Can we predict allergen‐induced asthma in patients with allergic rhinitis?

Buslau, A.; Voss, Sandra; Herrmann, Eva; Schubert, Ralf; Zielen, Stefan; Schulze, Johannes

doi:10.1111/cea.12427

Cited by 19 publications

(15 citation statements)

References 38 publications

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“…Thus, the level of specific serum IgE seems to be important for predicting significant bronchial obstruction after BAP. This strong relationship was also found in patients with grass pollen AR . In contrast, no correlation was found for the Lebel score and the specific IgE in our cohort.…”

Section: Discussionsupporting

confidence: 48%

Comparison of bronchial and nasal allergen provocation in children and adolescents with bronchial asthma and house dust mite sensitization

Fischl

Eckrich²,

Passlack

et al. 2019

Pediatric Allergy Immunology

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Background: Bronchial allergen provocation (BAP) is an established tool for the diagnosis of allergy in patients with asthma, but its use is limited by the potential risk of severe asthmatic reactions. Nasal provocation testing (NPT) may be an alternative safe method and does not require sophisticated equipment.Objective: The aim of this prospective study was to evaluate the concordance of both methods in patients with asthma and house dust mite (HDM) sensitization. Methods:A total of 112 patients with HDM sensitization underwent BAP and had the following parameters analysed: decrease in FEV1, exhaled NO, and total and specific IgE. Within 12 weeks, NPT with HDM was performed in 74 patients with a median age of 9 years (range, 5-16 years). The results were evaluated using the Lebel score which quantifies major symptoms like rhinorrhea, nasal obstruction, sneezes and minor symptoms, such as pruritus, conjunctivitis and pharyngitis.Results: Fifty-seven of 74 patients had an early asthmatic reaction, of which 41 were identified using the Lebel score. The Lebel score had a sensitivity of 71.9% and a positive predictive value (PPV) of 89.1%. In addition, an eNO ≥ 10 ppb (AUC 0.78), a specific IgE Dermatophagoïdes pteronyssinus ≥ 25.6 kU/L (AUC 0.76) and a specific IgE Dermatophagoïdes farinae ≥ 6.6 kU/L (AUC 0.78) were good predictors of an early asthmatic reaction. Conclusion:A sequential use of NPT prior to BAP is justified to establish the relevance of HDM allergy. In patients with a negative NPT, BAP is still recommended to rule out a HDM-induced asthmatic reaction. K E Y W O R D Sasthma, bronchial allergen provocation, house dust allergy, Lebel score, nasal provocation test, specific IgE

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Section: Discussionsupporting

confidence: 48%

Comparison of bronchial and nasal allergen provocation in children and adolescents with bronchial asthma and house dust mite sensitization

Fischl

Eckrich²,

Passlack

et al. 2019

Pediatric Allergy Immunology

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“…In addition, the diagnosis was partially based on the SPT results which needed to be evaluated, making this parameter inoperative. Other studies indicated that sIgE was a valid predictor for allergen‐induced allergic symptoms. A recent study reported an excellent correlation for the SPT and bronchial provocation, especially for Alt a, in asthmatic subjects, and that a high sIgE concentration against Alt a was an effective predictor for a positive challenge .…”

Section: Discussionmentioning

confidence: 99%

How to diagnose mould allergy? Comparison of skin prick tests with specific IgE results

Kespohl

Maryska

Bünger

et al. 2016

Clin Experimental Allergy

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“…Unfortunately, neither the TH‐2 cytokines nor the transcription factor pattern could replace the diagnostic value of BAP. Sensitization to A fumigatus is therefore initially a laboratory or skin test finding, which together with sIgE to A fumigatus might be a possible justification for BAP as diagnostic test . Future studies may generate data from sufficient patient numbers to determine a certain A fumigatus sIgE cut‐off level for CF patients.…”

Section: Discussionmentioning

confidence: 99%

“…Sensitization to A fumigatus is therefore initially a laboratory or skin test finding, which together with sIgE to A fumigatus might be a possible justification for BAP as diagnostic test. 12,46 Future studies may generate data from sufficient patient numbers to determine a cer- However, this study has some limitations. The number of CF patients who underwent BAP was very small.…”

Section: Ta B L E 3 Mrna Expression Changes In Sputum Cellsmentioning

confidence: 99%

Clinical relevance of Aspergillus fumigatus sensitization in cystic fibrosis

Eickmeier

Zissler

Wittschorek

et al. 2020

Clin Experimental Allergy

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Rationale The clinical relevance of sensitization to Aspergillus (A) fumigatus in cystic fibrosis (CF) is unclear. Some researchers propose that specific A fumigatus IgE is an innocent bystander, whereas others describe it as the major cause of TH‐2‐driven asthma‐like disease. Objectives Lung function parameters in mild CF patients may be different in patients with and without A fumigatus sensitization. We aimed to ascertain whether allergen exposure to A fumigatus by bronchial allergen provocation (BAP) induces TH‐2 inflammation comparable to an asthma‐like disease. Methods A total of 35 patients, aged 14.8 ± 8.5 years, and 20 healthy controls were investigated prospectively. The patients were divided into two groups: group 1 (n = 18): specific (s)IgE negative, and group 2 (n = 17): sIgE positive (≥0.7 KU/L) for A fumigatus. Lung function, exhaled NO, and induced sputum were analysed. All sensitized patients with an FEV1 > 75% (n = 13) underwent BAP with A fumigatus, and cell counts, and the expression of IL‐5, IL‐13, INF‐γ, and IL‐8 as well as transcription factors T‐bet, GATA‐3, and FoxP3, were measured. Results Lung function parameters decreased significantly compared to controls, but not within the CF patient group. After BAP, 8 of 13 patients (61%) had a significant asthmatic response and increased eNO 24 hours later. In addition, marked TH‐2‐mediated inflammation involving eosinophils, IL‐5, IL‐13, and FoxP3 became apparent in induced sputum cells. Conclusion Our study demonstrated the clinical relevance of A fumigatus for the majority of sensitized CF patients. A distinct IgE/TH‐2‐dominated inflammation was found in induced sputum after A fumigatus exposure.

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Can we predict allergen‐induced asthma in patients with allergic rhinitis?

Abstract: There is a considerable discordance between reported asthma signs and diagnosed disease by BAP. Simple measurement of allergen-specific IgE for grass pollen was the best predictor of allergen-induced asthma in patients with AR.

Cited by 19 publications

References 38 publications

Comparison of bronchial and nasal allergen provocation in children and adolescents with bronchial asthma and house dust mite sensitization

Comparison of bronchial and nasal allergen provocation in children and adolescents with bronchial asthma and house dust mite sensitization

How to diagnose mould allergy? Comparison of skin prick tests with specific IgE results

Clinical relevance of Aspergillus fumigatus sensitization in cystic fibrosis

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