The Korean journal of internal medicine

  • 제35권2호
  • /
  • Pages.449-456
  • /
  • 2020
  • /
  • 1226-3303(pISSN)
  • /
  • 2005-6648(eISSN)
대한내과학회 (The Korean Association of Internal Medicine)
권호 표지
DOI QR코드

DOI QR Code

Association between primary immunodeficiency and asthma exacerbation in adult asthmatics

  • Lee, So-Hee (Department of Allergy and Clinical Immunology, Ajou University School of Medicine) ;
  • Ban, Ga-Young (Department of Pulmonology and Allergy, Hallym University Kangdong Sacred Heart Hospital) ;
  • Kim, Su-Chin (Department of Statistics, Clinical Trial Center, Ajou University Medical Center) ;
  • Chung, Chang-Gyu (Division of Allergy & Clinical Immunology, Department of Internal Medicine, Keimyung University Dongsan Medical Center) ;
  • Lee, Hyun-Young (Department of Statistics, Clinical Trial Center, Ajou University Medical Center) ;
  • Lee, Ji-Ho (Department of Internal Medicine, Yonsei University Wonju College of Medicine) ;
  • Park, Hae-Sim (Department of Allergy and Clinical Immunology, Ajou University School of Medicine)
  • 투고 : 2018.11.20
  • 심사 : 2019.02.18
  • 발행 : 2020.03.01
⟨ 이전 논문 다음 논문 ⟩

초록

Background/Aims: Primary immunodeficiency (PID) is a serious comorbid condition in adult asthmatics that have frequent exacerbations, which requires monthly replacement of intravenous immunoglobulin (IVIG). However, the prevalence and clinical significance of PID in adult asthmatics in Korea have not yet been reported. The aim of this study is to assess the prevalence of PID and its association with asthma exacerbation in Korean adult asthmatics. Methods: A total of 2,866 adult asthmatics were enrolled in this study. The PID group was defined as subjects who had lower levels of immunoglobulin G (IgG)/A/M and/or IgG subclass presenting with recurrent respiratory infections. Serum samples were assayed for total IgG/A/M by immunoturbidimetry, and IgG subclasses by nephelometry. Results: Of the 2,866 asthmatic patients enrolled, 157 (5.49%) had PID (classified as the PID group), while those without PID was classified as the non-PID group. IgG subclass deficiency (58%) is most prevalent, among which IgG3 subclass deficiency was most common (58%). The relative risk of asthma exacerbation was 1.70 times higher in the PID group compared to the non-PID group (1.696; 95% confidence interval, 1.284 to 2.239; p < 0.001); the prevalence of severe asthma was significantly higher in the PID group than in the non-PID group (32.48% vs. 13.00%, p < 0.001). Thirty-five among 157 patients in the PID group d maintained IVIG to prevent asthma exacerbation. Conclusions: It is suggested that PID, especially IgG3 subclass deficiency, is a significant risk factor for asthma exacerbation. Screening of IgG subclass levels and IVIG replacement should be considered in the management in adult asthmatics.

키워드

과제정보

This study was supported by Green Cross Corp. and by a grant from the Korean Health Technology R&D Project, Ministry of Health and Welfare, Republic of Korea (HI16C0992).

참고문헌

  1. Rhim JW, Kim KH, Kim DS, et al. Prevalence of primary immunodeficiency in Korea. J Korean Med Sci 2012;27:788-793. https://doi.org/10.3346/jkms.2012.27.7.788
  2. Carneiro-Sampaio M, Moraes-Vasconcelos D, Kokron CM, et al. Primary immunodeficiency diseases in different age groups: a report on 1,008 cases from a single Brazilian reference center. J Clin Immunol 2013;33:716-724. https://doi.org/10.1007/s10875-013-9865-6
  3. Gathmann B, Mahlaoui N; CEREDIH, et al. Clinical picture and treatment of 2212 patients with common variable immunodeficiency. J Allergy Clin Immunol 2014;134:116-126. https://doi.org/10.1016/j.jaci.2013.12.1077
  4. Kim JH, Park HJ, Choi GS, et al. Immunoglobulin G subclass deficiency is the major phenotype of primary immunodeficiency in a Korean adult cohort. J Korean Med Sci 2010;25:824-828. https://doi.org/10.3346/jkms.2010.25.6.824
  5. Kim JH, Ye YM, Ban GY, et al. Effects of immunoglobulin replacement on asthma exacerbation in adult asthmatics with IgG subclass deficiency. Allergy Asthma Immunol Res 2017;9:526-533. https://doi.org/10.4168/aair.2017.9.6.526
  6. Chung KF, Wenzel SE, Brozek JL, et al. International ERS/ATS guidelines on definition, evaluation and treatment of severe asthma. Eur Respir J 2014;43:343-373. https://doi.org/10.1183/09031936.00202013
  7. Modell V, Gee B, Lewis DB, et al. Global study of primary immunodeficiency diseases (PI): diagnosis, treatment, and economic impact: an updated report from the Jeffrey Modell Foundation. Immunol Res 2011;51:61-70. https://doi.org/10.1007/s12026-011-8241-y
  8. Lee WI, Huang JL, Jaing TH, et al. Distribution, clinical features and treatment in Taiwanese patients with symptomatic primary immunodeficiency diseases (PIDs) in a nationwide population-based study during 1985-2010. Immunobiology 2011;216:1286-1294. https://doi.org/10.1016/j.imbio.2011.06.002
  9. Takada H. Primary immunodeficiency in Japan: epidemiology, diagnosis, and pathogenesis. Pediatr Int 2013;55:671-674. https://doi.org/10.1111/ped.12224
  10. Lim DL, Thong BY, Ho SY, et al. Primary immunodeficiency diseases in Singapore: the last 11 years. Singapore Med J 2003;44:579-586.
  11. Mahlaoui N, Jais JP, Brosselin P, et al. Prevalence of primary immunodeficiencies in France is underestimated. J Allergy Clin Immunol 2017;140:1731-1733. https://doi.org/10.1016/j.jaci.2017.06.020
  12. Errante PR, Franco JL, Espinosa-Rosales FJ, Sorensen R, Condino-Neto A. Advances in primary immunodeficiency diseases in Latin America: epidemiology, research, and perspectives. Ann N Y Acad Sci 2012;1250:62-72. https://doi.org/10.1111/j.1749-6632.2011.06289.x
  13. Kilic SS, Ozel M, Hafizoglu D, Karaca NE, Aksu G, Kutukculer N. The prevalences [correction] and patient characteristics of primary immunodeficiency diseases in Turkey: two centers study. J Clin Immunol 2013;33:74-83. https://doi.org/10.1007/s10875-012-9763-3
  14. Ulambayar B, Lee SH, Yang EM, Ye YM, Park HS. Association between epithelial cytokines and clinical phenotypes of elderly asthma. Allergy Asthma Immunol Res 2019;11:79-89. https://doi.org/10.4168/aair.2019.11.1.79
  15. Ban GY, Ye YM, Kim SH, et al. Plasma LTE4/PGF2α ratio and blood eosinophil count are increased in elderly asthmatics with previous asthma exacerbation. Allergy Asthma Immunol Res 2017;9:378-382. https://doi.org/10.4168/aair.2017.9.4.378
  16. Eder W, Ege MJ, von Mutius E. The asthma epidemic N Engl J Med 2006;355:2226-2235. https://doi.org/10.1056/NEJMra054308
  17. Song WJ, Kang MG, Chang YS, Cho SH. Epidemiology of adult asthma in Asia: toward a better understanding. Asia Pac Allergy 2014;4:75-85. https://doi.org/10.5415/apallergy.2014.4.2.75
  18. Gupta S, Agrawal A, Agrawal S, Su H, Gollapudi S. A paradox of immunodeficiency and inflammation in human aging: lessons learned from apoptosis. Immun Ageing 2006;3:5. https://doi.org/10.1186/1742-4933-3-5
  19. Listi F, Candore G, Modica MA, et al. A study of serum immunoglobulin levels in elderly persons that provides new insights into B cell immunosenescence. Ann N Y Acad Sci 2006;1089:487-495. https://doi.org/10.1196/annals.1386.013
  20. Weksler ME. Changes in the B-cell repertoire with age. Vaccine 2000;18:1624-1628. https://doi.org/10.1016/S0264-410X(99)00497-1
  21. Radl J, Sepers JM, Skvaril F, Morell A, Hijmans W. Immunoglobulin patterns in humans over 95 years of age. Clin Exp Immunol 1975;22:84-90.
  22. Abdou NI, Greenwell CA, Mehta R, Narra M, Hester JD, Halsey JF. Efficacy of intravenous gammaglobulin for immunoglobulin G subclass and/or antibody deficiency in adults. Int Arch Allergy Immunol 2009;149:267-274. https://doi.org/10.1159/000199723
  23. Abrahamian F, Agrawal S, Gupta S. Immunological and clinical profile of adult patients with selective immunoglobulin subclass deficiency: response to intravenous immunoglobulin therapy. Clin Exp Immunol 2010;159:344-350. https://doi.org/10.1111/j.1365-2249.2009.04062.x
  24. Rich AL, Le Jeune IR, McDermott L, Kinnear WJ. Serial lung function tests in primary immune deficiency. Clin Exp Immunol 2008;151:110-113. https://doi.org/10.1111/j.1365-2249.2007.03550.x
  25. Verma N, Grimbacher B, Hurst JR. Lung disease in primary antibody deficiency. Lancet Respir Med 2015;3:651-660. https://doi.org/10.1016/S2213-2600(15)00202-7
  26. Kaveri SV, Maddur MS, Hegde P, Lacroix-Desmazes S, Bayry J. Intravenous immunoglobulins in immunodeficiencies: more than mere replacement therapy. Clin Exp Immunol 2011;164:2-5. https://doi.org/10.1111/j.1365-2249.2011.04387.x
  27. Albin S, Cunningham-Rundles C. An update on the use of immunoglobulin for the treatment of immunodeficiency disorders. Immunotherapy 2014;6:1113-1126. https://doi.org/10.2217/imt.14.67
  28. Quinti I, Soresina A, Guerra A, et al. Effectiveness of immunoglobulin replacement therapy on clinical outcome in patients with primary antibody deficiencies: results from a multicenter prospective cohort study. J Clin Immunol 2011;31:315-322. https://doi.org/10.1007/s10875-011-9511-0

피인용 문헌

  1. Efficacy of immunoglobulin replacement therapy and azithromycin in severe asthma with antibody deficiency vol.69, pp.2, 2020, https://doi.org/10.1016/j.alit.2019.10.011