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Large‐scale provocation studies identify maladaptive responses to ubiquitous aeroallergens as a correlate of severe allergic rhinoconjunctivitis and asthma
Author(s) -
Smith Alisha M.,
Ramirez Robert M.,
Harper Nathan,
Jimenez Fabio,
Branum Anne P.,
Meunier Justin A.,
Pandranki Lavanya,
Carrillo Andrew,
Winter Caitlyn,
Winter Lauryn,
Rather Cynthia G.,
Ramirez Daniel A.,
Andrews Charles P.,
Restrepo Marcos I.,
Maselli Diego J.,
Pugh Jacqueline A.,
Clark Robert A.,
Lee Grace C.,
Moreira Alvaro G.,
Manoharan Muthu Saravanan,
Okulicz Jason F.,
Jacobs Robert L.,
Ahuja Sunil K.
Publication year - 2022
Publication title -
allergy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.363
H-Index - 173
eISSN - 1398-9995
pISSN - 0105-4538
DOI - 10.1111/all.15124
Subject(s) - aeroallergen , maladaptation , medicine , provocation test , immunology , asthma , house dust mite , allergy , rhinovirus , airborne allergen , allergen , pathology , psychiatry , alternative medicine , virus
Abstract Background Allergic asthma (AA) and allergic rhinoconjunctivitis (ARC) are common comorbid environmentally triggered diseases. We hypothesized that severe AA/ARC reflects a maladaptive or unrestrained response to ubiquitous aeroallergens. Methods We performed provocation studies wherein six separate cohorts of persons (total n  = 217) with ARC, with or without AA, were challenged once or more with fixed concentrations of seasonal or perennial aeroallergens in an aeroallergen challenge chamber (ACC). Results Aeroallergen challenges elicited fully or partially restrained vs. unrestrained evoked symptom responsiveness, corresponding to the resilient and adaptive vs. maladaptive AA/ARC phenotypes, respectively. The maladaptive phenotype was evoked more commonly during challenge with a non‐endemic versus endemic seasonal aeroallergen. In an AA cohort, symptom responses evoked after house dust mite (HDM) challenges vs. recorded in the natural environment were more accurate and precise predictors of asthma severity and control, lung function (FEV1), and mechanistic correlates of maladaptation. Correlates included elevated levels of peripheral blood CD4+ and CD8+ T‐cells, eosinophils, and T‐cell activation, as well as gene expression proxies for ineffectual epithelial injury/repair responses. Evoked symptom severity after HDM challenge appeared to be more closely related to levels of CD4+ and CD8+ T‐cells than eosinophils, neutrophils, or HDM‐specific IgE. Conclusions Provocation studies support the concept that resilience, adaptation, and maladaptation to environmental disease triggers calibrate AA/ARC severity. Despite the ubiquity of aeroallergens, in response to these disease triggers in controlled settings (ie, ACC), most atopic persons manifest the resilient or adaptive phenotype. Thus, ARC/AA disease progression may reflect the failure to preserve the resilient or adaptive phenotype. The triangulation of CD8+ T‐cell activation, airway epithelial injury/repair processes and maladaptation in mediating AA disease severity needs more investigation.

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