The studies proposed in this grant are designed to provide new understanding of the role of both indoor allergen exposure and IgE antibodies specific for these proteins in relation to the prevalence and severity of asthma. Our recent investigation of a novel form of anaphylaxis identified IgE antibodies specific for the oligosaccharide galactose-?-1,3-galactose (alpha-gal) that are induced by tick bites. Those responses are common in the southeastern United States and are associated with delayed anaphylaxis following 3-4 hours after consumption of red meat. In keeping with that, the experiments proposed here take advantage of the fact that there are two allergens (alpha-gal and peanut) where sensitization appears to have become more common and which i) give rise to high titer IgE antibodies, ii) are thought to induce IgE antibodies by going through the skin, and iii) are not associated with asthma. Our central hypothesis is that IgE antibodies to protein antigens are an important contributor to asthma if they are chronically inhaled, and also that higher titers of these IgE antibodies increase that risk. The proposed experiments address several aspects of the problem from: I. Studies in developing or "pre-hygiene" regions, designed to understand why children in those countries do not have either high titer IgE antibodies to inhalant allergens or allergic asthma. These studies will include a comparison of home environments, allergic sensitization, clinical symptoms, and stool microbiome in Ecuador, Costa Rica, and Virginia. II. Studies within a Western "post-hygiene" environment focused on the evidence that different routes of exposure influence IgE antibody responses. These studies will investigate the effects of allergens on the skin in inducing Th2-related responses, with or without disruption of the skin barrier. The studies will also address the question whether changes in the skin due to excessive cleaning of infants could have contributed to the increase in IgE antibodies. III. We will use two different approaches to investigate the relevance of high titer IgE antibodies to understanding acute exacerbations of asthma. Those studies will first study children presenting with acute exacerbations to the hospital emergency room, and second, carry out RV challenges on adult subjects with asthma, using a new RV-16 pool. These studies will focus on the mechanisms by which Rhinovirus acts to cause exacerbation of allergic asthma. Taken together, the experiments proposed here have the potential to: i) explain the effects of high titer on prevalence and severity of asthma, ii) identify targets for treatment designed to reduce the severity of disease and the risk of exacerbations, and iii) provide information about why allergic diseases are continuing to increase in prevalence.

Public Health Relevance

Immediate hypersensitivity to common inhaled allergens is strongly associated with asthma in western countries. This form of sensitization can be quantified by measurement of serum IgE antibodies and recent evidence has shown that the risk of asthma is directly related to the titer of these antibodies. Identifying the factors that influence high titer IgE antibodies to different allergens with help, to identify children who are t risk, to explain how route of exposure influences IgE production, and to understand the mechanism by which high titers of IgE antibodies are related to acute exacerbations.

National Institute of Health (NIH)
Research Project (R01)
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Hypersensitivity, Autoimmune, and Immune-mediated Diseases Study Section (HAI)
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Minnicozzi, Michael
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University of Virginia
Internal Medicine/Medicine
Schools of Medicine
United States
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Commins, Scott P; James, Hayley R; Stevens, Whitney et al. (2014) Delayed clinical and ex vivo response to mammalian meat in patients with IgE to galactose-alpha-1,3-galactose. J Allergy Clin Immunol 134:108-15
Kennedy, Joshua L; Shaker, Marcus; McMeen, Victoria et al. (2014) Comparison of viral load in individuals with and without asthma during infections with rhinovirus. Am J Respir Crit Care Med 189:532-9
Mozzicato, Susan M; Tripathi, Anubha; Posthumus, Jonathon B et al. (2014) Porcine or bovine valve replacement in 3 patients with IgE antibodies to the mammalian oligosaccharide galactose-alpha-1,3-galactose. J Allergy Clin Immunol Pract 2:637-8
Agrawal, R; Wisniewski, J; Yu, M D et al. (2014) Infection with human rhinovirus 16 promotes enhanced IgE responsiveness in basophils of atopic asthmatics. Clin Exp Allergy 44:1266-73
Tripathi, Anubha; Commins, Scott P; Heymann, Peter W et al. (2014) Delayed anaphylaxis to red meat masquerading as idiopathic anaphylaxis. J Allergy Clin Immunol Pract 2:259-65
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Berg, Emily A; Platts-Mills, Thomas A E; Commins, Scott P (2014) Drug allergens and food--the cetuximab and galactose-?-1,3-galactose story. Ann Allergy Asthma Immunol 112:97-101
Commins, Scott P; Platts-Mills, Thomas A E (2013) Delayed anaphylaxis to red meat in patients with IgE specific for galactose alpha-1,3-galactose (alpha-gal). Curr Allergy Asthma Rep 13:72-7
Shim, Yun M; Burnette, Autumn; Lucas, Sean et al. (2013) Physical deconditioning as a cause of breathlessness among obese adolescents with a diagnosis of asthma. PLoS One 8:e61022
Posthumus, Jonathon; James, Hayley R; Lane, Charles J et al. (2013) Initial description of pork-cat syndrome in the United States. J Allergy Clin Immunol 131:923-5

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