Epidemiologic studies of worldwide increases in asthma have shown that the prevalence of wheezing varies markedly among countries ranging from 2% in Ecuador to 30% in New Zealand. Differences in allergen exposure and distinct immune responses to the allergens of dust mite and cat may explain some of these epidemiologic findings. It has recently been shown that high exposure to cat allergen compared with dust mite is associated with decreased prevalence of IgE antibody and decreased titers of IgE antibody that are not related to increased total IgE. Furthermore a high proportion of individuals living with a cat have immune tolerance consisting of IgG antibody to cat allergen without IgE antibody. Dramatic decreases in exposure to cat allergen can be associated with increased allergic symptoms upon re-exposure. This project combines three aims to characterize the mechanisms and immunological effects of cat tolerance. It is a plan to further evaluate a unique, successful cohort of students at the University of Virginia who have experienced a marked decrease in exposure to cat allergen by moving from a home with a cat to university housing. The first phase of the study relates serial questionnaires, percutaneous testing with allergen extracts, and serum antibody levels. The second part utilizes repeated measurements of systemic allergic inflammation as well as upper and lower airway inflammation.
The third aim focuses on T cell proliferative and functional responses to whole cat allergen and peptides during decreased exposure to cat allergen. This career development award will allow Dr. Erwin to answer an important clinical research question about changes in immune tolerance associated with decreased allergen exposure. Working with her experienced mentors and taking formal classes in epidemiology and biostatistics will provide her with the skills and foundation of knowledge necessary to complete these studies and impact the prevalence of allergic disease. Asthma is an increasingly common disease among children throughout the world but the cause is not understood. These studies will characterize immune responses that occur with natural changes in allergen exposure. The information gained will be used to decrease the prevalence of allergic disease in the future.

National Institute of Health (NIH)
National Institute of Allergy and Infectious Diseases (NIAID)
Mentored Patient-Oriented Research Career Development Award (K23)
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Allergy & Clinical Immunology-1 (AITC)
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Prograis, Lawrence J
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Nationwide Children's Hospital
United States
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Schuyler, Alexander J; Wilson, Jeffrey M; Tripathi, Anubha et al. (2018) Specific IgG4 antibodies to cow's milk proteins in pediatric patients with eosinophilic esophagitis. J Allergy Clin Immunol 142:139-148.e12
Erwin, Elizabeth A; Rhoda, Dale A; Redmond, Margaret et al. (2017) Using Serum IgE Antibodies to Predict Esophageal Eosinophilia in Children. J Pediatr Gastroenterol Nutr 65:520-525
Erwin, Elizabeth A; Kruszewski, Patrice G; Russo, John M et al. (2016) IgE antibodies and response to cow's milk elimination diet in pediatric eosinophilic esophagitis. J Allergy Clin Immunol 138:625-628.e2
Slack, Maria A; Ogbogu, Princess U; Phillips, Gary et al. (2015) Serum vitamin D levels in a cohort of adult and pediatric patients with eosinophilic esophagitis. Ann Allergy Asthma Immunol 115:45-50
Erwin, Elizabeth A; Tripathi, Anubha; Ogbogu, Princess U et al. (2015) IgE Antibody Detection and Component Analysis in Patients with Eosinophilic Esophagitis. J Allergy Clin Immunol Pract 3:896-904.e3
Erwin, Elizabeth A; Woodfolk, Judith A; James, Hayley R et al. (2014) Changes in cat specific IgE and IgG antibodies with decreased cat exposure. Ann Allergy Asthma Immunol 112:545-550.e1
Erwin, Elizabeth A; Asti, Lindsey; Hemming, Traci et al. (2012) A decade of hospital discharges related to eosinophilic esophagitis. J Pediatr Gastroenterol Nutr 54:427-9
Kelly, Libby A; Erwin, Elizabeth A; Platts-Mills, Thomas A E (2012) The indoor air and asthma: the role of cat allergens. Curr Opin Pulm Med 18:29-34
Erwin, Elizabeth A; Faust, Russell A; Platts-Mills, Thomas A E et al. (2011) Epidemiological analysis of chronic rhinitis in pediatric patients. Am J Rhinol Allergy 25:327-32
Erwin, Elizabeth A; James, Hayley R; Gutekunst, Heather M et al. (2010) Serum IgE measurement and detection of food allergy in pediatric patients with eosinophilic esophagitis. Ann Allergy Asthma Immunol 104:496-502

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