Patterns of allergic sensitization in adults with severe asthma: the ATLAS non-interventional study

Abstract

Objectives

Severe asthma is heterogeneous, with childhood-onset asthma believed more likely to be allergic, whereas adult-onset asthma is considered typically non-allergic. However, the allergic diagnosis is typically by exclusion: if patients do not react to an allergen panel, which is not standardized and often limited to few allergens, they are considered non-allergic. The overall aim of the ATLAS study was to characterize the sensitization to allergens in severe asthma (independent of phenotype).

Methods

Single-visit, cross-sectional, non-interventional study in adults with severe asthma. Analyses were conducted for total and specific immunoglobulin E against 53 allergens, overall and in subgroups, including age at asthma onset (<20 [childhood-onset] and >40 years of age).

Results

Among 1010 recruited patients, 28.4% reported childhood-onset asthma and 33.6% onset >40 years of age. After excluding patients receiving omalizumab/anti-IL5 therapy, 27.6% were not sensitized to any tested allergens, whereas 19.1% were sensitized to >10 allergens. All allergens triggered sensitization in some patients. Baseline characteristics in the two onset subgroups were similar; 23.2% with childhood-onset asthma were not sensitized to any allergen, compared to 32.0% with onset >40 years of age.

Conclusion

When a broad panel of allergens is used for sensitization testing, as many as three quarters of patients with severe asthma display sensitivity to at least one allergen, with substantial overlaps in all characteristics between the two age-at-onset subgroups. All of the tested allergens triggered a response in at least some patients, emphasizing the importance of including a broad range of allergens in any testing panel.

Keywords:

• Asthma
• allergens
• immunoglobulin E
• eosinophils
• subgroups

Acknowledgements

The authors would like to acknowledge the contribution of the late Dr Annelore Ittenson to the study. They also thank Dr Claudia Mailänder, Novartis Pharma GmbH, Nürnberg, Germany, for her helpful comments on the manuscript, Ms Karina Heynemann and Ms Marianne Blichmann for their skillful technical assistance, and the investigators and patients at the investigative sites for their support of this study. Writing support was provided by David Young of Young Medical Communications and Consulting Ltd. This support was funded by Otto-von-Guericke University, Magdeburg, Germany.

Authors’ contributions

Eva Lücke: Methodology, investigation, formal analysis, writing—review & editing. Burkhart Schraven: Methodology, investigation, writing—review & editing. Katrin Borucki: Methodology, investigation, writing—review & editing. Anke Lux: Formal analysis, writing—review & editing. Dirk Reinhold: Methodology, investigation, writing—review & editing. Qingyu Wu: Investigation, writing—review & editing. Jens Schreiber: Conceptualization, methodology, investigation, writing—review & editing, visualization, supervision.

Declaration of statement

In addition to the medical writing support disclosed above, the authors declare the following conflicts of interest: JS declares the receipt of honoraria and research support from Novartis Pharma during the conduct of this study. Outside the submitted work, he declares consulting fees from GSK, AstraZeneca, Chiesi and MSD, payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from AstraZeneca, GSK, MSD, Boehringer Ingelheim, Novartis and Janssen Cilag, and support for attending meetings and/or travel from AstraZeneca and Boehringer Ingelheim. The other authors have no other relevant conflicts of interest to declare.

Data availability statement

The data from this study are available on reasonable request to the corresponding author, following submission of a valid research protocol.

Additional information

Funding

This study was funded by Novartis Pharma GmbH and Thermo Fisher Scientific. The work of BS was funded by the German-Research Foundation (DFG, CRC854, project B19) and by grants of the State of Saxony-Anhalt (SI-2 and SI-3).