N Tsolakis1, A Malinovschi2, L Nordvall1, C Janson2, M P Borres1,3, K Alving1. 1. Women's and Children's Health, Uppsala University, Uppsala, Sweden. 2. Medical Sciences, Uppsala University, Uppsala, Sweden. 3. Thermo Fisher Scientific, Uppsala, Sweden.
Abstract
BACKGROUND: Atopic asthma is associated with elevated type-2 biomarkers such as fraction of exhaled nitric oxide (FeNO) and blood eosinophil (B-Eos) count. However, increased type 2 markers have also been reported in traditionally defined non-atopic asthma. OBJECTIVE: To determine a clinically useful level of IgE sensitization for ruling out type 2 asthma. METHODS: Asthmatics (N = 408; age 10-35 years) were analysed using the multi-allergen tests Phadiatop and fx5 (ImmunoCAP). Subjects were grouped based on IgE-antibody concentrations: ≥0.35 kUA /L for at least one test (n = 326) or <0.35 kUA /L for both tests (n = 82). Τhe latter group was subsequently divided into 2 groups: IgE 0.10-0.34 kUA /L (n = 34) and IgE < 0.10 kUA /L (n = 48). The relationships between type 2 biomarkers, and inadequate asthma control (ACT < 20), reduced lung function (FEV1 < 80%), recent asthma attacks and airway hyperresponsiveness (AHR) to methacholine were determined. RESULTS: In univariate analyses, at least one type 2 marker related to each asthma outcome in subjects with IgE ≥0.35 kUA /L. In subjects with IgE 0.10-0.34 kUA /L, elevated FeNO related to reduced lung function (P = .008) and B-Eos to AHR (P = .03). No associations were found in subjects with IgE < 0.10 kUA /L. In multivariate analysis, a relationship between FeNO and reduced lung function remained in subjects with IgE < 0.35 kUA /L (P = .03). CONCLUSION AND CLINICAL RELEVANCE: Clinically relevant elevation of type 2 biomarkers was seen in young asthmatics with IgE antibodies <0.35 kUA /L, but not those with IgE < 0.10 kUA /L. It seems possible to define non-type 2 asthma through sensitive IgE-antibody measurement.
BACKGROUND:Atopic asthma is associated with elevated type-2 biomarkers such as fraction of exhaled nitric oxide (FeNO) and blood eosinophil (B-Eos) count. However, increased type 2 markers have also been reported in traditionally defined non-atopic asthma. OBJECTIVE: To determine a clinically useful level of IgE sensitization for ruling out type 2 asthma. METHODS: Asthmatics (N = 408; age 10-35 years) were analysed using the multi-allergen tests Phadiatop and fx5 (ImmunoCAP). Subjects were grouped based on IgE-antibody concentrations: ≥0.35 kUA /L for at least one test (n = 326) or <0.35 kUA /L for both tests (n = 82). Τhe latter group was subsequently divided into 2 groups: IgE 0.10-0.34 kUA /L (n = 34) and IgE < 0.10 kUA /L (n = 48). The relationships between type 2 biomarkers, and inadequate asthma control (ACT < 20), reduced lung function (FEV1 < 80%), recent asthma attacks and airway hyperresponsiveness (AHR) to methacholine were determined. RESULTS: In univariate analyses, at least one type 2 marker related to each asthma outcome in subjects with IgE ≥0.35 kUA /L. In subjects with IgE 0.10-0.34 kUA /L, elevated FeNO related to reduced lung function (P = .008) and B-Eos to AHR (P = .03). No associations were found in subjects with IgE < 0.10 kUA /L. In multivariate analysis, a relationship between FeNO and reduced lung function remained in subjects with IgE < 0.35 kUA /L (P = .03). CONCLUSION AND CLINICAL RELEVANCE: Clinically relevant elevation of type 2 biomarkers was seen in young asthmatics with IgE antibodies <0.35 kUA /L, but not those with IgE < 0.10 kUA /L. It seems possible to define non-type 2 asthma through sensitive IgE-antibody measurement.
Authors: Jennifer Johnson; Andrei Malinovschi; Jonas Lidholm; Carl Johan Petersson; Lennart Nordvall; Christer Janson; Kjell Alving; Magnus P Borres Journal: Clin Mol Allergy Date: 2020-06-23
Authors: Victoria S Benson; Sylvia Hartl; Neil Barnes; Nicholas Galwey; Melissa K Van Dyke; Namhee Kwon Journal: Eur Respir J Date: 2022-01-13 Impact factor: 16.671