Asthma severity and atopy: how clear is the relationship?

Abstract

Background:The relationship between asthma severity and atopy is complex. Many studies have failed to show significant relationships between clinical severity or lung function and markers of atopic sensitisation. Aim: To determine whether increasing asthma severity is related to atopic sensitisation in a population of children with asthma. Methods: A total of 400 children (7-18 years) with asthma were recruited as part of a multicentre study of the genetics of asthma. Detailed phenotypic data were collected on all participants. Associations between measures of asthma severity and atopic sensitisation were sought using multilevel models allowing variation at the individual and family level. Results: Children recruited to the study had a range of asthma severities, with just over a third having mild persistent asthma. The logarithm of total serum IgE was associated with increased asthma severity score, decreased FEV 1 , increased airways obstruction, risk of hospital admission, and inhaled steroid use. Increasing skin prick test reactivity to a panel of seven aeroallergens was associated with increased risk of hospital admission, use of an inhaled steroid, and airways obstruction. The results remained highly significant after corrections for age, gender, and birth order. Conclusions: In children with asthma, increasing atopy is associated with increasing asthma severity. However, the relationships between asthma severity and skin prick tests, and asthma severity and total serum IgE values, appear subtly different.

Role of Periostin in Uncontrolled Asthma in Children (DADO study)

“…In children with an FEV 1 <80% in the UcSA group, irreversible obstruction or remodelling may well have occurred already. Levels of total serum IgE, which have been linked to greater asthma severity, have been found to be higher in the UcSA group [36], and most children were sensitized to aeroallergens. According to various studies [37,38], unlike adults [39], children tend to be atopic with high levels of total IgE and FeNO and with peripheral eosinophilia and aeroallergen sensitization.…”

The Effect of Omalizumab on Eosinophilic Inflammation of the Respiratory Tract in Patients with Allergic Asthma

“…IgE is also believed to play a role in the remodelling that occurs in the airways [1]. Burrow et al [2] report that a high level of IgE in plasma represents a risk factor for the development of bronchial asthma, and Kovac [3] and Carroll [4] also note that it correlates with the degree of severity. Hence immunoglobulin E represents a significant target for drugs used for treating asthma.…”

Omalizumab for childhood asthma

“…Thus, severe persistent disease has a higher total IgE than any other disease categories, and this is associated with a higher probability of reduced lung function and hospital admission for exacerbation [5]. Indeed, food allergy is a major risk factor for life-threatening asthma in children [6].…”