title: Staphylococcus aureus enterotoxin sensitization is associated with allergic poly-sensitization and allergic multimorbidity in adolescents.
abstract: BACKGROUND
  Staphylococcus aureus (S. aureus) carriage and sensitization to S. aureus enterotoxins (SEs) have been associated with allergic diseases. From the Tromsø Study Fit Futures 2, we have previously shown an association between S. aureus carriage and severe allergic disease and allergic multimorbidity. However, the role of S. aureus carriage and SE sensitization on allergic multimorbidity and allergic sensitization is unclear.
  
  
  OBJECTIVE
  To study associations of both nasal S. aureus carriage and SE sensitization to allergic disease and allergic sensitization.
  
  
  METHODS
  A cross-sectional study of a school-based cohort in late adolescence (aged 18-19 years: The Tromsø Study Fit Futures 2). Self-reported allergic diseases were assessed using the Mechanisms of the Development of ALLergy questionnaire (MeDALL). Participants were tested for nasal S. aureus carriage, serum total IgE and specific IgE to SEs, and food and inhalant allergens.
  
  
  RESULTS
  A total of 868 participants were studied. Sensitization to at least one food or inhalant allergen was found in 319 of 765 (41.7%), and to at least one SE in 173 of 656 (26.2%) participants. SE sensitization, but not S. aureus carriage, was associated with poly-sensitization to food and inhalant allergens. SE-sensitized participants had higher median specific IgE to inhalant allergens (41.4 kUA/L, IQR 10.1-118.4) compared to non-SE-sensitized participants (18.0 kUA/L, IQR 5.5-48.6, P=.004), but not to food allergens. SE sensitization was associated with allergic multimorbidity.
  
  
  CONCLUSIONS
  Sensitization to SEs may play a role in the development of allergen poly-sensitization and allergic multimorbidity.
authors.affiliation: Department of Paediatric and Adolescent medicine, University Hospital of North Norway, Tromsø, Norway.|Paediatric Research Group, Deptarment of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway.
authors.forename: M
authors.identifier: http://orcid.org/0000-0002-0581-4789
authors.initials: M
authors.lastname: Sørensen
authors.affiliation: Department of Paediatric and Adolescent medicine, University Hospital of North Norway, Tromsø, Norway.|Paediatric Research Group, Deptarment of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway.
authors.forename: C
authors.initials: C
authors.lastname: Klingenberg
authors.affiliation: Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.|Sachs Children's Hospital, Södersjukhuset, Stockholm, Sweden.
authors.forename: M
authors.initials: M
authors.lastname: Wickman
authors.affiliation: Research Group for Host-Microbe Interactions, Department of Medical Biology, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway.
authors.forename: J U E
authors.initials: JUE
authors.lastname: Sollid
authors.affiliation: Department of Microbiology and Infection Control, University Hospital of North Norway, Tromsø, Norway.|Epidemiology of Chronic Diseases Research Group, Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway.
authors.forename: A-S
authors.initials: AS
authors.lastname: Furberg
authors.affiliation: Upper Airways Research Laboratory, Department of Otorhinolaryngology and Head and Neck Surgery, Ghent University, Ghent, Belgium.
authors.forename: C
authors.identifier: http://orcid.org/0000-0003-4742-1665
authors.initials: C
authors.lastname: Bachert
authors.affiliation: Hospital Montpellier France, European Innovation Partnership on Active and Healthy Ageing Reference Site MACVIA-LR Contre les MAladies Chroniques pour un VIeillissement Actif en Languedoc-Roussillon, Paris, France.|VIMA: Ageing and Chronic Diseases, Epidemiological and Public Health Approaches, U1168 INSERM, Paris, France.|Université Versailles St-Quentin-en-Yvelines UVSQ, UMR-S 1168, Versailles, France.
authors.forename: J
authors.initials: J
authors.lastname: Bousquet
mesh_terms: D000293:Adolescent; D000367:Age Factors; D000485:Allergens / Q000276:immunology*; D000942:Antigens, Bacterial / Q000276:immunology*; D002353:Carrier State; D003429:Cross Reactions / Q000276:immunology*; D003430:Cross-Sectional Studies; D004768:Enterotoxins / Q000276:immunology*; D005260:Female; D006801:Humans; D006967:Hypersensitivity / Q000453:epidemiology* / Q000276:immunology*; D007114:Immunization; D007073:Immunoglobulin E / Q000097:blood / Q000276:immunology; D008297:Male; D000076322:Multimorbidity; D016017:Odds Ratio; D015995:Prevalence; D013211:Staphylococcus aureus / Q000276:immunology*
chemical_list: D000485:Allergens; D000942:Antigens, Bacterial; D004768:Enterotoxins; D007073:Immunoglobulin E
keywords: 
  Staphylococcus aureus
  ; Allergic disease; Allergic multimorbidity; Poly-sensitization; Staphylococcus aureus Enterotoxins