Asthmatics With Concordant Eosinophilic Disease Classified According To Their Serum Ige Status

Background. - Eosinophilic inflammation has long been associated with asthma. Looking at systemic and airway eosinophilia, we have recently identified a group of patients exhibiting diffuse eosinophilic inflammation. Among the mechanisms governing eosinophilic inflammation, IgE-mediated mast cell activation is a key event leading to eosinophilia in atopic asthmatics.Methods. - We conducted a retrospective study on our asthma clinic database containing more than 1500 patients and identified 205 asthmatics with successful sputum induction and concordant eosinophilic phenotype. This phenotype was defined as a sputum eosinophil count >= 3% and a blood eosinophils concentration >= 400 cells/mm(3). IgE-high atopic phenotype was characterized by the presence of at least one positive specific IgE (> 0.35 kU/L) to common aeroallergens and a raised total serum IgE (>= 113 kU/L).Results. - The largest group of asthmatics displaying concordant eosinophilic phenotype had a raised total serum IgE and atopy (45%). IgE-low non-atopic concordant eosinophilic asthma was a predominantly late onset disease, exhibited a more intense airway eosinophilic inflammation (P < 0.05), required more often maintenance treatment with oral corticosteroids (P < 0.05) but, surprisingly, had a reduced level of bronchial hyperresponsiveness to methacholine (P < 0.05) despite similar baseline airway calibre impairment.Conclusion. - The more severe airway eosinophilic inflammation in IgE-low non-atopic asthmatics despite similar treatment with ICS and a higher burden of OCS points to a certain corticosteroid resistance in this asthma phenotype.