• Micheál Mac Aogáin, Pei Yee Tiew, Albert Yick Hou Lim, Teck Boon Low, Gan Liang Tan, Tidi Hassan, Thun How Ong, Sze Lei Pang, Zi Yang Lee, Xiao Wei Gwee, Christopher Martinus, Yang Yie Sio, Sri Anusha Matta, Tan Ching Ong, Yuen Seng Tiong, Kang Ning Wong, Sriram Narayanan, Au Veonice Bijin VB 8 Institute of Molecular and Cell Biology, A*STAR, Singapore., Damien Marlier, Holly R Keir, Augustine Tee, John Arputhan Abisheganaden, Mariko Siyue Koh, Wang De Yun Y 10 Department of Otolaryngology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore., John E Connolly, Fook Tim Chew, James D Chalmers, and Sanjay H Chotirmall.
• 1 Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.
• Am. J. Respir. Crit. Care Med. 2019 Apr 1; 199 (7): 842-853.

RationaleAllergic sensitization is associated with poor clinical outcomes in asthma, chronic obstructive pulmonary disease, and cystic fibrosis; however, its presence, frequency, and clinical significance in non-cystic fibrosis bronchiectasis remain unclear.ObjectivesTo determine the frequency and geographic variability that exists in a sensitization pattern to common and specific allergens, including house dust mite and fungi, and to correlate such patterns to airway immune-inflammatory status and clinical outcomes in bronchiectasis.MethodsPatients with bronchiectasis were recruited in Asia (Singapore and Malaysia) and the United Kingdom (Scotland) (n = 238), forming the Cohort of Asian and Matched European Bronchiectasis, which matched recruited patients on age, sex, and bronchiectasis severity. Specific IgE response against a range of common allergens was determined, combined with airway immune-inflammatory status and correlated to clinical outcomes. Clinically relevant patient clusters, based on sensitization pattern and airway immune profiles ("immunoallertypes"), were determined.Measurements And Main ResultsA high frequency of sensitization to multiple allergens was detected in bronchiectasis, exceeding that in a comparator cohort with allergic rhinitis (n = 149). Sensitization was associated with poor clinical outcomes, including decreased pulmonary function and more severe disease. "Sensitized bronchiectasis" was classified into two immunoallertypes: one fungal driven and proinflammatory, the other house dust mite driven and chemokine dominant, with the former demonstrating poorer clinical outcome.ConclusionsAllergic sensitization occurs at high frequency in patients with bronchiectasis recruited from different global centers. Improving endophenotyping of sensitized bronchiectasis, a clinically significant state, and a "treatable trait" permits therapeutic intervention in appropriate patients, and may allow improved stratification in future bronchiectasis research and clinical trials.

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