https://orcid.org/0000-0002-4236-7367
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ABSTRACT
Introduction
S. aureus is a major opportunistic pathogen that has been implicated in the pathogenesis of several chronic inflammatory diseases including bronchial asthma, chronic rhinosinusitis with nasal polyps (CRSwNP), chronic spontaneous urticaria (CSU), and atopic dermatitis. S. aureus can induce the production of both polyclonal and specific IgE that can elicit an inflammatory cascade.
Areas covered
The link between the sensitization to S. aureus enterotoxins and the severity of several chronic inflammatory diseases is reviewed in detail, as well as its therapeutic implications.
Expert opinion
An anti-IgE strategy to inhibit S. aureus enterotoxins would be a valid approach to treat several endotypes of severe asthma, CRSwNP and CSU in which IgE against S. aureus enterotoxins should represent, not only a marker of severity of the diseases but also a target of a treatment.
Article highlights
Colonization with S. aureus has been associated with bronchial asthma, chronic rhinosinusitis with nasal polyps (CRSwNP), chronic spontaneous urticaria (CSU), and atopic dermatitis.
S. aureus can be an IgE-inducing pathogen and IgE against S. aureus enterotoxins can induce the production of both polyclonal and specific IgE that can elicit the inflammatory cascade.
A link between sensitization to S. aureus enterotoxins and the severity of these diseases has been shown and an anti-IgE strategy appears to be a valid approach to treat the IgE-mediated endotypes of severe asthma, CRSwNP and CSU.
The anti-IgE agent omalizumab is currently the only biological agent that specifically targets IgE approved for the treatment of severe asthma, CRSwNP and CSU.
In CRSwNP and CSU, omalizumab can be prescribed regardless of the presence and nature of the allergic sensitization, while in severe asthma omalizumab can be prescribed only to patients sensitized to perennial allergens.
There is a need to measure specific IgE to S. aureus enterotoxins in severe asthmatic patients because, in our opinion, S. aureus enterotoxins can be considered as perennial allergens.
In conclusion, S. aureus in patients sensitized to staphylococcal enterotoxins should be considered as a driver of pathology and potential target for treatment.
Further studies to better assess the role of S. aureus in severe asthma, CRSwNP, CSU, and atopic dermatitis are warranted.
Declaration of interest
V Seccia has accepted grants, speaking and conference invitations, and has been part of advisory boards for AstraZeneca, GlaxoSmithKline, Novartis, and Sanofi in the last 3 years. F Spinelli and P Morini are employees of Novartis. A Rizzi was an employee of Novartis at the time the work was initially submitted. A Detoraki participated in advisory boards upon invitation for GlaxoSmithKline and Sanofi in the past three years. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.
Reviewer disclosures
Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.
Acknowledgments
The authors thank Patrick Moore of Health Publishing & Services Srl for providing medical writing support, which was funded by Novartis Farma in accordance with Good Publication Practice (GPP3) guidelines (http://www.ismpp.org/gpp3).
Data availability
Data sharing is not applicable to this article as no new data were created or analyzed in this study.
Author contributions
All authors made substantial contributions to the conception and design of the work; took part in drafting or revised it critically. All authors agree for the final version of the manuscript to be published.