Levels of Immunoglobulin E Sensitization Drive Symptom Thresholds in Allergic Rhinitis

BACKGROUND

Allergic rhinitis (AR) is a common respiratory disease encompassing a variety of phenotypes. Patients can be sensitized to one or more allergens. There are indications that polysensitization is associated with more severe disease. However, the extent to which the level of sensitization is associated to clinical disease variability, underlying the distinct nature of AR from AR+ conjunctivitis or AR+ asthma, is not known.

OBJECTIVE

The aim of this study was to evaluate phenotypical differences between mono- and poly-sensitized patients with AR and to quantify their symptomatic variability.

METHODS

565 patients with a confirmed diagnosis of AR were included in this cross-sectional study. 155 were mono-sensitized and 410 poly-sensitized. Interactions between sensitization levels and reporting of different symptoms of AR and co-morbidities, disease duration and impact, were assessed. Furthermore, patients were stratified into mono- oligo- and poly-sensitized to assess whether the effect of sensitization on phenotype was ranked.

RESULTS

Poly-sensitized patients reported significantly more often itchy eyes (p=0.001) and had higher number of ocular (p=0.005), itch-related (p=0.036) and total symptoms (p=0.007) than mono-sensitized patients. In addition, polysensitized adults and children more often reported wheeze (p=0.015) and throat-clearing (p=0.04), respectively. Polysensitization was associated with more burdensome AR according to VAS (p=0.005). Increasing sensitization level was reflected in more itchy eyes, number of ocular, itch-related and total number of symptoms, as well as disease burden.

CONCLUSION

With increasing number of sensitizations, AR patients experience an increased diversity of symptoms. Multimorbidity-related symptoms increase with sensitization rank, suggesting organ-specific thresholds.

Allergen Sensitization in Children in Weifang, China: Differences Between Monosensitization and Polysensitization

Background

Children are the age group with the highest prevalence of allergy diseases. There is currently a lack of knowledge regarding monosensitization and polysensitization characteristics in children. In this study, we investigated the characteristics and differences between monosensitization and polysensitization in children in Weifang, eastern China.

Objective

To demonstrate the basic features of monosensitization and polysensitization in children. To explore the inherent and clinical parameter differences between monosensitized and polysensitized children.

Material and Methods

A total of 6030 individuals with a physician-determined need for allergy testing were tested for 15 common allergens, including 9 aeroallergens and 6 food allergens. A total of 938 allergen-positive children aged 1 month to 18 years were eventually included in this analysis. Complete blood count results from the same time as the allergen test were derived from the computerized medical records. Intrinsic features such as age, gender, sIgE, T-IgE, and clinical parameters such as eosinophil percentage, eosinophil count, basophil percentage, and basophil count were compared.

Results

The results showed that dust mite-related allergens, mould-related allergens, and tree and grass pollen-related allergens were the most prevalent allergens among monosensitized children. Additionally, the results of the combined pattern of polysensitive childhood allergens indicate the most common two allergens that were present together included dust mites and mould-related allergens, dust mite and Artemisia pollens, and dust mite and Humulus scandens pollens. Polysensitization can result in higher sIgE, T-IgE and eosinophil levels.

Conclusion

In conclusion, we provide a basic overview of allergens in monosensitized and polysensitized children. These findings provide new insight into the management of allergic diseases, particularly from the standpoint of polysensitization.

Clinical Evaluation for Sublingual Immunotherapy With Dermatophagoides farinae in Polysensitized Allergic Asthma Patients

Background: Many studies have demonstrated the efficacy of single-allergen sublingual immunotherapy (SLIT) in polysensitized patients with allergic rhinitis (AR), but less is reported in polysensitized patients with allergic asthma (AS).

Method: Data of 133 adult patients with house dust mite (HDM)-induced AS who had been treated for 3 years were collected. These patients were divided into the control group (treated with low to moderate dose of inhaled glucocorticoids and long-acting β2 agonists, n = 37) and the SLIT group (further treated with Dermatophagoides farinae drops, n = 96). The SLIT group contained three subgroups: the single-allergen group (only sensitized to HDM, n = 35), the 1- to 2-allergen group (HDM combined with one to two other allergens, n = 32), and the 3-or-more-allergen group (HDM combined with three or more other allergens, n = 29). The total asthma symptom score (TASS), total asthma medicine score (TAMS), and asthma control test (ACT) were assessed before treatment and at yearly visits. Forced expiratory volume in 1 s/forced vital capacity (FEV1/FVC) was assessed before treatment and at the end of SLIT.

Results: TASS and ACT scores in the control group were significantly higher than that in the single-allergen group and the 1- to 2-allergen group after 1, 2, and 3 years of SLIT and significantly higher than that in the 3-or-more-allergen group after 3-year SLIT (all p < 0.05). TAMS of the control group was significantly higher than that of the other three groups after 0.5, 1, 2, and 3 years of SLIT (all p < 0.05). FEV1/FVC in the control group was significantly higher than baseline after 3 years of immunotherapy (p < 0.05).

Conclusion: Patients sensitized to HDM with/without other allergens showed similar efficacy after 3 years of SLIT. However, the initial response of patients with three or more allergens was slower during immunotherapy process.

Single and multiple time-point allergic sensitization during childhood and risk of asthma by age 13

BACKGROUND

The relationship between allergic sensitization during childhood and risk of developing asthma remains unclear.

OBJECTIVE

To analyze single time-point and temporal patterns of sensitization in childhood in relation to asthma at age 13.

METHODS

Specific IgE (sIgE) level and skin prick test (SPT) toward 22 food allergens and aeroallergens were assessed at 6, 18 months, 4, 6, and 13 years in children from the high-risk Copenhagen Prospective Studies on Asthma in Childhood₂₀₀₀ (COPSAC₂₀₀₀ ) mother-child cohort. We analyzed the association between single time-point monosensitization, polysensitization, and quantitative assessment of sensitization, that is, sum of all sIgE levels and SPT wheal sizes, against asthma at age 13. In addition, we analyzed the association between three temporal patterns of sensitization: (a) early-transient, (b) late-onset, and (c) persistent sensitization and asthma.

RESULTS

Polysensitization status measured by SPT or sIgE was at all single time-points associated with increased risk of asthma at age 13: OR range, SPT = 3.0-15.7, and sIgE = 2.6-15.7, respectively, whereas monosensitization status was inconsistently associated with asthma. Quantitative assessment of both sIgE and SPT results was associated with asthma at all single time-points: OR range, SPT = 1.3-3.6, and sIgE = 1.1-1.7. Persistent sensitization, but not early-transient or late-onset sensitization was associated with asthma by age 13: OR [95% CI], SPT = 8.9 [2.8-28.23], and sIgE = 2.9 [1.1-7.6], respectively.

CONCLUSION

Sensitization to multiple allergens at single time-points, increasing sIgE levels and SPT wheal sizes, and persistent sensitization during childhood were associated with increased risk of asthma at age 13, suggesting the use of quantitative and repetitive sensitization measurements when assessing risk of developing asthma.

Immunologic modification in mono- and poly-sensitized patients after sublingual immunotherapy

OBJECTIVES/HYPOTHESIS

To compare immunologic modification and treatment outcomes after 2 years of sublingual immunotherapy (SLIT) with house dust mite extracts (HDM) between monosensitized and polysensitized patients with allergic rhinitis.

STUDY DESIGN

Retrospective cohort study.

METHODS

Among the patients who were prospectively enrolled in the SLIT cohort study, patients with allergic rhinitis who were sensitized to HDM and treated with SLIT for at least 2 years were studied. All participants underwent serologic tests at baseline and after SLIT to evaluate changes in immunologic parameters. The total nasal symptom score (TNSS) was measured before and after SLIT, and effective and less effective responder groups were categorized depending on whether patients had a TNSS reduction of 50%, as compared with baseline.

RESULTS

The increase in Dermatophagoides pteronyssinus and Dermatophagoides farinae specific immunoglobulin G4 levels was significantly higher in monosensitized patients than in polysensitized patients (P = .020 and P = .005, respectively). The TNSS significantly improved after SLIT in both the monosensitized and polysensitized groups (P < .001 in both groups). However, the difference in the changes in TNSS from baseline was not significant between the two groups (P = .374).

CONCLUSIONS

This study demonstrated different immunologic modifications after SLIT between monosensitized and polysensitized patients. However, patients in the polysensitized group who were treated with single-allergen SLIT experienced clinical improvement in TNSS that was comparable with that in the monosensitized group despite demonstrating different immunologic changes.

LEVEL OF EVIDENCE

2b Laryngoscope, 129:E170-E177, 2019.

The sensitization pattern differs according to rhinitis and asthma multimorbidity in adults: the EGEA study

BACKGROUND

Mono- and polysensitization are different IgE-mediated allergic phenotypes in children. Allergic sensitization is associated with both allergic asthma and allergic rhinitis, however, associations between the sensitization pattern and particularly polysensitization with asthma and rhinitis remains poorly studied in adults.

AIM

The aim of this study was to assess how the allergic sensitization pattern associates with asthma, rhinitis and their multimorbidity.

METHODS

1199 adults from the EGEA study, with extensive phenotypic characterization and all data available on skin prick tests to 10 allergens, total IgE and blood eosinophils were included. Using questionnaires only, participants were classified into 6 groups: asymptomatic (no asthma, no rhinitis), non-allergic rhinitis alone, allergic rhinitis alone, asthma alone, asthma+non-allergic rhinitis and asthma+allergic rhinitis. Mono- and polysensitization were defined by a positive skin prick test to one or more than one allergen respectively.

RESULTS

Asymptomatic participants and those with non-allergic rhinitis alone were mostly non-sensitized (around 72%) while around 12% were polysensitized. Between 32% and 43% of participants with allergic rhinitis alone, asthma alone and asthma+non-allergic rhinitis were non-sensitized and between 37% and 46% of them were polysensitized. 65% of the participants with asthma+allergic rhinitis were polysensitized. The level of total IgE followed a similar trend to that of allergic sensitization. Eosinophils were increased in asthma, especially when associated with rhinitis. Nasal symptoms were more severe and eczema more common in participants with both asthma and allergic rhinitis than in the other groups.

CONCLUSIONS

Allergic sensitization and particularly polysensitization rates widely differ according to asthma and rhinitis status. This study emphasized the importance of taking into account multimorbidity between asthma and rhinitis and showed that allergic sensitization is not a dichotomic variable.