title: Can HLA-DRB4 Help to Identify Asthmatic Patients at Risk of Churg-Strauss Syndrome?
abstract: HLA-DRB4 gene is associated with Churg-Strauss syndrome (CSS), a systemic eosinophilic vasculitis with a prodromal phase characterized by severe asthma, eosinophilia, nasal polyposis, and sinusitis. Aim of this study was to evaluate if the presence of HLA-DRB4 in asthmatic patients is associated with a clinical picture resembling that of the prodromal phase of CSS. HLA-DRB1 was determined in a cohort of 159 asthmatic patients and its frequency was compared with that of 1808 blood donors. HLA-DRB4 presence/absence was correlated with clinical features, including sinusitis, nasal polyposis, eosinophils, antiasthmatic drugs, asthma severity, and pulmonary function tests. HLA-DRB4 gene was associated with severe persistent asthma before treatment (P < 0.02), near fatal or severe hypoxemic asthma (P < 0.01), sinusitis (P < 0.01), nasal polyposis (P < 0.01), number of patients with eosinophils >1000/ μ l: (P < 0.05), need of beclomethasone >1000-2000  μ g/daily (P < 0.001), use of a third controller (P < 0.05), and oral prednisone (P < 0.02). HLA-DRB4 gene is associated in asthmatic patients with a clinical picture characterized by asthma severity, sinusitis, nasal polyposis, and eosinophilia closely resembling that of the prodromal phase of CSS and might be useful to suspect corticosteroids-masked cases of CSS.
authors.affiliation: Allergy and Clinical Immunology Outpatients Clinic, Azienda Ospedaliera Legnano, Ospedale di Magenta, Via Donatore di Sangue 50, Magenta, 20013 Milan, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Bottero
authors.affiliation: Immunohematology Unit, Azienda Ospedaliera Legnano, Ospedale di Magenta, Via Donatore di sangue 50, Magenta, 20013 Milan, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Motta
authors.affiliation: Hygienics and Public Health Unit, Azienda Sanitaria Locale Provincia Milano1, Via Spagliardi 19, Parabiago, 20014 Milan, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Bonini
authors.affiliation: Allergy and Clinical Immunology Outpatients Clinic, Azienda Ospedaliera Legnano, Ospedale di Magenta, Via Donatore di Sangue 50, Magenta, 20013 Milan, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Vecchio
authors.affiliation: Immunohematology Unit, Azienda Ospedaliera Legnano, Ospedale di Magenta, Via Donatore di sangue 50, Magenta, 20013 Milan, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Ierna
authors.affiliation: Immunohematology Unit, Azienda Ospedaliera Legnano, Ospedale di Magenta, Via Donatore di sangue 50, Magenta, 20013 Milan, Italy.
authors.forename: I
authors.initials: I
authors.lastname: Cuppari
authors.affiliation: Clinical Immunology Unit and Renal Unit, Department of Medicine, Azienda Ospedaliera Ospedale San Carlo Borromeo, Via Pio Secondo 3, 20153 Milan, Italy.
authors.forename: R A
authors.initials: RA
authors.lastname: Sinico
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