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.
|Number of pages||12|
|Journal||American Journal of Respiratory and Critical Care Medicine|
|Early online date||28 Sep 2018|
|Publication status||Published - 1 Apr 2019|
- House dust-mite