Distinct "immunoallertypes" of disease and high frequencies of sensitization in non-cystic fibrosis bronchiectasis

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

Research output: Contribution to journalArticle

8 Citations (Scopus)

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, includinghouse dustmite andfungi,andtocorrelate 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 immuneinflammatory 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, andmay allow improved stratification in future bronchiectasis research and clinical trials.

Original languageEnglish
Pages (from-to)842-853
Number of pages12
JournalAmerican Journal of Respiratory and Critical Care Medicine
Volume199
Issue number7
DOIs
Publication statusPublished - 1 Apr 2019

Fingerprint

Bronchiectasis
Fibrosis
Allergens
Pyroglyphidae
Malaysia
Singapore
Scotland
Chemokines
Cystic Fibrosis
Chronic Obstructive Pulmonary Disease
Immunoglobulin E
Asthma
Clinical Trials
Lung

Keywords

  • Allergy
  • Aspergillus
  • Bronchiectasis
  • House dust mite
  • Sensitization

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine

Cite this

Distinct "immunoallertypes" of disease and high frequencies of sensitization in non-cystic fibrosis bronchiectasis. / Mac Aogáin, Micheál; Tiew, Pei Yee; Lim, Albert Yick Hou; Low, Teck Boon; Tan, Gan Liang; Tidi Maharani, Hassan; Ong, Thun How; Pang, Sze Lei; Lee, Zi Yang; Gwee, Xiao Wei; Martinus, Christopher; Sio, Yang Yie; Matta, Sri Anusha; Ong, Tan Ching; Tiong, Yuen Seng; Wong, Kang Ning; Narayanan, Sriram; Au, Veonice Bijin; Marlier, Damien; Keir, Holly R.; Tee, Augustine; Abisheganaden, John Arputhan; Koh, Mariko Siyue; Wang, De Yun; Connolly, John E.; Chew, Fook Tim; Chalmers, James D.; Chotirmall, Sanjay H.

In: American Journal of Respiratory and Critical Care Medicine, Vol. 199, No. 7, 01.04.2019, p. 842-853.

Research output: Contribution to journalArticle

Mac Aogáin, M, Tiew, PY, Lim, AYH, Low, TB, Tan, GL, Tidi Maharani, H, Ong, TH, Pang, SL, Lee, ZY, Gwee, XW, Martinus, C, Sio, YY, Matta, SA, Ong, TC, Tiong, YS, Wong, KN, Narayanan, S, Au, VB, Marlier, D, Keir, HR, Tee, A, Abisheganaden, JA, Koh, MS, Wang, DY, Connolly, JE, Chew, FT, Chalmers, JD & Chotirmall, SH 2019, 'Distinct "immunoallertypes" of disease and high frequencies of sensitization in non-cystic fibrosis bronchiectasis', American Journal of Respiratory and Critical Care Medicine, vol. 199, no. 7, pp. 842-853. https://doi.org/10.1164/rccm.201807-1355OC
Mac Aogáin, Micheál ; Tiew, Pei Yee ; Lim, Albert Yick Hou ; Low, Teck Boon ; Tan, Gan Liang ; Tidi Maharani, Hassan ; Ong, Thun How ; Pang, Sze Lei ; Lee, Zi Yang ; Gwee, Xiao Wei ; Martinus, Christopher ; Sio, Yang Yie ; Matta, Sri Anusha ; Ong, Tan Ching ; Tiong, Yuen Seng ; Wong, Kang Ning ; Narayanan, Sriram ; Au, Veonice Bijin ; Marlier, Damien ; Keir, Holly R. ; Tee, Augustine ; Abisheganaden, John Arputhan ; Koh, Mariko Siyue ; Wang, De Yun ; Connolly, John E. ; Chew, Fook Tim ; Chalmers, James D. ; Chotirmall, Sanjay H. / Distinct "immunoallertypes" of disease and high frequencies of sensitization in non-cystic fibrosis bronchiectasis. In: American Journal of Respiratory and Critical Care Medicine. 2019 ; Vol. 199, No. 7. pp. 842-853.
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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, includinghouse dustmite andfungi,andtocorrelate 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 immuneinflammatory 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, andmay allow improved stratification in future bronchiectasis research and clinical trials.",
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T1 - Distinct "immunoallertypes" of disease and high frequencies of sensitization in non-cystic fibrosis bronchiectasis

AU - Mac Aogáin, Micheál

AU - Tiew, Pei Yee

AU - Lim, Albert Yick Hou

AU - Low, Teck Boon

AU - Tan, Gan Liang

AU - Tidi Maharani, Hassan

AU - Ong, Thun How

AU - Pang, Sze Lei

AU - Lee, Zi Yang

AU - Gwee, Xiao Wei

AU - Martinus, Christopher

AU - Sio, Yang Yie

AU - Matta, Sri Anusha

AU - Ong, Tan Ching

AU - Tiong, Yuen Seng

AU - Wong, Kang Ning

AU - Narayanan, Sriram

AU - Au, Veonice Bijin

AU - Marlier, Damien

AU - Keir, Holly R.

AU - Tee, Augustine

AU - Abisheganaden, John Arputhan

AU - Koh, Mariko Siyue

AU - Wang, De Yun

AU - Connolly, John E.

AU - Chew, Fook Tim

AU - Chalmers, James D.

AU - Chotirmall, Sanjay H.

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N2 - 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, includinghouse dustmite andfungi,andtocorrelate 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 immuneinflammatory 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, andmay allow improved stratification in future bronchiectasis research and clinical trials.

AB - 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, includinghouse dustmite andfungi,andtocorrelate 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 immuneinflammatory 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, andmay allow improved stratification in future bronchiectasis research and clinical trials.

KW - Allergy

KW - Aspergillus

KW - Bronchiectasis

KW - House dust mite

KW - Sensitization

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