Parallel reductions of IgE and exhaled nitric oxide after optimized anti‐inflammatory asthma treatment

Abstract

Immunoglobulin E (IgE) is crucial for the development of airway inflammation in atopic asthma, and inhibition of IgE using monoclonal antibodies is now part of asthma therapy. However, the impact of ordinary anti‐inflammatory treatment on IgE is unclear. The aim of this study was to investigate if optimization of treatment with inhaled corticosteroid (ICS) and leukotriene‐receptor antagonist (LTRA) according to symptoms or exhaled nitric oxide (FENO) levels over a one‐year period affects IgE concentrations. Altogether, 158 relatively well‐controlled but multi‐sensitized asthmatics (age 18–65 years), with ongoing ICS treatment at baseline, were included in this post hoc analysis of data from a randomized, controlled trial on FENO‐guided asthma therapy. Asthma control and quality of life (Juniper ACQ and mAQLQ), FENO, and serum IgE were measured at baseline and after one year. Concentrations of IgE antibodies to six common perennial aeroallergens were summed up (perennial IgE). We found that perennial and total IgE decreased by 10.2% and 16.0% (P < .001 both comparisons). This was not related to allergen exposure, whereas the total use of ICS and LTRA during the year correlated with the reduction in perennial IgE (P = .030 and P = .013). The decrease in perennial and total IgE correlated significantly with the reduction in FENO (P < .003 and P < .001), and with improvements in ACQ and mAQLQ scores (P < 0.05, all comparisons). We conclude that one year of optimization of treatment with ICS and LTRA in patients with persistent atopic asthma resulted in significant decreases in total IgE and IgE antibodies; these decreases correlated with a reduction in FENO and improvements in asthma control and quality of life. Thus, IgE is reduced by ordinary asthma controller medications and the effect on IgE seems to be clinically important.

Associations between self-rated health, sickness behaviour and inflammatory markers in primary care patients with allergic asthma: a longitudinal study

“…In the present study no associations between IgE or any of the inflammatory markers and sickness behaviour were found. However, in an earlier report from the same study sample, a reduction in perennial, total and all specific IgE was significantly associated with an improvement in asthma-related quality of life, 27 suggesting that certain IgE measures might be related to other factors than sickness behaviour relevant for subjective health perception. Hence, measuring levels of IgE could be a valuable clinical complement when evaluating variables associated with asthma-related quality of life, self-rated health and other patient-reported outcomes in asthma 27 and future research might delineate if IgE differs from other disease-specific variables in its relation to indices of subjective health.…”

“…In a previous study, a decrease in IgE concentrations was found to correlate with an improvement on both asthma control and asthma-related quality of life. 27 Furthermore, poor asthma-related quality of life has been shown to be associated with both poor self-rated health and increased sickness behaviour. 28 Thus, it could be of interest to investigate the relationship between asthma control and patient-reported outcome measurements in future studies.…”

“… 33 Also, although F E NO was associated with asthma symptom control and IgE levels, no significant association was found between F E NO and asthma-related quality of life in the earlier report from the study. 27 Therefore, patient-reported outcomes and FENO might be considered to be used as complementary measures since they assess different dimensions of asthma in addition to the traditional measures.…”

Bronchial Asthma as a Cardiovascular Risk Factor: A Prospective Observational Study

“…Yin SS et al also investigated the correlation between FENO and ICS efficacy in childhood bronchial asthma [ 65 ]. Syk et al highlights the possibility of IgE reduction with common asthma control drugs, which is confirmed in patients with persistent atopic asthma with annual optimization of ICS and LTRA treatment, resulting in a significant decrease in total IgE correlating with a reduction in FENO and an improvement in asthma control and quality of life [ 66 ]. Total IgE may predict asthma severity and the risk of exacerbations and loss of asthma control.…”

Persistent induction of goblet cell differentiation in the airways: Therapeutic approaches

“…A number of studies have utilized monoclonal antibody (mAb) treatment to attenuate signaling pathways involved in numerous airways diseases, including asthma and COPD (Arora, McDonald, Toews, & Huffnagle, 2006;Kondo et al, 2006;Kumar, Herbert, Webb, Li, & Foster, 2004;Syk et al, 2016). Monoclonal antibodies are thought to exhibit a number of advantages over small molecule based therapies; 1) mAbs are considered to exert greater specificity for the target molecule, 2) they do not form toxic metabolites following breakdown, and 3) they generally have longer half-lives (Chames, Van Regenmortel, Weiss, & Baty, 2009).…”