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COBRAPed cohort: Do sensitization patterns differentiate children with severe asthma from those with a milder
Stéphanie Lejeune1,2, Naïm Bouazza3, Pascale Roland Nicaise4,5
1Pediatric Pulmonology and Allergy Department, U1019-UMR 9017-CIIL-Center for Infection and Immunity of Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, Hôpital Jeanne de Flandre, Univ. Lille, Lille, France.
Insights
Sensitization patterns in children with asthma are common but do not strongly differentiate severe from mild disease. Asthma severity may involve both IgE-mediated and non-IgE-mediated mechanisms.
Area of Science:
- Pediatric Allergy and Immunology
- Respiratory Medicine
- Immunology
Background:
- Distinguishing severe recurrent wheeze (SRW)/severe asthma (SA) from non-severe recurrent wheeze (NSRW)/non-severe asthma (NSA) in children based on sensitization patterns remains unclear.
- Understanding these patterns is crucial for targeted therapeutic strategies in pediatric asthma.
Purpose of the Study:
- To investigate whether specific sensitization patterns can differentiate children with NSRW/NSA from those with SRW/SA within the French COBRAPed cohort.
- To identify distinct sensitization profiles associated with different asthma severities in children.
Main Methods:
- Analysis of IgE to 112 components (c-sIgE) using ImmunoCAP® ISAC in 125 preschool and 170 school-age children.
- Application of supervised analyses and clustering methods to identify sensitization patterns in children with positive c-sIgE.
Main Results:
- Sensitization to house dust mite (HDM) was more frequent in NSRW than SRW (53% vs. 24%).
- Sensitization to non-specific lipid transfer protein (nsLTP) was more frequent in SA than NSA (16% vs. 4%) and linked to reduced FEV1/FVC.
- A cluster with multiple sensitizations (grass pollen, HDM, PR-10, nsLTP) was associated with SA in school-age children.
Conclusions:
- While sensitization is prevalent in children with wheeze/asthma, specific patterns did not strongly discriminate between severe and mild disease.
- The findings suggest that pediatric asthma severity might be influenced by both IgE-mediated and non-IgE-mediated immunological pathways.
Background:
It is unclear whether sensitization patterns differentiate children with severe recurrent wheeze (SRW)/severe asthma (SA) from those with non-severe recurrent wheeze (NSRW)/non-severe asthma (NSA). Our objective was to determine whether sensitization patterns can discriminate between children from the French COBRAPed cohort with NSRW/NSA and those with SRW/SA.
Methods:
IgE to 112 components (c-sIgE) (ImmunoCAP® ISAC) were analyzed in 125 preschools (3-6 years) and 170 school-age children (7-12 years). Supervised analyses and clustering methods were applied to identify patterns of sensitization among children with positive c-sIgE.
Results:
We observed c-sIgE sensitization in 51% of preschool and 75% of school-age children. Sensitization to house dust mite (HDM) components was more frequent among NSRW than SRW (53% vs. 24%, p < .01). Sensitization to non-specific lipid transfer protein (nsLTP) components was more frequent among SA than NSA (16% vs. 4%, p < .01) and associated with an FEV1/FVC < -1.64 z-score. Among sensitized children, seven clusters with varying patterns were identified. The two broader clusters identified in each age group were characterized by "few sensitizations, mainly to HDM." One cluster (n = 4) with "multiple sensitizations, mainly to grass pollen, HDM, PR-10, and nsLTP" was associated with SA in school-age children.
Conclusions:
Although children with wheeze/asthma display frequent occurrences and high levels of sensitization, sensitization patterns did not provide strong signals to discriminate children with severe disease from those with milder disease. These results suggest that the severity of wheeze/asthma may depend on both IgE- and non-IgE-mediated mechanisms.
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