The Role Of Enterotoxins In Severe Asthma

Introduction-Aim: In severe asthma patients, specific IgE to Staphylococcal enterotoxins (se-IgE) can frequently be detected in serum. We aimed to determine whether the presence of se-IgE in patients with severe asthma is associated with aspects of a wide spectrum assessment of the disease. Methods: Enterotoxins were measured in serum samples. Demographics in details, Asthma control test (ACT), co-morbidities, % percentage of cells in induced sputum, blood eosinophils as % and absolute count (AC), spirometry, treatment regimes, cell populations in BAL and finally bronchial biopsies for measuring features of remodeling were the variables of assessment. Results: 29 patients with severe asthma all optimally treated and followed up by specialized clinics [age 51±12, 13 males, 11 ex-smokers, 14 on oral Cs as maintenance dose, 12 on biologics, 15 atopics] were recruited. Se-Ige were detected in 21 patients with the remaining 8 to be considered as the negative ones. Patients with positive enterotoxins had a higher percentage of nasal polyposis [50% vs 34%, p<0.001], lower blood eosinophils AC [median IR 140 (45,550) vs 190(70,520), p=0.032] and finally higher epithelium intact % [40±24% vs 26±18, p=0.021] and lower ASM % [median IR 8(5,15) vs 14(6,18),p=0.026. All the other variables were lacking statistical significance. Conclusions: This preliminary data supports that the presence of se-IgE in patients with severe asthma is associated with increased percentage of nasal polyposis, lower AC of blood eosinophils and may have a protective role in particular features of airway remodeling.