title: Staphylococcal enterotoxin IgE sensitization in late-onset severe eosinophilic asthma in the elderly.
abstract: BACKGROUND
  Asthma in the elderly (aged ≥ 65 years old) is a significant concern with high morbidity, but the pathophysiology remains unclear particularly in late-onset asthma. Recent studies suggest staphylococcal enterotoxin IgE (SE-IgE) sensitization to be a risk factor for asthma in general populations; however, the associations have not been examined in late-onset elderly asthma.
  
  
  OBJECTIVE
  We aimed to examine the associations of SE-IgE sensitization with late-onset asthma in the elderly, using a database of elderly asthma cohort study.
  
  
  METHODS
  A total of 249 elderly patients with asthma and 98 controls were analysed. At baseline, patients were assessed for demographics, atopy, induced sputum profiles and comorbidities including chronic rhinosinusitis (CRS). Serum total IgE and SE-IgE levels were measured. Asthma severity was assessed on the basis of asthma outcomes during a 12-month follow-up period.
  
  
  RESULTS
  At baseline, serum SE-IgE concentrations were significantly higher in patients with asthma than in controls [median 0.16 (interquartile range 0.04-0.53) vs. 0.10 (0.01-0.19), P < 0.001]. Elderly asthma patients with high SE-IgE levels had specific characteristics of having more severe asthma, sputum eosinophilia and CRS, compared to those with lower SE-IgE levels. In multivariate logistic regression analyses, the associations between serum SE-IgE concentrations and severe asthma were significant, independently of covariables [SE-IgE-high (≥ 0.35 kU/L) vs. negative (< 0.10 kU/L) group: odds ratio 7.47, 95% confidence interval 1.86-30.03, P = 0.005]. Multiple correspondence analyses also showed that high serum SE-IgE level had close relationships with severe asthma, CRS and sputum eosinophilia together.
  
  
  CONCLUSIONS
  This is the first report on the significant associations of SE-IgE sensitization with late-onset asthma in the elderly, particularly severe eosinophilic asthma with CRS comorbidity. Our findings indicate a potential implication of SE in the high morbidity burden of elderly asthma and suggest clues to the pathogenesis of severe late-onset eosinophilic asthma in the elderly.
authors.affiliation: Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: W-J
authors.identifier: http://orcid.org/0000-0002-4630-9922
authors.initials: WJ
authors.lastname: Song
authors.affiliation: Upper Airways Research Laboratory, Department of Otorhinolaryngology, Ghent University, Ghent, Belgium.
authors.forename: I
authors.initials: I
authors.lastname: Sintobin
authors.affiliation: Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: K-H
authors.initials: KH
authors.lastname: Sohn
authors.affiliation: Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: M-G
authors.initials: MG
authors.lastname: Kang
authors.affiliation: Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: H-K
authors.initials: HK
authors.lastname: Park
authors.affiliation: Department of Internal Medicine, Pusan National University School of Medicine, Pusan, Korea.
authors.forename: E-J
authors.initials: EJ
authors.lastname: Jo
authors.affiliation: Department of Internal Medicine, Pusan National University School of Medicine, Pusan, Korea.
authors.forename: S-E
authors.initials: SE
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.|Department of Internal Medicine, SMG-SNU Boramae Medical Center, Seoul, Korea.
authors.forename: M-S
authors.initials: MS
authors.lastname: Yang
authors.affiliation: Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.|Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: S-H
authors.initials: SH
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Pusan National University School of Medicine, Pusan, Korea.
authors.forename: H-K
authors.initials: HK
authors.lastname: Park
authors.affiliation: Department of Internal Medicine, Chosun University Medical School, Gwangju, Korea.
authors.forename: Y E
authors.initials: YE
authors.lastname: Kwon
authors.affiliation: Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: T-B
authors.initials: TB
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea.
authors.forename: S-H
authors.initials: SH
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: H-W
authors.initials: HW
authors.lastname: Park
authors.affiliation: Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.|Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: Y-S
authors.initials: YS
authors.lastname: Chang
authors.affiliation: Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: B-J
authors.initials: BJ
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, Dankook University College of Medicine, Cheonan, Korea.
authors.forename: Y-K
authors.initials: YK
authors.lastname: Jee
authors.affiliation: Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea.
authors.forename: B W
authors.initials: BW
authors.lastname: Choi
authors.affiliation: Upper Airways Research Laboratory, Department of Otorhinolaryngology, Ghent University, Ghent, Belgium.
authors.forename: C
authors.initials: C
authors.lastname: Bachert
authors.affiliation: Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: S-H
authors.initials: SH
authors.lastname: Cho
mesh_terms: D000328:Adult; D017668:Age of Onset; D000368:Aged; D000369:Aged, 80 and over; D000918:Antibody Specificity / Q000276:immunology; D001249:Asthma / Q000175:diagnosis / Q000276:immunology* / Q000473:pathology*; D016022:Case-Control Studies; D015331:Cohort Studies; D004768:Enterotoxins / Q000276:immunology*; D004804:Eosinophils / Q000276:immunology* / Q000473:pathology*; D005260:Female; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood / Q000276:immunology*; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D012129:Respiratory Function Tests; D012307:Risk Factors; D012720:Severity of Illness Index; D013211:Staphylococcus aureus / Q000276:immunology*
chemical_list: D004768:Enterotoxins; D007073:Immunoglobulin E
keywords: Staphylococcus aureus; aged; asthma; enterotoxins; eosinophils; immunoglobulin E; nasal polyps