Sensitization to Aspergillus species is associated with frequent exacerbations in severe asthma
BACKGROUND: 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 investiga...
| Main Authors: | , , , , , , |
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| Format: | Journal Article |
| Language: | English |
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2017
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| Online Access: | https://hdl.handle.net/10356/83023 http://hdl.handle.net/10220/42387 |
| _version_ | 1826114198284795904 |
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| author | Goh, Ken Junyang Yii, Anthony Chau Ang Lapperre, Therese Sophie Chan, Adrian K. W. Chew, Fook Tim Chotirmall, Sanjay Haresh Koh, Mariko Siyue |
| author2 | Lee Kong Chian School of Medicine (LKCMedicine) |
| author_facet | Lee Kong Chian School of Medicine (LKCMedicine) Goh, Ken Junyang Yii, Anthony Chau Ang Lapperre, Therese Sophie Chan, Adrian K. W. Chew, Fook Tim Chotirmall, Sanjay Haresh Koh, Mariko Siyue |
| author_sort | Goh, Ken Junyang |
| collection | NTU |
| description | BACKGROUND: 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. METHODS: 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). RESULTS: 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. CONCLUSION: 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. |
| first_indexed | 2024-10-01T03:35:33Z |
| format | Journal Article |
| id | ntu-10356/83023 |
| institution | Nanyang Technological University |
| language | English |
| last_indexed | 2024-10-01T03:35:33Z |
| publishDate | 2017 |
| record_format | dspace |
| spelling | ntu-10356/830232020-11-01T05:14:28Z Sensitization to Aspergillus species is associated with frequent exacerbations in severe asthma Goh, Ken Junyang Yii, Anthony Chau Ang Lapperre, Therese Sophie Chan, Adrian K. W. Chew, Fook Tim Chotirmall, Sanjay Haresh Koh, Mariko Siyue Lee Kong Chian School of Medicine (LKCMedicine) Airway Atopy BACKGROUND: 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. METHODS: 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). RESULTS: 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. CONCLUSION: 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. Published version 2017-05-12T01:56:11Z 2019-12-06T15:10:23Z 2017-05-12T01:56:11Z 2019-12-06T15:10:23Z 2017 Journal Article Goh, K. J., Yii, A. C. A., Lapperre, T. S., Chan, A. K. W., Chew, F. T., Chotirmall, S. H., et al. (2017). Sensitization to Aspergillus species is associated with frequent exacerbations in severe asthma. Journal of Asthma and Allergy, 10, 131-140. 1178-6965 https://hdl.handle.net/10356/83023 http://hdl.handle.net/10220/42387 10.2147/JAA.S130459 en Journal of Asthma and Allergy © 2017 Goh et al. This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. 10 p. application/pdf |
| spellingShingle | Airway Atopy Goh, Ken Junyang Yii, Anthony Chau Ang Lapperre, Therese Sophie Chan, Adrian K. W. Chew, Fook Tim Chotirmall, Sanjay Haresh Koh, Mariko Siyue Sensitization to Aspergillus species is associated with frequent exacerbations in severe asthma |
| title | Sensitization to Aspergillus species is associated with frequent exacerbations in severe asthma |
| title_full | Sensitization to Aspergillus species is associated with frequent exacerbations in severe asthma |
| title_fullStr | Sensitization to Aspergillus species is associated with frequent exacerbations in severe asthma |
| title_full_unstemmed | Sensitization to Aspergillus species is associated with frequent exacerbations in severe asthma |
| title_short | Sensitization to Aspergillus species is associated with frequent exacerbations in severe asthma |
| title_sort | sensitization to aspergillus species is associated with frequent exacerbations in severe asthma |
| topic | Airway Atopy |
| url | https://hdl.handle.net/10356/83023 http://hdl.handle.net/10220/42387 |
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