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. 2019 Apr 1;199(7):842-853.
doi: 10.1164/rccm.201807-1355OC.

Distinct "Immunoallertypes" of Disease and High Frequencies of Sensitization in Non-Cystic Fibrosis Bronchiectasis

Micheál Mac Aogáin  1 , Pei Yee Tiew  1   2 , Albert Yick Hou Lim  3 , Teck Boon Low  4 , Gan Liang Tan  2 , Tidi Hassan  5 , Thun How Ong  2 , Sze Lei Pang  6   7 , Zi Yang Lee  6 , Xiao Wei Gwee  6 , Christopher Martinus  6 , Yang Yie Sio  6 , Sri Anusha Matta  6 , Tan Ching Ong  6 , Yuen Seng Tiong  6 , Kang Ning Wong  6 , Sriram Narayanan  8 , Veonice Bijin Au  8 , Damien Marlier  8 , Holly R Keir  9 , Augustine Tee  4 , John Arputhan Abisheganaden  3 , Mariko Siyue Koh  2 , De Yun Wang  10 , John E Connolly  8 , Fook Tim Chew  6 , James D Chalmers  9 , Sanjay H Chotirmall  1
Affiliations

Distinct "Immunoallertypes" of Disease and High Frequencies of Sensitization in Non-Cystic Fibrosis Bronchiectasis

Micheál Mac Aogáin et al. Am J Respir Crit Care Med. .

Abstract

Rationale: Allergic sensitization is associated with poor clinical outcomes in asthma, chronic obstructive pulmonary disease, and cystic fibrosis; however, its presence, frequency, and clinical significance in non-cystic fibrosis bronchiectasis remain unclear.

Objectives: To determine the frequency and geographic variability that exists in a sensitization pattern to common and specific allergens, including house dust mite and fungi, and to correlate such patterns to airway immune-inflammatory status and clinical outcomes in bronchiectasis.

Methods: Patients with bronchiectasis were recruited in Asia (Singapore and Malaysia) and the United Kingdom (Scotland) (n = 238), forming the Cohort of Asian and Matched European Bronchiectasis, which matched recruited patients on age, sex, and bronchiectasis severity. Specific IgE response against a range of common allergens was determined, combined with airway immune-inflammatory status and correlated to clinical outcomes. Clinically relevant patient clusters, based on sensitization pattern and airway immune profiles ("immunoallertypes"), were determined.

Measurements and main results: A high frequency of sensitization to multiple allergens was detected in bronchiectasis, exceeding that in a comparator cohort with allergic rhinitis (n = 149). Sensitization was associated with poor clinical outcomes, including decreased pulmonary function and more severe disease. "Sensitized bronchiectasis" was classified into two immunoallertypes: one fungal driven and proinflammatory, the other house dust mite driven and chemokine dominant, with the former demonstrating poorer clinical outcome.

Conclusions: Allergic sensitization occurs at high frequency in patients with bronchiectasis recruited from different global centers. Improving endophenotyping of sensitized bronchiectasis, a clinically significant state, and a "treatable trait" permits therapeutic intervention in appropriate patients, and may allow improved stratification in future bronchiectasis research and clinical trials.

Keywords: allergy; bronchiectasis; house dust mite; sensitization.

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