Original Article
  

Influence of Sensitization Patterns on Fractional Exhaled Nitric Oxide in Asthmatic Children

Abstract

Fractional exhaled nitric oxide (FeNO) has been suggested as a non-invasive biomarker of airway inflammation, which is increased in atopic subjects. Whether sensitization to particular allergens is a predictive factor for increased FeNO levels is not yet fully understood. We conducted a retrospective cross-sectional study. From October to December in 2015, the medical documents of 127 mild, steroid-naive asthmatic children and 34 healthy age-matched children were enrolled in this study. The results of the FeNO measurements, skin prick test, and the spirometry were collected for analysis. Sensitization patterns to the 18 aeroallergens (5 categories: mites, molds, animal dander, pollen, and other) were determined in study population. A significant increase in FeNO level was observed in poly-sensitized asthmatic children (34.7 part per billion, (ppb) [28.3-41.1 p.p.b]), compared with mono-sensitized asthmatics (30.7 p.p.b [18.3-43.2 p.p.b]) and with non-sensitized asthmatics (17.3 p.p.b [10.8-24.5 p.p.b]). With sensitization to perennial allergens (mites, mold, and animal dander), blood eosinophil counts were significantly associated with increased FeNO (p<0.05 for all). The highest FeNO level was identified in children sensitized to a combination of the perennial, seasonal, and other allergens, when compared with those sensitized to one category of allergen alone (p=0.004). Our study showed that variations in FeNO level were associated with individuals’ sensitization patterns. Being sensitized to some particular allergens might contribute to prompt the airway inflammation. 

1. Lambrecht BN, Hammad H: The immunology of asthma.Nat Immunol 2015; 16(1):45-56.

2. Reddel HK, Bateman ED, Becker A, Boulet LP, Cruz AA, Drazen JM, et al. A summary of the new GINA strategy: a roadmap to asthma control. EurRespir J. 2015;46(3):622-39.

3. Boulet LP, FitzGerald JM, Reddel HK. The revised 2014 GINA strategy report: opportunities for change. CurrOpinPulm Med 2015; 21(1):1-7.

4. Gordon IO, Husain AN, Charbeneau J, Krishnan JA Hogarth DK. Endobronchial biopsy: a guide for asthma therapy selection in the era of bronchial thermoplasty. J Asthma. 2013; 50(6):634-41.

5. Leung TF, Ko FW, Wong GW. Recent advances in asthma biomarker research. TherAdvRespir Dis 2013; 7(5):297-308.

6. Ko FW, Leung TF, Wong GW, Chu JH, Sy HY, Hui DS.Determinants of, and reference equation for, exhaled nitric oxide in the Chinese population.EurRespir J 2013;42(3):767-75.

7. Warke TJ, Fitch PS, Brown V, Taylor R, Lyons JD, Ennis M, et al. Exhaled nitric oxide correlates with airway eosinophils in childhood asthma. Thorax 2002;57(5):383-7.

8. Lu M, Wu B, Che D, Qiao R, Gu H. FeNO and asthma treatment in children: a systematic review and meta- analysis. Medicine (Baltimore) 2015; 94(4):e347.

9. Lazic N, Roberts G,Custovic A, Belgrave D, Bishop CM, Winn J, et al. Multiple atopy phenotypes and their associations with asthma: similar findings from two birth cohorts. Allergy 2013; 68(6):764-70.

10. Simpson A1, Tan VY, Winn J, Svensén M, Bishop CM, Heckerman DE, et al. Beyond atopy: multiple patterns of Influence of Sensitization Patterns on FeNO in Asthmatic Children sensitization in relation to asthma in a birth cohort study. Am J RespirCrit Care Med 2010; 181(11):1200-6.

11 Li J, Sun B, Huang Y, Lin X, Zhao D, Tan G, et al.

Alliance of Research on Respiratory Allergic Disease. A multicentre study assessing the prevalence of sensitizations in patients with asthma and/or rhinitis in China. Allergy 2009; 64(7):1083-92.

12. Leuppi JD, Downs SH, Downie SR, Marks GB, Salome CM. Exhaled nitric oxide levels in atopic children: relation to specific allergic sensitisation, AHR, and respiratory symptoms. Thorax 2002; 57(6):518-23.

13. American Thoracic Society; European Respiratory Society.

ATS/ERS recommendations for standardized procedures for the online and offline measurement of exhaled lower respiratory nitric oxide and nasal nitric oxide 2005. Am J RespirCrit Care Med 2005; 171(8):912-30.

14. Jang WN, Park IS, Choi CH, Bauer S, Harmin S, Seo SC, et al. Relationships between exhaled nitric oxide and atopy profiles in children with asthma. Allergy Asthma Immunol Res 2013; 5(3):155-61.

15. Yamamoto M, Tochino Y, Chibana K, Trudeau JB, Holguin F, Wenzel SE. Nitric oxide and related enzymes in asthma: relation to severity, enzyme function and inflammation. ClinExp Allergy 2012; 42(5):760-8.

16. Roos AB, Mori M, Grönneberg R, Österlund C, Claesson HE, Wahlström J, et al. Elevated exhaled nitric oxide in allergen-provoked asthma is associated with airway epithelial iNOS. PLoS One 2014; 9(2):e90018.

17. Bommarito L, Migliore E, Bugiani M, Heffler E, Guida G, Bucca C, et al. Exhaled nitric oxide in a population sample of adults. Respiration 2008; 75(4):386-92.

18. Thomas PS, Gibson PG, Wang H, Shah S, Henry RL. The relationship of exhaled nitric oxide to airway

inflammation and responsiveness in children. J Asthma2005; 42(4):291-95.

19. Lee YK, Yang S, Park J, Kim H, Hahn YS. House dust mite-specific immunoglobulin E and longitudinal exhaled nitric oxide measurements in children with atopic asthma. Korean J Pediatr 2015; 58(3):89-95.

20. Chinn S, Burney P, Sunyer J, Jarvis D, Luczynska C. Sensitization to individual allergens and bronchial responsiveness in the ECRHS. European Community Respiratory Health Survey.EurRespir J 1999; 14(4):876-84.

21. Yao TC, Tsai HJ, Tu YL, Chang SW, Hua MC, Liao SL, et al. Multiplexed immunoglobulin E sensitization in relation to exhaled nitric oxide in a population sample of children. Allergy 2014; 69(5):678-82.

22. Ekroos H, Rouhos A, Pallasaho P, Karjalainen J, Sarna S,Sovijärvi AR. Equally elevated concentrations of exhaled nitric oxide in nonatopic and low-sensitized atopic asthmatics. Respir Med 2009;103(1):152-8.

23. Barreto M, Villa MP, Martella S, Ronchetti F, Darder MT, Falasca C, et al. Exhaled nitric oxide in asthmatic and non-asthmatic children: influence of type of allergen sensitization and exposure to tobacco smoke. Pediatr Allergy Immunol 2001; 12(5):247-56.

24. Patelis A, Gunnbjörnsdottir M, Malinovschi A, Matsson P, Onell A, Högman M, et al. Population-based study of multiplexed IgE sensitization in relation to asthma, exhaled nitric oxide, and bronchial responsiveness. J Allergy ClinImmunol 2012; 130(2):397-402.

25. Spanier AJ, Hornung RW, Kahn RS, Lierl MB, Lanphear BP. Seasonal variation and environmental predictors of exhaled nitric oxide in children with asthma. Pediatr Pulmonol 2008; 43(6):576-83.

Files
IssueVol 16, No 1 (2017) QRcode
SectionOriginal Article(s)
Keywords
Asthma Atopy Exhaled nitric oxide Perennial allergens Sensitization patterns Skin prick test
Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
Qing M, Wei X, Zhen L, Hui G, Xiao-Ying L, Hui-Jie H, Yan W, Yi-Xin R, Yong-Ge L, Li X. Influence of Sensitization Patterns on Fractional Exhaled Nitric Oxide in Asthmatic Children. Iran J Allergy Asthma Immunol. 2017;16(1):53-59.