Sensitization to Aspergillus species is associated with frequent exacerbations in severe asthma.
Sensitization to Aspergillus species is associated with frequent exacerbations in severe asthma.
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DOI：
10.2147/jaa.s130459
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发表时间：
2017
影响因子：
3.2
通讯作者：
Koh MS
中科院分区：
文献类型：
--
作者：
Goh KJ;Yii ACA;Lapperre TS;Chan AK;Chew FT;Chotirmall SH;Koh MS
重度哮喘是一种具有不同表型特征的异质性疾病。特异性过敏原致敏和哮喘严重程度之间的关系，特别是在亚洲，仍然不清楚。我们的目的是研究特定过敏原致敏模式的患病率，并调查其与亚洲严重哮喘队列结局的相关性。我们对接受第4步或第5步全球哮喘治疗倡议的患者进行了一项横断面研究。进行了单变量和多变量分析，以评估皮肤点刺试验（SPT）对特定可识别过敏原的致敏性与未控制哮喘（在我们的研究中定义为过去一年内使用≥2次类固醇或住院治疗，有近乎致命的哮喘史或肺量测定法显示气流阻塞的证据）之间的相关性。对206例重度哮喘患者（平均年龄45±17岁，99例[48.1%]男性）进行了评价。其中78.2%对一种或多种过敏原有阳性反应。最常见的过敏原，患者致敏的屋尘螨（Blomia tropicalis，屋尘螨和粉尘螨）。曲霉菌致敏率为11.7%。在多变量分析中，曲霉菌致敏与未控制的哮喘相关（比值比6.07，95%置信区间1.80-20.51）。特别是，曲霉菌致敏与过去一年中使用≥2次类固醇爆发独立相关（比值比3.05，95%置信区间1.04-8.95）。未发现哮喘不受控制与其他过敏原致敏的相关性。在亚洲重度哮喘人群中，通过SPT观察到高过敏原，特别是曲霉菌致敏。曲霉菌致敏与频繁的急性加重和更大的皮质类固醇需求特别相关。对曲霉菌致敏表型的严重哮喘的认识有待提高，它可能是真菌致敏的严重哮喘的一个亚组。
Severe asthma is a largely heterogeneous disease with varying phenotypic profiles. The relationship between specific allergen sensitization and asthma severity, particularly in Asia, remains unclear. We aim to study the prevalence of specific allergen sensitization patterns and investigate their association with outcomes in a severe asthma cohort in an Asian setting. We conducted a cross-sectional study of patients receiving step 4 or 5 Global Initiative for Asthma treatment. Univariate and multivariate analyses were performed to assess the association between sensitization to a specific identifiable allergen by skin prick test (SPT) and uncontrolled asthma (defined in our study as the use of ≥2 steroid bursts or hospitalization in the past year, a history of near-fatal asthma or evidence of airflow obstruction on spirometry). Two hundred and six severe asthma patients (mean age 45±17 years, 99 [48.1%] male) were evaluated. Of them, 78.2% had a positive SPT to one or more allergens. The most common allergen to which patients were sensitized was house dust mites (Blomia tropicalis, Dermatophagoides pteronyssinus and Dermatophagoides farinae). Also, 11.7% were sensitized to Aspergillus species. On multivariate analysis, Aspergillus sensitization was associated with uncontrolled asthma (odds ratio 6.07, 95% confidence interval 1.80–20.51). In particular, Aspergillus sensitization was independently associated with the use of ≥2 steroid bursts in the past year (odds ratio 3.05, 95% confidence interval 1.04–8.95). No similar associations of uncontrolled asthma with sensitization to any other allergens were found. High allergen, specifically Aspergillus sensitization was observed in the Asian population with severe asthma by SPT. Aspergillus sensitization was specifically associated with frequent exacerbations and a greater corticosteroid requirement. An improved understanding of the severe asthma with Aspergillus sensitization phenotype is warranted, which is likely a subgroup of severe asthma with fungal sensitization.