High titers of IgE antibody to dust mite allergen and risk for wheezing among asthmatic children infected with rhinovirus

• Published in: Journal of allergy and clinical immunology Vol. 129; no. 6; pp. 1499 - 1505.e5
• Main Authors: Soto-Quiros, Manuel, MD, Avila, Lydiana, MD, Platts-Mills, Thomas A.E., MD, PhD, FRS, Hunt, John F., MD, Erdman, Dean D., PhD, Carper, Holliday, BS, Murphy, Deborah D., RN, Odio, Silvia, MD, James, Hayley R., BS, Patrie, James T., MS, Hunt, William, O'Rourke, Ashli K., MD, Davis, Michael D., RT, Steinke, John W., PhD, Lu, Xiaoyan, MS, Kennedy, Joshua, MD, Heymann, Peter W., MD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.06.2012; Elsevier; Mosby
• Subjects: Acute asthma; Allergens; Allergens - immunology; Allergy and Immunology; Animals; Asthma; Asthma - complications; Asthma - immunology; Atopy; Biological and medical sciences; Case-Control Studies; Child; Children; Chronic obstructive pulmonary disease, asthma; Dermatophagoides; Dust; dust mite–specific IgE; emergency department visits; Epitopes - immunology; Exhalation; exhaled nitric oxide; Female; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Humans; Immunoglobulin E; Immunoglobulin E - blood; Immunopathology; Infection; inhaled allergens; Male; Medical sciences; Nitric oxide; Nitric Oxide - analysis; Pathogens; Picornaviridae Infections - complications; Picornaviridae Infections - diagnosis; Picornaviridae Infections - immunology; Pneumology; Polymerase chain reaction; Pyroglyphidae - immunology; Respiratory Sounds - etiology; Rhinovirus; Rhinovirus - genetics; Rhinovirus - immunology; rhinovirus strain C; Risk; Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis; total serum IgE; viral respiratory tract infections; Wheezing; viral respiratory tract infections; total serum IgE; Intercellular adhesion molecule 1; ETS; F eno; GM; emergency department visits; Fraction of exhaled nitric oxide; dust mite–specific IgE; ICAM-1; Environmental tobacco smoke; Emergency department; Respiratory syncytial virus; RSV; Geometric mean; Acute asthma; exhaled nitric oxide; inhaled allergens; rhinovirus strain C; ED; Feno; Allergy; Picornaviridae; Mite; Risk; Wheezing; Respiratory system infection; Immunology; Bronchus disease; Serum; Obstructive pulmonary disease; Child; Rhinovirus; Human; Lung disease; Immunopathology; Specific IgE; Respiratory disease; Antibody; Acute; Expiration; dust mite―specific IgE; Asthma; Inhalation; Strain; Infection; Virus; Dust; rhinovirus strain C. total serum IgE; Nitric oxide; Viral disease; Risk factor; Respiration; Allergen
• ISSN: 0091-6749; 1097-6825
• DOI: 10.1016/j.jaci.2012.03.040

Background The relevance of allergic sensitization, as judged by titers of serum IgE antibodies, to the risk of an asthma exacerbation caused by rhinovirus is unclear. Objective We sought to examine the prevalence of rhinovirus infections in relation to the atopic status of children treated for wheezing in Costa Rica, a country with an increased asthma burden. Methods The children enrolled (n = 287) were 7 through 12 years old. They included 96 with acute wheezing, 65 with stable asthma, and 126 nonasthmatic control subjects. PCR methods, including gene sequencing to identify rhinovirus strains, were used to identify viral pathogens in nasal washes. Results were examined in relation to wheezing, IgE, allergen-specific IgE antibody, and fraction of exhaled nitric oxide levels. Results Sixty-four percent of wheezing children compared with 13% of children with stable asthma and 13% of nonasthmatic control subjects had positive test results for rhinovirus ( P  < .001 for both comparisons). Among wheezing subjects, 75% of the rhinoviruses detected were group C strains. High titers of IgE antibodies to dust mite allergen (especially Dermatophagoides species) were common and correlated significantly with total IgE and fraction of exhaled nitric oxide levels. The greatest risk for wheezing was observed among children with titers of IgE antibodies to dust mite of 17.5 IU/mL or greater who tested positive for rhinovirus (odds ratio for wheezing, 31.5; 95% CI, 8.3-108; P  < .001). Conclusions High titers of IgE antibody to dust mite allergen were common and significantly increased the risk for acute wheezing provoked by rhinovirus among asthmatic children.