Persistent rhinitis associated with IgE sensitization, total IgE levels
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Key takeaways:
- Of 132 healthy subjects, 112 were still healthy, 16 had rhinitis and four had asthma and rhinitis 10 years later.
- Of 82 subjects with rhinitis, 53 still had it, 26 were in remission and three also had asthma.
Persistent rhinitis and the presence of both rhinitis and asthma were associated with IgE sensitization and total IgE levels, according to a study published in Clinical and Translational Allergy.
Higher levels of allergen sensitization and type 2 inflammation markers also were higher at baseline among patients with persistent allergic disease compared with participants who remained healthy, Viiu Blöndal, PhD student, department of medical sciences, respiratory, allergy and sleep research, Uppsala University, and colleagues wrote.
The study examined data from the European Community Respiratory Health Survey (ECRHS), which included visits in 1991-1992 (ECRHS I), 1999-2000 (ECRHS II) and 2011-2012 (ECRHS III).
When the researchers assessed 132 individuals who were healthy during ECRHS II again during ECRHS III, they found 112 who had remained healthy, 16 who had developed rhinitis and four who had developed asthma and rhinitis.
Meanwhile, 26 of the 82 participants who had rhinitis during ECRHS II had gone into remission by ECRHS III, whereas 53 still had rhinitis and three had developed asthma as well. However, none of the 41 participants with asthma and rhinitis during ECRHS II had gone into remission by ECRHS III.
The participants who had persistent rhinitis and asthma were younger than the healthy individuals. Also, the participants with persistent disease were more likely to have heredity for allergic disease and asthma. Participants with persistent disease, mainly concomitant asthma and rhinitis, had lower lung function during ECRHS II as well.
Compared with participants who were healthy during ECRHS II and III, participants with persistent rhinitis were more likely to be sensitized to any allergen, food of plant origin, grass, or tree pollen during ECRHS II.
Participants with persistent rhinitis also were more likely to be sensitized to grass pollen than those participants who went into remission. Participants with persistent asthma, however, were more likely to be sensitized to tree pollen and furry animals than those participants who only had persistent rhinitis.
Compared with the participants who remained healthy and with those who experienced rhinitis remission, participants with persistent rhinitis had higher levels of total IgE during ECRHS II and III.
Further, measurements during ECRHS II included elevated levels of eosinophil cationic protein (ECP) for participants with persistent rhinitis compared with the healthy participants, as well as higher levels of fractional exhaled nitric oxide for participants with persistent rhinitis and asthma compared with those who only had persistent rhinitis.
Finally, the participants with persistent rhinitis and asthma had higher levels of total IgE during ECRHS II and III, in addition to higher levels of FeNO and ECP during ECRHS II, compared with the participants who remained healthy from ECRHS II to ECRHS III.
Based on these findings, the researchers concluded that patients who had persistent rhinitis for more than a decade were more likely to be sensitized to allergens and have higher specific IgE levels for allergens than those patients who remained healthy or who went into remission during that decade.
By identifying patients who are at risk for continued rhinitis and asthma, the researchers said, physicians can better plan follow-up appointments and improve selection of patients who may benefit from immunotherapy or treatments for type 2 inflammation.
Perspective
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This article illustrates evidence that the presence of persistent T2 inflammation and allergic sensitization does impact remission of rhinosinusitis and asthma, in addition to being predictive of development of asthma in later life. These findings may induce clinicians to test and treat allergic sensitization sooner in the hopes of preventing future morbidities.
Pulmonologists are mainly focused on T2 inflammatory marker testing on patients with severe uncontrolled asthma to determine their eligibility for biologic treatment. Testing for allergen sensitization and subsequent eligibility to immunotherapy is dependent on history suggestive of atopy and availability of services that can provide immunotherapy. I think that more pulmonologists will be testing for allergen sensitivity and T2 inflammation sooner to induce remission and prevent worsening asthma.
The authors of the study do acknowledge the small number of participants in the study, which is also confined to the Swedish population. Also, the authors do not include race characterization of the study participants. This limits the generalizability of the study. Future studies should be multicentric and multinational to validate the results of this study.
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