Journal
JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY
Volume 130, Issue 2, Pages 376-+Publisher
MOSBY-ELSEVIER
DOI: 10.1016/j.jaci.2012.05.012
Keywords
Asthma; asthma severity; hospitalizations; FEV1; IgE; Staphylococcus aureus; enterotoxins; superantigens
Categories
Funding
- Flemish Scientific Research Board, FWO [A12/5-HB-KH3, G.0436.04]
- Interuniversity Attraction Poles Programme (IUAP), Belgian state, Belgian Science Policy [P6/35]
- UK Medical Research Council [G0800649]
- Global Allergy and Asthma European Network (GA2LEN)
- Belgian Network BioMAGNet (Bioinformatics and Modelling: from Genomes to Networks)
- Interuniversity Attraction Poles Programme (Phase VI/4)
- IST Programme of the European Community under the PASCAL2 Network of Excellence [IST-2007-216886]
- MRC [G0800649, G0900453, G0400473] Funding Source: UKRI
- Medical Research Council [G0900453, G0400473, G0800649, G0800766] Funding Source: researchfish
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Background: The role of IgE in patients with severe asthma is not fully understood. Objective: We sought to investigate whether IgE to Staphylococcus aureus enterotoxins might be relevant to disease severity in adult asthmatic patients. Methods: Specific IgE antibody concentrations in serum against enterotoxins, grass pollen (GP), and house dust mite allergens and total IgE levels were measured in adult cohorts of 69 control subjects, 152 patients with nonsevere asthma, and 166 patients with severe asthma. Severe asthma was defined as inadequately controlled disease despite high-dose inhaled corticosteroids plus at least 2 other controller therapies, including oral steroids. Results: Enterotoxin IgE positivity was significantly greater in patients with severe asthma (59.6%) than in healthy control subjects (13%, P < .001). Twenty-one percent of patients with severe asthma with enterotoxin IgE were considered nonatopic. Logistic regression analyses demonstrated significantly increased risks for enterotoxin IgE-positive subjects to have any asthma (OR, 7.25; 95% CI, 2.7-19.1) or severe asthma (OR, 11.09; 95% CI, 4.1-29.6) versus enterotoxin IgE-negative subjects. The presence of GP or house dust mite IgE antibodies was not associated with either significantly increased risk for asthma or severity. Oral steroid use and hospitalizations were significantly increased in patients with enterotoxin IgE and nonatopic asthma. GP IgE was associated with a higher FEV1 percent predicted value, and enterotoxin IgE was associated with a lower FEV1 percent predicted value. Conclusions: Staphylococcal enterotoxin IgE antibodies, but not IgE against inhalant allergens, are risk factors for asthma severity. We hypothesize that the presence of enterotoxin IgE in serum indicates the involvement of staphylococcal superantigens in the pathophysiology of patients with severe asthma. (J Allergy Clin Immunol 2012;130:376-81.)
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