Marcia Frellick

September 22, 2016

BARCELONA, Spain — Patients with common variable immunodeficiency (CVID) who also have asthma or allergic disease have higher rates of upper respiratory infection and bronchiectasis than those who do not, according to results from a study presented here at the European Society for Immunodeficiencies 2016 Biennial Meeting.

Patients with primary antibody deficiencies "should be routinely examined every 6 months by an expert immunologist for all complications of the disease, including asthma and allergy," Hassan Abolhassani, MD, PhD, from Karolinska University Hospital Huddinge in Stockholm, told Medscape Medical News.

Although many patients with CVID have a clinical history of allergic respiratory disease, the prevalence of asthma and the role of atopic diseases is not well understood.

For their study, Dr Abolhassani and his colleagues reviewed hospital records and immunologic findings for 112 males and 75 females with CVID.

In the study cohort of 187 patients, 22 (11.7%) had asthma or allergic disease and 165 (88.3%) did not. The most common manifestations were asthma (nine patients), atopic dermatitis (six patients), hives (five patients), and food allergy (five patients).

Upper respiratory infection was more common in the group with asthma or allergic disease than in the group without (8.3 vs 5.8; P =.0001), as was bronchiectasis (50% vs 40%; P = .0003).

At 15-year follow-up, the survival rate was lower in the group with asthma or allergic disease than in the group without (60.9% vs 79.1%).

Physicians should look for indications of asthma and allergic disease in the medical history and during physical examination, Dr Abolhassani said. A pulmonary function test or skin prick test and complementary laboratory tests can be conducted, if necessary.

Management should be adjusted if the presence of atopic complication has been proven.

"Management should be adjusted if the presence of atopic complication has been proven," he explained. This could include antihistamines, decongestants, inhaled corticosteroids, monoclonal antibody treatments, and even epinephrine injection.

In addition, patients with a current diagnosis of atopic disorder (such as asthma, hyper-reactive airway disease, hives, atopic dermatitis, allergic rhinitis, allergic conjunctivitis, food allergy, and drug allergy) should undergo at least one immunologic profile that includes complete immunoglobulin levels, not just immunoglobulin E, he advised.

Even in the advanced healthcare centers, immunoglobulin tests are often not included in the routine workup of those patients, he pointed out.

This study addresses the controversial issue of whether immunodeficiencies and allergies can coexist, said Ricardo Sorensen, MD, clinical professor of pediatrics at Children's Hospital in New Orleans.

"Many patients thought to have asthma actually have an immune deficiency," he said.

It is interesting that, in the CVID cohort, the substantial subgroup with asthma was also found to have more infections, Dr Sorensen told Medscape Medical News.

If the study findings are confirmed, there will be "larger implications," he said.

"Many patients are treated for asthma and are assumed to have allergy. The fact that they have an immune deficiency is often missed," he explained. If the patient is found to have immunodeficiency, that opens up lines of treatment other than those for the inflammation, he added.

Dr Abolhassani and Dr Sorenson have disclosed no relevant financial relationships.

European Society for Immunodeficiencies (ESID) 2016 Biennial Meeting: Poster 115 published September 21, 2016.


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