RATIONALE: Allergic sensitization is associated with poor clinical outcomes in asthma, chronic obstructive pulmonary disease, and cystic fibrosis; however, its presence, frequency, and clinical significance in non-cystic fibrosis bronchiectasis remain unclear. OBJECTIVES: To determine the frequency and geographic variability that exists in a sensitization pattern to common and specific allergens, including house dust mite and fungi, and to correlate such patterns to airway immune-inflammatory status and clinical outcomes in bronchiectasis. METHODS: Patients with bronchiectasis were recruited in Asia (Singapore and Malaysia) and the United Kingdom (Scotland) (n = 238), forming the Cohort of Asian and Matched European Bronchiectasis, which matched recruited patients on age, sex, and bronchiectasis severity. Specific IgE response against a range of common allergens was determined, combined with airway immune-inflammatory status and correlated to clinical outcomes. Clinically relevant patient clusters, based on sensitization pattern and airway immune profiles ("immunoallertypes"), were determined. MEASUREMENTS AND MAIN RESULTS: A high frequency of sensitization to multiple allergens was detected in bronchiectasis, exceeding that in a comparator cohort with allergic rhinitis (n = 149). Sensitization was associated with poor clinical outcomes, including decreased pulmonary function and more severe disease. "Sensitized bronchiectasis" was classified into two immunoallertypes: one fungal driven and proinflammatory, the other house dust mite driven and chemokine dominant, with the former demonstrating poorer clinical outcome. CONCLUSIONS: Allergic sensitization occurs at high frequency in patients with bronchiectasis recruited from different global centers. Improving endophenotyping of sensitized bronchiectasis, a clinically significant state, and a "treatable trait" permits therapeutic intervention in appropriate patients, and may allow improved stratification in future bronchiectasis research and clinical trials.
RATIONALE: Allergic sensitization is associated with poor clinical outcomes in asthma, chronic obstructive pulmonary disease, and cystic fibrosis; however, its presence, frequency, and clinical significance in non-cystic fibrosis bronchiectasis remain unclear. OBJECTIVES: To determine the frequency and geographic variability that exists in a sensitization pattern to common and specific allergens, including house dust mite and fungi, and to correlate such patterns to airway immune-inflammatory status and clinical outcomes in bronchiectasis. METHODS:Patients with bronchiectasis were recruited in Asia (Singapore and Malaysia) and the United Kingdom (Scotland) (n = 238), forming the Cohort of Asian and Matched European Bronchiectasis, which matched recruited patients on age, sex, and bronchiectasis severity. Specific IgE response against a range of common allergens was determined, combined with airway immune-inflammatory status and correlated to clinical outcomes. Clinically relevant patient clusters, based on sensitization pattern and airway immune profiles ("immunoallertypes"), were determined. MEASUREMENTS AND MAIN RESULTS: A high frequency of sensitization to multiple allergens was detected in bronchiectasis, exceeding that in a comparator cohort with allergic rhinitis (n = 149). Sensitization was associated with poor clinical outcomes, including decreased pulmonary function and more severe disease. "Sensitized bronchiectasis" was classified into two immunoallertypes: one fungal driven and proinflammatory, the other house dust mite driven and chemokine dominant, with the former demonstrating poorer clinical outcome. CONCLUSIONS: Allergic sensitization occurs at high frequency in patients with bronchiectasis recruited from different global centers. Improving endophenotyping of sensitized bronchiectasis, a clinically significant state, and a "treatable trait" permits therapeutic intervention in appropriate patients, and may allow improved stratification in future bronchiectasis research and clinical trials.
Entities:
Keywords:
allergy; bronchiectasis; house dust mite; sensitization
Authors: Micheál Mac Aogáin; Jayanth Kumar Narayana; Pei Yee Tiew; Nur A'tikah Binte Mohamed Ali; Valerie Fei Lee Yong; Tavleen Kaur Jaggi; Albert Yick Hou Lim; Holly R Keir; Alison J Dicker; Kai Xian Thng; Akina Tsang; Fransiskus Xaverius Ivan; Mau Ern Poh; Martina Oriano; Stefano Aliberti; Francesco Blasi; Teck Boon Low; Thun How Ong; Brian Oliver; Yan Hui Giam; Augustine Tee; Mariko Siyue Koh; John Arputhan Abisheganaden; Krasimira Tsaneva-Atanasova; James D Chalmers; Sanjay H Chotirmall Journal: Nat Med Date: 2021-04-05 Impact factor: 53.440
Authors: Pei Yee Tiew; Micheál Mac Aogáin; Soo Kai Ter; Stefano Aliberti; James D Chalmers; Sanjay H Chotirmall Journal: Mycopathologia Date: 2021-03-11 Impact factor: 2.574
Authors: Pei Yee Tiew; Fanny Wai San Ko; Sze Lei Pang; Sri Anusha Matta; Yang Yie Sio; Mau Ern Poh; Kenny J X Lau; Micheál Mac Aogáin; Tavleen Kaur Jaggi; Fransiskus Xaverius Ivan; Nicolas E Gaultier; Akira Uchida; Daniela I Drautz-Moses; Huiying Xu; Mariko Siyue Koh; David Shu Cheong Hui; Augustine Tee; John Arputhan Abisheganaden; Stephan C Schuster; Fook Tim Chew; Sanjay H Chotirmall Journal: Eur Respir J Date: 2020-08-27 Impact factor: 16.671