Relationship between ınflammatory parameters and total ige values in patients diagnosed with asthma

Abstract

AimIn this study, we aimed to investigate the relationship between Total IgE levels obtained during follow-up of asthma patients receiving moderate to high dose inhaled corticosteroid therapy with a pre-diagnosis of lower respiratory tract infection, and post-treatment, with infective parameters, hospitalization, and frequency of attacks.MethodsRetrospective analysis was conducted on 132 patients diagnosed with asthma, despite the use of moderate to high dose inhaled steroids, based on their medical history, pulmonary function tests, and laboratory investigations.ResultsThe frequency of Total IgE levels being 100 or higher in patients hospitalized in the last year and the frequency of decrease in Total IgE levels with a decrease in CRP levels were statistically significantly higher among the patients included in the study. In conclusion, the frequency of attacks and hospitalizations was statistically significant in patients with variable Total IgE levels.ConclusionWe observed statistically significant increase in Total IgE levels in patients followed with a preliminary diagnosis of lower respiratory tract infection. Additionally, a significant correlation was observed between elevated Total IgE levels and patients who experienced exacerbations within a year and those hospitalized due to asthma attacks. This suggests that Total IgE may be valuable both in predicting the severity of the disease and in assessing the risk of exacerbation within a year in asthma patients. Furthermore, the data in our study suggest that serum Total IgE levels may be valuable as a biomarker in patients with Asthma-COPD overlap.

Keywords

Introduction

Asthma is a heterogeneous disease characterized by chronic airway inflammation and variable airflow limitation. The clinical features, natural course, pathophysiological mechanisms, and treatment response vary among different asthma types. The best‑known endotype of asthma is Type 2 asthma, characterized by Th2 cytokines accompanying airway and peripheral blood eosinophilia.
IgE is a major immunoglobulin involved in allergic response and parasitic infections. Total and antigen‑specific IgE measurements assist in the diagnosis of allergic diseases. Although IgE levels are not specific for the diagnosis of asthma, they are a critical factor in the development of bronchial hyperreactivity in asthmatics.
In our study, we investigated the relationship between Total IgE and infectious parameters during follow‑up of asthma patients receiving medium‑ to high‑dose ICS therapy with a pre‑diagnosis of lower respiratory tract infection, as well as the relationship between Total IgE levels and asthma attacks and hospitalizations experienced in the last year.^1-2-3

Materials and Methods

The inclusion criteria for the study were as follows: patients diagnosed with asthma who presented to the Chest Diseases Clinic of Bolu Abant Izzet Baysal University Training and Research Hospital, had symptoms despite using medium‑ to high‑dose inhaled steroids, had laboratory tests (complete blood count, CRP, Total IgE, control Total IgE) performed, and had chest X‑rays requested at the time of evaluation.
Exclusion criteria included those diagnosed with any rheumatological disease, those who received steroid treatment for any indication other than asthma, those diagnosed with any allergic disease other than asthma, those using anti‑IgE therapy, and those diagnosed with immunodeficiency.
This study is a retrospective cohort study. The study population consisted of patients who presented to the Chest Diseases Clinic of Bolu Abant Izzet Baysal University Training and Research Hospital between 01.01.2017 and 01.01.2021 and met the criteria.Ethical ApprovalThis study was approved by the Ethics Committee of Bolu Abant Izzet Baysal University (Date: 10.07.2023, Decision No: 2023/216).

Results

The mean age of the patients included in the study was 63.53 ( ± 12.95) years. 62.12% of the participants (n = 82) were male. It was observed that 51.52% of the patients (n = 68) had a Total IgE value of 100 or higher, 75.76% (n = 100) had a CRP value of 5 mg/dL or higher, and 12.12% (n = 16) had an eosinophil count of 0.4 × 10³/µL or higher.
Radiological findings were present in 61.07% of the patients (n = 80) on Posterior‑Anterior chest X‑rays. 82.58% (n = 109) had obstructive respiratory function tests, 10.61% (n = 14) had normal results, and 4.55% (n = 6) had a restrictive pattern. It was determined that 52.27% of the patients (n = 68) were hospitalized, and 48.48% (n = 64) had asthma attacks. In 30.30% of the patients (n = 40), there was a decrease in Total IgE with a decrease in CRP levels. The percentage of patients evaluated as Asthma‑COPD Overlap (ACO) was 11.36% (n = 15).
The frequency of patients with Total IgE levels ≥100 was statistically significantly higher among those with CRP levels ≥5 mg/dL (p<0.01). The frequency of patients hospitalized for asthma attacks during one year, with Total IgE levels ≥100, the frequency of asthma attacks, and the frequency of a decrease in Total IgE with a decrease in CRP levels were statistically significantly higher (p<0.01).
The frequency of patients hospitalized with obstructive spirometry findings was higher than those not hospitalized, while the frequency of having normal spirometry findings was lower. There was a statistically significant difference between the groups (p<0.01) (Table 1).
The frequency of patients experiencing attacks within the last year, with Total IgE levels ≥100, and the frequency of a decrease in Total IgE with a decrease in CRP levels were statistically significantly higher (p<0.01). The frequency of patients experiencing attacks with an obstructive pattern in spirometry was higher than those without attacks, while the frequency of having a normal pattern was lower. There was a statistically significant difference between the groups (p<0.01) (Table 2).
The frequency of Total IgE levels ≥100 in patients evaluated as Asthma‑COPD Overlap was statistically significantly higher than in patients not evaluated as Asthma‑COPD Overlap. The frequency of radiological findings in Posterior‑Anterior chest X‑rays of patients with CRP levels ≥5 mg/dL was statistically significantly higher compared to those with CRP levels <5 mg/dL (p<0.01).
Patients with a decrease in CRP accompanied by a decrease in Total IgE were found to have a statistically significantly higher frequency of hospitalization and asthma attacks (p<0.01) (Table 3).

Discussion

In our study, the symptoms, physical examination findings, and radiological evaluations of patients diagnosed with asthma and receiving medium‑ to high‑dose inhaled corticosteroid treatment were considered as a preliminary diagnosis of lower respiratory tract infection. According to the Turkish Thoracic Society Asthma guideline, asthma is reported to be more common in females compared to males in our country.⁴ However, in our study, the proportion of male participants was higher (62%). Additionally, the average age of asthma onset is reported to be 50 years, but the average age of our patients was 63. We believe that the distribution of gender and age in our study is related to our inclusion and exclusion criteria. It was observed that some patients had elevated Total IgE levels. In studies conducted in the literature, serum Total IgE levels are reported to be elevated in adults with allergic asthma.⁵ Furthermore, elevated Total IgE levels have been associated with asthmatic patients.⁶ In spirometric evaluations, most patients had an obstructive pattern, though normal and restrictive patterns were also observed. This suggests that spirometry values in asthma patients can vary between obstructive and normal due to reversible airway obstruction. Restrictive spirometry findings may rarely be observed in advanced stages of the disease. A low FEV1 value under treatment (especially <60%) suggests that the patient is at risk for asthma attacks and persistent airflow limitation. Among infective parameters, patients with CRP levels ≥5 mg/dL had elevated Total IgE levels. Patients who had attacks also had high Total IgE levels, and a decrease in Total IgE accompanied by a decrease in CRP. These results indicate that Total IgE levels may increase in relation to infections in asthma patients. One study stated that atypical bacterial pneumonia pathogens play an important role in the pathogenesis of asthma, and concluded that *C. pneumoniae* infection can trigger IgE‑specific responses in asthmatics.⁷ In our study, we also observed a statistically significant elevation of Total IgE in patients followed up with a pre‑diagnosis of lower respiratory tract infection. With this result, we conclude that lower respiratory tract infections may lead to Total IgE elevation in asthma patients. However, due to not including microbiological culture evaluation, we cannot reach a conclusion associated with the pathogen. Patients who experienced asthma attacks or were hospitalized in the last year showed a statistically significant frequency of Total IgE levels ≥100, and a frequency of decrease in Total IgE levels with a decrease in CRP. Similar evaluations have been reported in previous studies. In one study, increased Total IgE levels were found to have a negative correlation with lung function in asthma patients.⁸ Another study conducted in Spain reported no significant relationship between disease severity or degree of airflow limitation, but a higher percentage of patients in the severe asthma subgroup had IgE levels >400 IU/mL.⁵ In another study, the asthma control test score was significantly lower in patients with IgE increase or decrease compared to patients with unchanged IgE levels, and these patients experienced more acute exacerbations within one year.⁹ These results indicate that variable IgE levels over time are associated with poor asthma control. In our study, a significant correlation was observed between increased Total IgE levels and patients experiencing attacks within one year. This suggests that Total IgE may be valuable both in predicting disease severity and assessing the risk of asthma attacks within one year. A similar situation was observed for patients hospitalized in the last year, and variable Total IgE levels in controls may be valuable in predicting hospitalization within one year.¹⁰ Limitations of the study include: Inability to perform culture studies Inability to perform procalcitonin studies Low number of ACO patients

Conclusion

Despite these limitations, the results of our study indicate that total IgE levels may be an important biomarker in asthma patients and may vary in relation to infections.

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