COBRAPed cohort: Sensitization patterns do not differentiate children
with severe asthma from those with a milder disease
Abstract
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 compare the sensitization patterns between children
with SRW/SA and NSRW/NSA from the French COBRAPed cohort. Methods: IgE
to 112 components (c-sIgE) (ImmunoCAP® ISAC) were analyzed in 125
preschool (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<0.01).
Sensitization to non-specific lipid transfer protein (nsLTP) components
was more frequent among SA than NSA (16% vs 4%, p<0.01) and
associated with a 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, the sensitization patterns did not clearly
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.