 0.06, 11.5) versus 0.1 (0.01, 3.0), p < 0.000001]. The odds ratio for positive sensitisation to HDM conveyed by the EMG status was 2.61 (95%CI, 1.8-3.8), p < 0.0001. Compared to the White group, the EMG had higher median total serum IgE [326 KU/L (115, 971) versus 114 (29.8, 434.8), p < 0.000001], higher blood eosinophil count (0.36 × 10 (0.18, 0.62) versus 0.23 (0.1,0.47), p < 0.000001), were marginally more atopic (79.2% vs. 75.6%, p = 0.098) and were less likely to being on maintenance oral corticosteroids (22% vs. 39.7%, p < 0.0001).
In this DTA cohort, positive HDM sensitisation was greater amongst the EMG than the White patients. The EMG status was a significant risk factor for HDM sensitisation.
屋尘螨（HDM）是哮喘中最常见的致敏变应原。英国的少数族裔群体（EMGs）更有可能生活在贫困环境中，接触HDM和其他空气变应原的机会更多。
比较难治性哮喘（DTA）患者中基于种族的空气变应原致敏模式以及种族对临床结局的影响。
从伯明翰地区重症哮喘服务（BRSAS）登记处提取DTA患者的数据，该服务覆盖英格兰中部730万人口。比较白人和EMG背景患者的特应性患病率、血清总免疫球蛋白E（IgE）、特异性血清IgE（ssIgE）及哮喘相关临床结局。进行逻辑回归分析以探讨基于种族的HDM致敏危险因素。
共纳入1272例患者[白人1016例（79.9%），EMG 256例（20.1%）]，中位年龄51岁（范围16 - 97岁）进行分析。与白人患者（25.5%）相比，EMG患者居住在多重贫困指数（IMD）最差等级的可能性更高（64%），p < 0.0001。EMG组HDM致敏阳性率高于白人组[142/216（66%）对375/842（45%），p < 0.0001]。EMG组HDM ssIgE中位水平高于白人组[3.0 KUA/L（IQR 0.06，11.5）对0.1（0.01，3.0），p < 0.000001]。EMG状态导致HDM致敏阳性的比值比为2.61（95%CI，1.8 - 3.8），p < 0.0001。与白人组相比，EMG组血清总IgE中位水平更高[326 KU/L（115，971）对114（29.8，434.8），p < 0.000001]，血嗜酸性粒细胞计数更高（0.36×10（0.18，0.62）对0.23（0.1，0.47），p < 0.000001），特应性略多（79.2%对75.6%，p = 0.098），接受维持性口服糖皮质激素治疗的可能性更小（22%对39.7%，p < 0.0001）。
在这个DTA队列中，EMG患者HDM致敏阳性率高于白人患者。EMG状态是HDM致敏的重要危险因素。
