Effects of Immunoglobulin Replacement on Asthma Exacerbation in Adult Asthmatics with IgG Subclass Deficiency

Kim, Joo Hee; Ye, Young-Min; Ban, Ga Young; Shin, Yoo Seob; Lee, Hyun Young; Nam, Young Hee; Lee, Soo Keol; Cho, You Sook; Jang, Seung Hun; Jung, Ki Suck; Park, Hae‐Sim

doi:10.4168/aair.2017.9.6.526

Cited by 21 publications

(18 citation statements)

References 32 publications

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“…A potential contributing role of antibody deficiency in asthma has also been suggested by a small case‐control study which found that asthma patients are more likely to have a diagnosis of CVID or selective IgA deficiency than non‐asthmatic individuals, potentially accounting for the increased risk of bacterial infections in some individuals with asthma . A preliminary proof‐of‐concept study found that IVIG significantly reduces the frequency of asthma exacerbations and improved asthma control in adults with IgG subclass deficiency …”

Section: Impaired Airway Mucosal Defencementioning

confidence: 93%

Precision medicine in united airways disease: A “treatable traits” approach

Yii

Tay

Choo

et al. 2018

Allergy

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United airways disease (UAD) is the concept that the upper and lower airways, which are anatomically and immunologically related, form a single organ. According to this concept, upper and lower airway diseases are frequently comorbid because they reflect manifestations of a single underlying disease at different sites of the respiratory tract. Allergic asthma-allergic rhinitis is the archetypal UAD, but emerging data indicate that UAD is a heterogeneous condition and consists of multiple phenotypes (observable clinical characteristics) and endotypes (pathobiologic mechanisms). The UAD paradigm also extends to myriad sinonasal diseases (eg, chronic rhinosinusitis with or without nasal polyps) and lower airway diseases (eg, bronchiectasis, chronic obstructive pulmonary disease). Here, we review currently known phenoendotypes of UAD and propose a "treatable traits" approach for the classification and management of UAD, wherein pathophysiological mechanisms and factors contributing to disease are identified and targeted for treatment. Treatable traits in UAD can be analyzed according to a framework comprising airway inflammation (eosinophilic, neutrophilic), impaired airway mucosal defense (impaired mucociliary clearance, antibody deficiency), and exogenous cofactors (allergic sensitizers, tobacco smoke, microbes). Appreciation of treatable traits is necessary in advancing the effort to deliver precise treatments and achieve better outcomes in patients with UAD.

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Section: Impaired Airway Mucosal Defencementioning

confidence: 93%

Precision medicine in united airways disease: A “treatable traits” approach

Yii

Tay

Choo

et al. 2018

Allergy

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“…Different studies confirmed the positive impact of Ig replacement therapy in improving asthma control status, ameliorating airway obstruction and reducing the frequency of exacerbations in asthmatic and COPD patients with previously undiagnosed PAD [83][84][85]. This means a reduction in courses of oral corticosteroids, cumulative annual dose of oral corticosteroids, rescue antibiotic use and hospitalisations for acute COPD exacerbations, and has implication both in terms of quality of life and healthcare costs.…”

Section: Asthma and Copdmentioning

confidence: 94%

The broad spectrum of lung diseases in primary antibody deficiencies

et al. 2018

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Human primary immunodeficiency diseases (PIDs) represent a heterogeneous group of more than 350 disorders. They are rare diseases, but their global incidence is more relevant than generally thought. The underlying defect may involve different branches of the innate and/or adaptive immune response. Thus, the clinical picture may range from severe phenotypes characterised by a broad spectrum of infections to milder infectious phenotypes due to more selective (and frequent) immune defects. Moreover, infections may not be the main clinical features in some PIDs that might present with autoimmunity, auto-inflammation and/or cancer. Primary antibody deficiencies (PADs) represent a small percentage of the known PIDs but they are the most frequently diagnosed, particularly in adulthood. Common variable immunodeficiency (CVID) is the most prevalent symptomatic PAD.PAD patients share a significant susceptibility to respiratory diseases that represent a relevant cause of morbidity and mortality. Pulmonary complications include acute and chronic infection-related diseases, such as pneumonia and bronchiectasis. They also include immune-mediated interstitial lung diseases, such as granulomatous-lymphocytic interstitial lung disease (GLILD) and cancer. Herein we will discuss the main pulmonary manifestations of PADs, the associated functional and imaging findings, and the relevant role of pulmonologists and chest radiologists in diagnosis and surveillance.

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“…The dose of IVIG administered was recommended as 400 to 600 mg/kg every 3 to 4 weeks (or the equivalent given in divided doses once or twice a week subcutaneously) [5,27,28]. The present study evaluated the current status of IVIG replacement in adult asthmatics in a single tertiary hospital setting and demonstrated that 31.85% of the PID group patients had maintained IVIG (probably due to the high cost).…”

Section: Discussionmentioning

confidence: 81%

“…However, there have been a few studies demonstrating the efficacy of IVIG replacement in asthmatic patients with IgGSCD in whom monthly IVIG replacement significantly improved quality of life, diminished the number of infections and decreased the need for antibiotics and hospitalization [22,23]. Our previous multicenter trial demonstrated that IVIG replacement (> 6 months) in adult asthmatics with IgG 3 SCD could significantly reduce the frequency of respiratory infections and asthma exacerbations as well as improve asthma control asthma status and quality of life [5]. Once asthma exacerbation occurs, inflammations and remodeling pathways are activated, which result in the deterioration of lung function.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, these repiratoty infections are known as major triggering factors for asthma exacerbation in adult asthmatics [3]. Recently, we demonstrated that immunoglobulin G 3 (IgG 3 ) subclass deficiency (IgG 3 SCD) is the most common type of PID associated with asthma exacerbation in adult asthmatics [4], in which monthly intravenous immunoglobulin (IVIG) therapy was beneficial for preventing asthma exacerbation [5]. We hypothesized that PID is associated with frequent asthma exacerbations and severe asthma in adult asthmatics.…”

Section: Introductionmentioning

confidence: 99%

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Association between primary immunodeficiency and asthma exacerbation in adult asthmatics

Lee

Ban

Kim

et al. 2020

Korean J Intern Med

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Background/Aims: Primary immunodef iciency (PID) is a serious comorbid condition in adult asthmatics that have frequent exacerbations, which requires monthly replacement of intravenous immunoglobulin (IVIG). However, the prevalence and clinical significance of PID in adult asthmatics in Korea have not yet been reported. The aim of this study is to assess the prevalence of PID and its association with asthma exacerbation in Korean adult asthmatics. Methods: A total of 2,866 adult asthmatics were enrolled in this study. The PID group was defined as subjects who had lower levels of immunoglobulin G (IgG)/ A/M and/or IgG subclass presenting with recurrent respiratory infections. Serum samples were assayed for total IgG/A/M by immunoturbidimetry, and IgG subclasses by nephelometry. Results: Of the 2,866 asthmatic patients enrolled, 157 (5.49%) had PID (classified as the PID group), while those without PID was classified as the non-PID group. IgG subclass deficiency (58%) is most prevalent, among which IgG 3 subclass deficiency was most common (58%). The relative risk of asthma exacerbation was 1.70 times higher in the PID group compared to the non-PID group (1.696; 95% confidence interval, 1.284 to 2.239; p < 0.001); the prevalence of severe asthma was significantly higher in the PID group than in the non-PID group (32.48% vs. 13.00%, p < 0.001). Thirty-five among 157 patients in the PID group d maintained IVIG to prevent asthma exacerbation. Conclusions: It is suggested that PID, especially IgG 3 subclass deficiency, is a significant risk factor for asthma exacerbation. Screening of IgG subclass levels and IVIG replacement should be considered in the management in adult asthmatics.

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Effects of Immunoglobulin Replacement on Asthma Exacerbation in Adult Asthmatics with IgG Subclass Deficiency

Cited by 21 publications

References 32 publications

Precision medicine in united airways disease: A “treatable traits” approach

Precision medicine in united airways disease: A “treatable traits” approach

The broad spectrum of lung diseases in primary antibody deficiencies

Association between primary immunodeficiency and asthma exacerbation in adult asthmatics

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