eISSN: 2299-0046
ISSN: 1642-395X
Advances in Dermatology and Allergology/Postępy Dermatologii i Alergologii
Current issue Archive Manuscripts accepted About the journal Editorial board Reviewers Abstracting and indexing Subscription Contact Instructions for authors Publication charge Ethical standards and procedures
Editorial System
Submit your Manuscript
SCImago Journal & Country Rank
5/2023
vol. 40
 
Share:
Share:
Original paper

The importance of specific IgE antibodies in the epidemiology of allergic rhinitis and asthma (ECAP survey): part four. The relationship between the concentration of specific IgE antibodies in serum and types of asthma

Andrzej Namysłowski
1
,
Agnieszka Lipiec
1
,
Wojciech Zieliński
1, 2
,
Filip Raciborski
1
,
Edyta Krzych-Fałta
1
,
Krzysztof Samoliński
3
,
Anna Szylling
4
,
Bolesław Samoliński
1

  1. Department of the Prevention of Environmental Hazards, Allergology and Immunology, Medical University of Warsaw, Warsaw, Poland
  2. Department of Econometrics and Statistics, Warsaw University of Life Sciences, Warsaw, Poland
  3. Department of Emergency Medical Services, Medical University of Warsaw, Warsaw, Poland
  4. Department of Allergology and Clinical Immunology of the Central Clinical Hospital, Warsaw, Poland
Adv Dermatol Allergol 2023; XL (5): 611-616
Online publish date: 2023/08/02
Article file
Get citation
 
 

Introduction

Scientific studies accomplished within the last decades demonstrate that allergy and asthma are the most rapidly proliferating diseases in the paediatric population, and they affect more than 30% of infants in developed countries. Asthma appears to be the most common non-infectious chronic disease in young people, and it significantly impacts on the quality of life of the patients and may socially exclude some of them [15]. A broad survey called Epidemiology of Allergic Diseases in Poland (ECAP) proved the epidemiological significance of allergic rhinitis and asthma in Poland and the great diversity of allergy risk factors, sensitization to inhalation allergens among them [69]. Determination of specific IgE in serum of the respondents, the most reliable method to evaluate allergic hypersensitivity [10, 11], has been the continuation of the ECAP study [12].

Aim

The aim of the study was to determine the relationship between the concentration of specific IgE antibodies in serum and types of asthma.

Material and methods

The quantitative data presented in the article were collected as part of the Epidemiology of Allergic Diseases in Poland (ECAP) project and its continuation. The ECAP comprised 2 main phases: (i) a questionnaire-based study (computer-assisted personal interview – CAPI); and (ii) a complementary clinical assessment (spirometry with bronchodilator challenge, skin-prick tests, peak nasal inspiratory flow, and blood sampling for genetic and immune tests). A total of 18,617 individuals from 8 cities (each with a population in excess of 150,000) and one rural region took part in the study (phase one). The sample was drawn (by stratified cluster sampling method) from a personal identity number (PESEL) database (maintained by the Minister of the Interior and Administration). 4783 respondents were randomly selected and examined by allergists (phase 2 of the study). Blood from 4077 respondents was collected, and the concentration of sIgE antibodies against allergens d1 (Dermatophagoides pteronyssinus), e1 (cat dander), g6 (timothy grass), and m6 (Alternaria alternata) was determined in serum, using the reference method CAP (Phadia reagents, UniCAP 100 laboratory system). A concentration of sIgE antibodies of at least 0.35 IU/ml (classes 1–6) or 0.7 IU/ml (classes 2–6) was considered positive. The sIgE-determined respondents included 2223 females and 1854 males. 1026 respondents were aged 6–7 years, 1153 respondents were aged 13–14 years, and 1898 respondents were adults. An exact methodology of the ECAP survey is described at www.ecap.pl [12] and in the “Polish Journal of Allergology” [13].

The results of determination of sIgE antibodies were correlated as follows:

  • to the following clinical diagnoses: healthy, atopic asthma, non-atopic asthma, mild asthma, moderate asthma, severe asthma, intermittent asthma, persistent asthma, occupational asthma;

  • to results of skin-prick tests: negative (0–2 mm), + (3–5 mm), ++ (6–8 mm), +++ (at least 9 mm).

Statistical analysis

The aim of the statistical analysis was to compare proportions of people with a high level of immunoglobulin in 2 groups. The classical approximate test for comparison of 2 proportions was applied [14]. If the calculated p-value was less than 0.05, a statistically significant difference between the investigated proportions was recognised. Otherwise, the fractions of people with a high level of immunoglobulin in the investigated groups was treated as similar. Calculations were performed using the statistical package Statistica (Statistica, Tulsa, Oklahoma, US).

Results

In respondents with atopic asthma, sIgE antibodies against D. pteronyssinus and timothy grass were the most frequently detected (“D. pteronyssinus” vs. “cat dander”, classes 1–6 p < 0.001, classes 2–6 p < 0.001; “timothy grass” vs. “cat dander”, classes 1–6 p < 0.001, classes 2–6 p < 0.001). In the same group, sIgE antibodies against A. alternata were the least frequently detected (“A. alternata” vs. “cat dander”, classes 1–6 p < 0.05, classes 2–6 p < 0.05) (Table 1).

Table 1

Number (percentage) of respondents with sIgE concentration ≥ 0.35 IU/ml (classes 1–6) or ≥ 0.7 IU/ml (classes 2–6) – respondents with atopic asthma

ClassesRespondents’ sIgE against, n (%)
D. pteronyssinus (d1)Cat dander (e1)Timothy grass (g6)A. alternata (m6)N (100%)
1–695 (50.8)43 (23.0)88 (47.1)24 (12.8)187
2–683 (44.4)33 (17.6)75 (40.1)20 (10.7)187

sIgE antibodies against any allergen were detected in 74.3% (classes 1–6)/69.0% (classes 2–6) of respondents with atopic asthma, but also in 9.9% (classes 1–6)/7.6% (classes 2–6) of healthy respondents.

Comparing respondents with mild asthma to respondents with moderate asthma, no statistically significant differences were identified, although in respondents with moderate asthma, the percentages are frequently much greater than in respondents with mild asthma (Table 2). Similar values were obtained after excluding from the statistical analysis respondents with non-atopic asthma. Also, no statistically significant differences were identified when comparing respondents with intermittent asthma to respondents with persistent asthma (Table 3). Similar values were obtained after excluding from the statistical analysis respondents with non-atopic asthma.

Table 2

Number (percentage) of respondents with sIgE concentration ≥ 0.35 IU/ml (classes 1–6) or ≥ 0.7 IU/ml (classes 2–6) – respondents with mild asthma or moderate asthma

ClassesRespondents’ sIgE against, n (%)
D. pteronyssinus (d1)Cat dander (e1)Timothy grass (g6)A. alternata (m6)Any allergen at allN (100%)
Mild asthma:
 1–641 (31.5)23 (17.7)40 (30.8)11 (8.5)71 (54.6)130
 2–638 (29.2)18 (13.8)32 (24.6)9 (6.9)55 (42.3)130
Moderate asthma:
 1–620 (37.0)14 (25.9)19 (35.2)9 (16.7)32 (59.3)54
 2–615 (27.8)11 (20.4)16 (29.6)7 (13.0)19 (35.2)54
Table 3

Number (percentage) of respondents with sIgE concentration ≥ 0.35 IU/ml (classes 1–6) or ≥ 0.7 IU/ml (classes 2–6) – respondents with intermittent asthma or persistent asthma

ClassesRespondents’ sIgE against, n (%)
D. pteronyssinus (d1)Cat dander (e1)Timothy grass (g6)A. alternata (m6)Any allergen at allN (100%)
Intermittent asthma:
 1–649 (30.3)26 (16.1)45 (27.8)14 (8.6)77 (47.5)162
 2–644 (27.2)21 (13.0)38 (23.5)14 (8.6)61 (37.7)162
Persistent asthma:
 1–619 (35.2)11 (20.4)17 (31.5)3 (5.6)29 (53.7)54
 2–615 (27.8)7 (13.0)14 (25.9)2 (3.7)18 (33.3)54

Relating to allergens of D. pteronyssinus, cat dander, and A. alternata, sIgE antibodies were more frequently detected in respondents with atopic asthma and a negative skin-prick test as compared to healthy respondents with a negative skin-prick test. Numerous statistically significant differences were identified (p < 0.005 to p < 0.001). Relating to allergens of D. pteronyssinus, cat dander, and timothy grass, sIgE antibodies were more frequently detected in respondents with atopic asthma and a weakly positive skin-prick test as compared to healthy respondents with a weakly positive skin-prick test. Numerous statistically significant differences were identified (p < 0.05 to p < 0.001) (Table 4, Figure 1).

Table 4

Number (percentage) of respondents with sIgE concentration ≥ 0.35 IU/ml (classes 1–6) or ≥ 0.7 IU/ml (classes 2–6) – healthy respondents and respondents with atopic asthma

ClassesRespondents’ sIgE against, n (%)
D. pteronyssinus (d1)Cat dander (e1)Timothy grass (g6)A. alternata (m6)N (100%) d1, e1, g6, m6
Healthy – skin-prick test negative:
 1–628 (1.7)14 (0.8)23 (1.4)4 (0.2)1683, 1797, 1710, 1817
 2–612 (0.7)3 (0.2)15 (0.9)1 (0.1)
Atopic asthma – skin-prick test negative:
 1–69 (13.4)4 (3.9)2 (2.7)3 (2.0)67, 103, 74, 147
 2–68 (11.9)4 (3.9)1 (1.4)2 (1.4)
Healthy – skin-prick test+:
 1–640 (28.0)14 (20.3)26 (20.3)9 (20.0)143, 69, 128, 45
 2–627 (18.9)10 (14.5)19 (14.8)6 (13.3)
Atopic asthma – skin-prick test+:
 1–628 (53.9)18 (36.7)29 (56.9)8 (32.0)52, 49, 51, 25
 2–623 (44.2)13 (26.5)25 (49.0)6 (24.0)
Figure 1

Percentage of respondents with sIgE concentration ≥ 0.35 IU/ml (classes 1–6) or ≥ 0.7 IU/ml (classes 2–6) – healthy respondents and respondents with atopic asthma

/f/fulltexts/PDIA/51196/PDIA-40-51196-g001_min.jpg

Discussion

A broad ECAP survey proved the epidemiological significance of allergic rhinitis and asthma in Poland and the great diversity of allergy risk factors. The determination of specific IgE in respondents’ serum, a reliable method to evaluate allergic hypersensitivity, has been the continuation of ECAP. The aim of the study described in this article was to determine the relationship between the concentration of specific IgE antibodies in serum and types of asthma.

When comparing respondents with mild asthma to respondents with moderate asthma, no statistically significant differences were identified, although in respondents with moderate asthma, the percentages were frequently much greater than in respondents with mild asthma. The lack of the differences may result partially from the small number of analysed respondents, and because often the allergists did not define the type of asthma [12]. Similar values were obtained after excluding from the statistical analysis respondents with non-atopic asthma. No statistically significant differences were identified when comparing respondents with intermittent asthma to respondents with persistent asthma. Similar values were obtained after excluding from the statistical analysis respondents with non-atopic asthma. In a study by Matsui et al., allergen-specific IgE levels were associated with more severe asthma across a range of clinical and biologic markers [15]. In a study by Wickman et al., the presence of IgE antibodies seems not only to predict allergic diseases, but also relates to severity of such diseases, in particular to asthma [16]. In a study by Custovic et al., among children with wheezing, those in the complete mite sensitization trajectory had significantly higher risk of severe exacerbations [17]. In a study by Wang et al., sensitization to environmental allergens and total IgE correlated with increased healthcare and medication use, but not with wheeze symptoms [18]. In a study by Just et al. the following observations were made: a) children suffering from asthma with severe exacerbations and multiple allergies had more sensitisations to inhaled allergens and food allergens; b) children suffering from severe asthma with bronchial obstruction had significantly higher levels of all classes of immunoglobulin, except IgE; and c) children suffering from mild asthma did not show statistically significant features [19]. In a study by Manise et al., severe asthmatics had slightly increased total serum IgE compared with mild-to-moderate asthmatics without any difference in the sensitisation rate to common aeroallergens [20]. In a study by Haselkorn et al., severe or difficult-to-treat asthma in children and adolescents was characterized by high total serum IgE levels [21]. In a study by Satwani et al., serum total IgE levels were associated with severity of bronchial asthma [22]. In a study by Peat et al., subjects who had respiratory symptoms had higher total serum IgE levels than those who were lifelong asymptomatic [23]. In a study by Louis et al., variation in total serum IgE was weakly associated with asthma control but not with exacerbation [24].

Relating to allergens of D. pteronyssinus, cat dander, and A. alternata, sIgE antibodies were more frequently detected in respondents with atopic asthma and a negative skin-prick test as compared to healthy respondents with a negative skin-prick test. Relating to allergens of D. pteronyssinus, cat dander, and timothy grass, sIgE antibodies were more frequently detected in respondents with atopic asthma and a weakly positive skin-prick test as compared to healthy respondents with a weakly positive skin-prick test. Thus, relating to respondents with a negative or weakly positive skin-prick test, when sIgE antibodies against the same allergen are detected, occurrence of asthma is much more probable. If we suspect atopic asthma, determination of specific IgE antibodies is especially helpful in such patients. The results of this determination enhance the probability of a correct diagnosis. In a study by Simpson et al., the probability of wheeze and reduced lung respondents function increased with increasing specific IgE antibody levels, while there was no association between current wheeze and the size of skin test wheal [25]. In a study by Toppila-Salmi et al., polysensitization to more than one allergen type and the number of SPT-positive reactions was associated with asthma [26]. In a study by Chauveau et al., skin-prick test had a higher specificity for asthma and hay fever than sIgE, without difference for sensitivity [27]. In a study by Hourihane et al., peanut-specific IgE levels did not predict clinical severity, and skin-prick test weal size correlated weakly with severity [28]. In a study by Peat et al., total serum IgE was not more predictive of airway hyperresponsiveness than skin-prick tests [23]. In a study by Moore et al., the severe asthma group had less atopy by skin tests, but total IgE did not differentiate disease severity [29].

Conclusions

sIgE antibodies against any allergen are detected in 74.3% (classes 1 – 6)/69.0% (classes 2 – 6) of respondents with atopic asthma, but also in 9.9% (classes 1 – 6)/7.6% (classes 2 – 6) of healthy respondents. No statistically significant differences were identified when comparing sIgE antibodies of respondents with intermittent asthma to sIgE antibodies of respondents with persistent asthma. Regarding subjects with a negative or weakly positive skin test, when sIgE antibodies to the same allergen are detected, asthma is much more likely to occur.

Acknowledgments

The study was approved by the Institutional Bioethics Committee.

The study was performed as part of a research grant from the National Science Centre (Poland), 2011/01/B/NZ7/05289.

Conflict of interest

The authors declare no conflict of interest.

References

1 

Asher MI, Montefort S, Björkstén B, et al. Worldwide time trends in the prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and eczema in childhood: ISAAC Phases One and Three repeat multicountry cross-sectional surveys. Lancet 2006; 368: 733-43.

2 

World Allergy Organization (WAO) White Book on Allergy. Pawankar R, Canonica GW, Holgate ST, Lockey RD (eds.). WAO, Milwaukee, Wisconsin 2011.

3 

Matricardi PM. The allergy epidemic. In: Global Atlas of Allergy. Akdis CA, Agache I (eds.). EEACI, Zurich, Switzerland 2014: 112-4.

4 

Brożek JL, Bousquet J, Agache I, et al. Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines – 2016 revision. J Allergy Clin Immunol 2017; 140: 950-8.

5 

Van Cauwenberge P, Watelet JB, Van Zele T, et al. Spreading excellence in allergy and asthma: the Gallen Project. Allergy 2005; 60: 858-64.

6 

Samoliński B, Sybilski A, Raciborski F, et al. Wystêpowanie astmy oskrzelowej u dzieci, młodzieży i młodych dorosłych w Polsce w świetle badania ECAP. Alerg Astma Immun 2009; 14: 27-34.

7 

Samoliński B, Sybilski AJ, Raciborski F, et al. Prevalence of rhinitis in polish population according to the ECAP (Epidemiology of Allergic Disorders in Poland) study. Otolaryngol Pol 2009; 63: 324-30.

8 

Stankiewicz-Choroszucha B, Wawrzyniak Z, Lipiec A, et al. Consequences of smoke inhalation in the “Epidemiology of Allergic Diseases in Poland” project (ECAP). Ann Agric Environ Med 2011; 18: 420-8.

9 

Sybilski AJ, Raciborski F, Lipiec A, et al. Atopic dermatitis is a serious health problem in Poland. Epidemiology studies based on the ECAP study. Adv Dermatol Allergol 2015; 32: 1-10.

10 

Eriksson NE. Allergy screening with Phadiatop and CAP Phadiatop in combination with a questionnaire in adults with asthma and rhinitis. Allergy 1990; 45: 285-92.

11 

Bousquet J, Schünemann HJ, Samolinski B, et al. Allergic rhinitis and its impact on asthma (ARIA): achievements in 10 years and future needs. J Allergy Clin Immunol 2012; 130: 1049-62.

12 

Epidemiologia chorób alergicznych w Polsce (ECAP). Available at: www.ecap.pl (Access 28.07.2020).

13 

Samoliński B, Raciborski F, Lipiec A, et al. Epidemiologia chorób alergicznych w Polsce (ECAP). Pol J Allergol 2014; 1: 10-18.

14 

Zieliński W. Wybrane testy statystyczne. Fundacja Rozwój SGGW, Warsaw, Poland 1999.

15 

Matsui EC, Sampson HA, Bahnson HT, et al. Allergen-specific IgE as a biomarker of exposure plus sensitization in inner-city adolescents with asthma. Allergy 2010; 65: 1414-22.

16 

Wickman M, Ahlstedt S, Lilja G, van Hage Hamsten M. Quantification of IgE antibodies simplifies the classification of allergic diseases in 4-year-old children. A report from the prospective birth cohort study – BAMSE. Pediatr Allergy Immunol 2003; 14: 441-7.

17 

Custovic A, Sonntag HJ, Buchan IE, et al. Evolution pathways of IgE responses to grass and mite allergens throughout childhood. J Allergy Clin Immunol 2015; 136: 1645-52.

18 

Wang J, Visness CM, Calatroni A, et al. Effect of environmental allergen sensitization on asthma morbidity in inner city asthmatic children. Clin Exp Allergy 2009; 39: 1381-9.

19 

Just J, Gouvis-Echraghi R, Rouve S, et al. Two novel, severe asthma phenotypes identified during childhood using a clustering approach. Eur Respir J 2012; 40: 55-60.

20 

Manise M, Bakayoko B, Schleich F, et al. IgE mediated sensitisation to aeroallergens in an asthmatic cohort: relationship with inflammatory phenotypes and disease severity. Int J Clin Pract 2016; 70: 596-605.

21 

Haselkorn T, Szefler SJ, Simons FER, et al. Allergy, total serum immunoglobulin E, and airflow in children and adolescents in TENOR. Pediatr Allergy Immunol 2010; 21: 1157-65.

22 

Satwani H, Rehman A, Ashraf S, Hassan A. Is serum total IgE levels a good predictor of allergies in children? J Pak Med Assoc 2009; 59: 698-702.

23 

Peat JK, Toelle BG, Dermand J, et al. Serum IgE levels, atopy, and asthma in young adults: results from a longitudinal cohort study. Allergy 1996; 51: 804-10.

24 

Louis R, Pilette C, Michel O, et al. Variability in total serum IgE over 1 year in severe asthmatics. Allergy Asthma Clin Immunol 2019; 15: 20.

25 

Simpson A, Soderstrom L, Ahlstedt S, et al. IgE antibody quantification and the probability of wheeze in preschool children. J Allergy Clin Immunol 2005; 116: 744-9.

26 

Toppila-Salmi S, Huhtala H, Karjalainen J, et al. Sensitization pattern affects the asthma risk in Finnish adult population. Allergy 2015; 70: 1112-20.

27 

Chauveau A, Dalphin ML, Mauny F, et al. Skin prick tests and specific IgE in 10-year-old children: Agreement and association with allergic diseases. Allergy 2017; 72: 1365-73.

28 

Hourihane JO, Kilburn SA, Dean P, Warner JO. Clinical characteristics of peanut allergy. Clin Exp Allergy 1997; 27: 634-9.

29 

Moore WC, Bleecker ER, Curran-Everett D, et al. Characterization of the severe asthma phenotype by the National Heart, Lung, and Blood Institute’s Severe Asthma Research Program. J Allergy Clin Immunol 2007; 119: 405-13.

Copyright: © 2023 Termedia Sp. z o. o. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0) License (http://creativecommons.org/licenses/by-nc-sa/4.0/), allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, provided the original work is properly cited and states its license.
 
Quick links
© 2024 Termedia Sp. z o.o.
Developed by Bentus.