Staphylococcal enterotoxins may play a role in severe asthma

Determinants of severe refractory asthma (SRA) are not well characterized. Staphylococcus aureus enterotoxins with superantigenic activity have been associated with upper and lower airway inflammation.

The study included 109 patients with SRA and 101 patients with non-severe asthma, followed for 12 months.

A significant risk for severe asthma was associated with:

- female gender [Odds Ratio (OR)=2.04]
- history of wheezing in childhood (OR=2.47)
- presence of hypersensitivity to aspirin (OR=1.96)
- body mass index (OR=3.08)

The mean level of enterotoxin-specific IgE was 3-fold higher in patients with severe asthma when compared to patients with nonsevere asthma.

Serum-specific IgE to enterotoxins was significantly associated with low respiratory function parameters (FEV(1), FEV(1) /FVC and MEF 25/75) and increased airway reversibility in response to albuterol.

The presence of specific IgE to enterotoxin carried a risk for patients to have serum total IgE level above 100 kU/l (OR=7.84).

I wonder if treating the suspected staphylococcal skin colonization would make a difference in patients with severe asthma. For example, treatment with cephalexin followed by weekly bleach baths was beneficial in patients with atopic dermatitis. At baseline, S. aureus was cultured from 87% of skin and 81% of nares of patients (7% of skin bacteria and 4% of nares bacteria were methicillin resistant [MRSA]). S. aureus (enterotoxins), M sympodialis, and allergens are trigger factors of atopic dermatitis - they stimulate dendritic cells (JACI, 2012).


Kowalski ML, Cieślak M, Pérez-Novo CA, Makowska JS, Bachert C. Clinical and immunological determinants of severe/refractory asthma (SRA): association with Staphylococcal superantigen-specific IgE antibodies. Allergy 2010; DOI: 10.1111/j.1398-9995.2010.02379.x.
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