Distinct “Immunoallertypes” of Disease and High Frequencies of Sensitization in Non–Cystic Fibrosis Bronchiectasis

• Published in: American journal of respiratory and critical care medicine Vol. 199; no. 7; pp. 842 - 853
• Main Authors: Mac Aogáin, Micheál, Tiew, Pei Yee, Lim, Albert Yick Hou, Low, Teck Boon, Tan, Gan Liang, Hassan, Tidi, Ong, Thun How, Pang, Sze Lei, Lee, Zi Yang, Gwee, Xiao Wei, Martinus, Christopher, Sio, Yang Yie, Matta, Sri Anusha, Ong, Tan Ching, Tiong, Yuen Seng, Wong, Kang Ning, Narayanan, Sriram, Au, Veonice Bijin, Marlier, Damien, Keir, Holly R., Tee, Augustine, Abisheganaden, John Arputhan, Koh, Mariko Siyue, Wang, De Yun, Connolly, John E., Chew, Fook Tim, Chalmers, James D., Chotirmall, Sanjay H.
• Format: Journal Article
• Language: English
• Published: United States American Thoracic Society 01.04.2019
• Subjects: Adult; Aged; Aged, 80 and over; Allergens - adverse effects; Allergens - immunology; Allergies; Animals; Aspergillus; Asthma; Asthma - etiology; Asthma - immunology; Bronchiectasis - complications; Bronchiectasis - immunology; Cell adhesion & migration; Chronic obstructive pulmonary disease; Clinical outcomes; Cohort Studies; Cystic fibrosis; Cytokines; Female; Hospitals; Humans; Hypersensitivity - immunology; Immunization; Infections; Male; Middle Aged; Neutrophils; Outpatient care facilities; Patients; Pyroglyphidae; Kuala Lumpur Malaysia; Malaysia; Singapore; United Kingdom > UK; allergy; sensitization; house dust mite; bronchiectasis
• ISSN: 1073-449X; 1535-4970; 1535-4970
• DOI: 10.1164/rccm.201807-1355OC

Allergic sensitization is associated with poor clinical outcomes in asthma, chronic obstructive pulmonary disease, and cystic fibrosis; however, its presence, frequency, and clinical significance in non-cystic fibrosis bronchiectasis remain unclear. To determine the frequency and geographic variability that exists in a sensitization pattern to common and specific allergens, including house dust mite and fungi, and to correlate such patterns to airway immune-inflammatory status and clinical outcomes in bronchiectasis. Patients with bronchiectasis were recruited in Asia (Singapore and Malaysia) and the United Kingdom (Scotland) (n = 238), forming the Cohort of Asian and Matched European Bronchiectasis, which matched recruited patients on age, sex, and bronchiectasis severity. Specific IgE response against a range of common allergens was determined, combined with airway immune-inflammatory status and correlated to clinical outcomes. Clinically relevant patient clusters, based on sensitization pattern and airway immune profiles ("immunoallertypes"), were determined. A high frequency of sensitization to multiple allergens was detected in bronchiectasis, exceeding that in a comparator cohort with allergic rhinitis (n = 149). Sensitization was associated with poor clinical outcomes, including decreased pulmonary function and more severe disease. "Sensitized bronchiectasis" was classified into two immunoallertypes: one fungal driven and proinflammatory, the other house dust mite driven and chemokine dominant, with the former demonstrating poorer clinical outcome. Allergic sensitization occurs at high frequency in patients with bronchiectasis recruited from different global centers. Improving endophenotyping of sensitized bronchiectasis, a clinically significant state, and a "treatable trait" permits therapeutic intervention in appropriate patients, and may allow improved stratification in future bronchiectasis research and clinical trials.