Distinct 'Immuno-Allertypes' of Disease and High Frequencies of Sensitisation in Non-Cystic-Fibrosis Bronchiectasis

Micheál Mac Aogáin, Pei Yee Tiew, Albert Yick Hou Lim, Teck Boon Low, Gan Liang Tan, Tidi Hassan, Thun How Ong, Sze Lei Pang, Zi Yang Lee, Xiao Wei Gwee, Christopher Martinus, Yang Yie Sio, Sri Anusha Matta, Tan Ching Ong, Yuen Seng Tiong, Kang Ning Wong, Sriram Narayanan, Veonice Bijin Au, Damien Marlier, Holly R. KeirAugustine Tee, John Arputhan Abisheganaden, Mariko Siyue Koh, De Yun Wang, John E. Connolly, Fook Tim Chew, James D. Chalmers, Sanjay H. Chotirmall

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Abstract

Rationale: 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-CF bronchiectasis remain unclear.

Objective: To determine the frequency and geographic variability that exists in 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.

Methods: Patients with bronchiectasis were recruited in Asia (Singapore & Malaysia) and the United Kingdom (Scotland) (n=238) forming the Cohort of Asian and Matched European Bronchiectasis (CAMEB) which matched recruited patients on age, gender 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 ("immuno-allertypes") were determined.

Measurements and main results: A high frequency of sensitization to multiple allergens was detected in bronchiectasis, exceeding that in a comparator cohort with allergic rhinitis (n=149). Sensitization associated with poor clinical outcomes including decreased pulmonary function and more severe disease. 'Sensitized-bronchiectasis' was classified into two 'immuno-allertypes': one fungal-driven and pro-inflammatory versus house dust mite-driven, chemokine-dominant with the former demonstrating poorer clinical outcome.

Conclusion: Allergic sensitization occurs at high frequency in bronchiectasis patients recruited from different global centres. Improving endo-phenotyping of 'sensitized-bronchiectasis', a clinically significant state, and 'treatable trait' permits therapeutic intervention in appropriate patients and may allow improved stratification in future bronchiectasis research and clinical trials.

Original languageEnglish
Pages (from-to)842-853
Number of pages12
JournalAmerican Journal of Respiratory and Critical Care Medicine
Volume199
Issue number7
Early online date28 Sep 2018
DOIs
Publication statusPublished - 1 Apr 2019

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Keywords

  • Bronchiectasis
  • Sensitization
  • Allergy
  • House dust-mite
  • Aspergillus

Cite this

Mac Aogáin, M., Tiew, P. Y., Lim, A. Y. H., Low, T. B., Tan, G. L., Hassan, T., Ong, T. H., Pang, S. L., Lee, Z. Y., Gwee, X. W., Martinus, C., Sio, Y. Y., Matta, S. A., Ong, T. C., Tiong, Y. S., Wong, K. N., Narayanan, S., Bijin Au, V., Marlier, D., ... Chotirmall, S. H. (2019). Distinct 'Immuno-Allertypes' of Disease and High Frequencies of Sensitisation in Non-Cystic-Fibrosis Bronchiectasis. American Journal of Respiratory and Critical Care Medicine, 199(7), 842-853. https://doi.org/10.1164/rccm.201807-1355OC