Beyond atopy: multiple patterns of sensitization in relation to asthma in a birth cohort study.
BACKGROUND
The pattern of IgE response (over time or to specific allergens) may reflect different atopic vulnerabilities which are related to the presence of asthma in a fundamentally different way from current definition of atopy.


OBJECTIVE
To redefine the atopic phenotype by identifying latent structure within a complex dataset, taking into account the timing and type of sensitization to specific allergens, and relating these novel phenotypes to asthma.


METHODS
In a population-based birth cohort in which multiple skin and IgE tests have been taken throughout childhood, we used a machine learning approach to cluster children into multiple atopic classes in an unsupervised way. We then investigated the relation between these classes and asthma (symptoms, hospitalizations, lung function and airway reactivity).


RESULTS
A five-class model indicated a complex latent structure, in which children with atopic vulnerability were clustered into four distinct classes (Multiple Early [112/1053, 10.6%]; Multiple Late [171/1053, 16.2%]; Dust Mite [47/1053, 4.5%]; and Non-dust Mite [100/1053, 9.5%]), with a fifth class describing children with No Latent Vulnerability (623/1053, 59.2%). The association with asthma was considerably stronger for Multiple Early compared with other classes and conventionally defined atopy (odds ratio [95% CI]: 29.3 [11.1-77.2] versus 12.4 [4.8-32.2] versus 11.6 [4.8-27.9] for Multiple Early class versus Ever Atopic versus Atopic age 8). Lung function and airway reactivity were significantly poorer among children in Multiple Early class. Cox regression demonstrated a highly significant increase in risk of hospital admissions for wheeze/asthma after age 3 yr only among children in the Multiple Early class (HR 9.2 [3.5-24.0], P < 0.001).


CONCLUSIONS
IgE antibody responses do not reflect a single phenotype of atopy, but several different atopic vulnerabilities which differ in their relation with asthma presence and severity.
Simpson
Angela
A
The University of Manchester, Manchester Academic Health Science Centre, NIHR Translational Research Facility in Respiratory Medicine, University Hospital of South Manchester NHS Foundation Trust, Manchester, United Kingdom. angela.simpson@manchester.ac.uk
Tan
Vincent Y F
VY
Winn
John
J
Svensén
Markus
M
Bishop
Christopher M
CM
Heckerman
David E
DE
Buchan
Iain
I
Custovic
Adnan
A
D000818:Animals; D001249:Asthma / Q000145:classification* / Q000453:epidemiology / Q000276:immunology; D002648:Child; D016000:Cluster Analysis; D015331:Cohort Studies; D004198:Disease Susceptibility; D005260:Female; D006760:Hospitalization; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood; D008297:Male; D009035:Mothers; D015999:Multivariate Analysis; D010641:Phenotype; D010993:Plethysmography, Whole Body; D039981:Pyroglyphidae; D012129:Respiratory Function Tests; D012135:Respiratory Sounds; D012882:Skin Tests; D012907:Smoking / Q000453:epidemiology; D013147:Spirometry; D006113:United Kingdom / Q000453:epidemiology
D007073:Immunoglobulin E