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IgE sensitization against food allergens: Natural history, relation to airway inflammation and asthma
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences. (Respiratory, Allergy and Sleep Research)
2015 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: According to recent studies in children, IgE sensitization not only against perennial allergens, but also against food allergens, is related to asthma risk and increased airway inflammation. During the last decade, a new technique for IgE determination based on allergen components has become available, but its use in epidemiological studies has been limited.

Aims: To investigate the relationship between the pattern of IgE sensitization to allergen components and the prevalence of asthma, airway inflammation and hyperresponsiveness in a population-based setting. To examine the relationship of IgE sensitization to allergen extract, and airway inflammation, airway hyperresponsiveness and blood eosinophilia in asthmatics. To examine the natural history of IgE sensitization to food allergens in adults. To compare extract-based and component-based IgE measurements in relation with new-onset respiratory disease and airway inflammation and hyperresponsiveness.

Methods: The present thesis is based on cross-sectional and longitudinal analyses of the adult, the population-based study ECRHS (European Community Health Survey) and a cross-sectional, observational study of young subjects with asthma. IgE sensitization was examined by means of both extract-based and component-based tests. Airway inflammation was assessed by exhaled NO and airway hyperresponsiveness with methacholine test.

Results: IgE sensitization to food allergens independently related to increased airway inflammation in both a population-based study and a study of asthmatics. Furthermore, a relation was found with increased blood eosinophils in asthmatics. The decrease in prevalence of IgE sensitization against food allergens during a 9-year follow-up was larger than the decrease of aeroallergens. Subjects with IgE sensitization to both cat extract and components showed more frequent airway inflammation, greater bronchial responsiveness and higher likelihood of developing asthma and rhinitis than subjects with IgE sensitization only to cat extract.

Conclusions: The presence of IgE antibodies against food allergens was independently associated with airway and systemic inflammation. Both aeroallergens and food allergens should be examined in order to understand the signaling of local and systemic inflammation in asthma. Prevalence of IgE sensitization to food decreased in adults to a larger extent than IgE sensitization against aeroallergens. Measurement of IgE sensitization to cat allergen components appears to have a higher clinical value than extract-based measurement

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2015. , 66 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1107
Keyword [en]
allergen components, extract-based, exhaled NO, airway hyperresponsiveness, blood eosinophil count, IgE sensitization, food hypersensitivity, food allergens, perennial allergens, natural history, markers of systemic inflammation, markers of local inflammation
National Category
Respiratory Medicine and Allergy
Research subject
Lung Medicine; Physiology; Immunology
Identifiers
URN: urn:nbn:se:uu:diva-251396ISBN: 978-91-554-9256-4 (print)OAI: oai:DiVA.org:uu-251396DiVA: diva2:806165
Public defence
2015-06-02, Hedstrandssalen, Ing 70, Akademiska Sjukhuset, Uppsala, 13:15 (Swedish)
Opponent
Supervisors
Funder
Swedish Heart Lung FoundationVårdal FoundationSwedish Asthma and Allergy Association
Available from: 2015-05-12 Created: 2015-04-17 Last updated: 2015-07-07
List of papers
1. Population-based study of multiplexed IgE sensitization in relation to asthma, exhaled nitric oxide, and bronchial responsiveness
Open this publication in new window or tab >>Population-based study of multiplexed IgE sensitization in relation to asthma, exhaled nitric oxide, and bronchial responsiveness
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2012 (English)In: Journal of Allergy and Clinical Immunology, ISSN 0091-6749, E-ISSN 1097-6825, Vol. 130, no 2, 397-402 p.Article in journal (Refereed) Published
Abstract [en]

Background: IgE sensitization is an important risk factor for the development of asthma.

Objective: The aim of this study was to investigate the IgE antibody profile for a broad spectrum of allergen molecules in asthmatic patients.

Methods: Participants from the European Community Respiratory Health Survey II (n = 467) were tested with ImmunoCAP ISAC against 103 allergen molecules. The presence of bronchial hyperresponsiveness was measured with a methacholine challenge test and bronchial inflammation with fraction of exhaled nitric oxide (FENO).

Results: A total of 38% of the controls and 72% of the asthmatic patients were sensitized against at least 1 of the allergen components (P < .0001). Asthma was independently related to having IgE antibodies against pollen (odds ratio = 2.2) and perennial airway allergens (odds ratio = 5.6), increased FENO was independently related to having IgE antibodies against food allergens and perennial allergens, while bronchial responsiveness was independently associated with having IgE antibodies against only perennial allergens. Sensitization to food allergens was related to asthma and increased FENO if IgE antibody against pollen allergens was present. Simultaneous sensitization to perennial, pollen, and food allergens involves the highest risk of asthma (odds ratio = 18.3), bronchial inflammation, and responsiveness.

Conclusions: FENO, bronchial responsiveness, and the risk of asthma increase with multiple sensitizations to different allergen groups. We show for the first time that the presence of IgE antibodies against food allergens is independently associated with increased FENO and increases the risk of asthma in subjects with simultaneous sensitization to pollen allergens.

Keyword
Asthma, FENO, airway inflammation, methacholine test, bronchial responsiveness, ISAC, food allergy, multisensitization
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-181126 (URN)10.1016/j.jaci.2012.03.046 (DOI)000307002200019 ()
Available from: 2012-09-19 Created: 2012-09-17 Last updated: 2017-12-07Bibliographically approved
2. Aeroallergen and food IgE sensitization and local and systemic inflammation in asthma
Open this publication in new window or tab >>Aeroallergen and food IgE sensitization and local and systemic inflammation in asthma
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2014 (English)In: Allergy. European Journal of Allergy and Clinical Immunology, ISSN 0105-4538, E-ISSN 1398-9995, Vol. 69, no 3, 380-387 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: We recently reported an independent association between IgE sensitization to food allergens and increased airway inflammation, assessed by fraction of exhaled nitric oxide (FeNO), in a population-based study (J Allergy Clin Immunol, 130, 2012, 397). Similar studies have not been performed in populations with asthma. The aim of the present study was to investigate the allergic sensitization profile in asthmatics and examine FeNO, airway responsiveness and blood eosinophilia in relation to type and degree of IgE sensitization.

METHOD: FeNO, airway responsiveness, blood eosinophil count (B-Eos) and IgE sensitization to food allergens and aeroallergens were determined in 408 subjects with asthma, aged 10-34 years.

RESULTS: Asthmatics had higher prevalence of IgE sensitization against all allergens than controls (P < 0.001). Mite, pollen, furry animal, mould and food sensitizations were each associated with increased FeNO, airway responsiveness and B-Eos in asthmatics. IgE sensitization to mould, furry animals and food allergens was independently related to FeNO (all P < 0.05) after adjustment for age, sex, height, smoking history and medication. IgE sensitization to mould (P < 0.001) and furry animals (P = 0.02) was related to airway responsiveness in a similar model. Finally, IgE sensitization to mould (P = 0.001), furry animals (P < 0.001) and food allergens (P < 0.001) was independently related to B-Eos.

CONCLUSION: Independent effects of IgE sensitization to aeroallergens (furry animals and mould) and food allergens were found on both local and systemic markers of inflammation in asthma. The finding regarding food IgE sensitization is novel, and a clinical implication might be that even food sensitization must be assessed to fully understand inflammation patterns in asthma.

National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:uu:diva-215165 (URN)10.1111/all.12345 (DOI)000331358400012 ()24397423 (PubMedID)
Note

De sista två författarna delar sista författarskapet.

Available from: 2014-01-12 Created: 2014-01-12 Last updated: 2017-12-06Bibliographically approved
3. Natural History of Perceived Food Hypersensitivity and IgE Sensitisation to Food Allergens in a Cohort of Adults
Open this publication in new window or tab >>Natural History of Perceived Food Hypersensitivity and IgE Sensitisation to Food Allergens in a Cohort of Adults
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2014 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 9, no 1, e85333- p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND:

No longitudinal studies exist on the natural history of food hypersensitivity and IgE sensitisation to food allergens in adults.

OBJECTIVE:

To examine the natural history of food hypersensitivity, the natural history of IgE sensitisation to food allergens and to investigate the risk factors for new onset food hypersensitivity.

METHODS:

Food hypersensitivity was questionnaire-assessed in 2307 individuals (aged 20-45 years) from Iceland and Sweden during the European Community Respiratory Health Survey both at baseline and follow-up 9 years later. IgE food and aeroallergen sensitisation were assessed in a subgroup of these individuals (n = 807). Values of 0.35 kU/L and above were regarded as positive sensitisation.

RESULTS:

Food hypersensitivity was reported by 21% of the subjects and this proportion remained unchanged at follow-up (p = 0.58). Fruits, nuts and vegetables were the three most common causes of food hypersensitivity, with a similar prevalence at baseline and follow-up. The prevalence IgE sensitisation to food allergens decreased in general by 56% (p<0.001) and IgE sensitisation to peanut decreased in particular by 67% (p = 0.003). The prevalence of timothy grass IgE sensitisation decreased by 15% (p = 0.003) while cat, mite and birch IgE sensitisation did not decrease significantly. Female sex, rhinitis, eczema and presence of IgE sensitisation to aeroallergens were independently associated with new onset food hypersensitivity.

CONCLUSION:

The prevalence of food hypersensitivity remained unchanged while the prevalence of IgE sensitisation to food allergens decreased in adults over a 9-year follow-up period. The decrease in prevalence of IgE sensitisation to food allergens was considerably larger than the change in prevalence of IgE sensitisation to aeroallergens.

National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:uu:diva-215804 (URN)10.1371/journal.pone.0085333 (DOI)000329868200042 ()24427301 (PubMedID)
Note

De sista två förtfattarna delar sista författarskapet.

Available from: 2014-01-16 Created: 2014-01-16 Last updated: 2017-12-06Bibliographically approved
4. Allergen extract vs component sensitisation and airway inflammation, responsiveness and new-onset respiratory disease
Open this publication in new window or tab >>Allergen extract vs component sensitisation and airway inflammation, responsiveness and new-onset respiratory disease
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(English)In: Clinical and Experimental Allergy, ISSN 0954-7894, E-ISSN 1365-2222Article in journal (Other academic) Submitted
Abstract [en]

Background: The absence of IgE sensitization to allergen components in the presence of sensitization to the corresponding extract has been reported, but its clinical importance has not been studied.

Objective: To evaluate the clinical significance of IgE sensitization to three  aeroallergen extracts and the corresponding components in relation to the development of respiratory disease.

Methods: A total of 467 adults participated in the European Community Respiratory Health Survey (ECRHS) II and 302 in ECRHS III, 12 years later. IgE sensitization to allergen extract and components, exhaled nitric oxide (FeNO) and bronchial responsiveness to methacholine were measured in ECRHS II. Rhinitis and asthma symptoms were questionnaire-assessed in both ECRHS II and III.

Results: A good overall correlation was found between IgE sensitization to extract and components for cat (r=0.83), timothy (r=0.96) and birch (r=0.95). However, a substantial proportion of subjects tested IgE-positive for cat and timothy allergen extracts but negative for the corresponding components (48% and 21%, respectively). Subjects sensitized to both cat extract and components had higher FeNO (p=0.008) and more bronchial responsiveness (p=0.002) than subjects sensitized only to the extract. Further, subjects sensitized to cat components were more likely to develop asthma (p=0.005) and rhinitis (p=0.007) than subjects sensitized only to cat extract.

Conclusion: Measurement of IgE sensitization to cat allergen components would seem to have a higher clinical value than extract-based measurement, as it related better to airway inflammation and responsiveness and had a higher prognostic value for the development of asthma and rhinitis over a 12-year period.

National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:uu:diva-251581 (URN)
Available from: 2015-04-21 Created: 2015-04-21 Last updated: 2017-12-04Bibliographically approved

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