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Allergy. 2015 Sep;70(9):1062-78. doi: 10.1111/all.12637. Epub 2015 Jul 14.

Are allergic multimorbidities and IgE polysensitization associated with the persistence or re-occurrence of foetal type 2 signalling? The MeDALL hypothesis.

Author information

1
University Hospital, Montpellier, France.
2
MACVIA-LR, Contre les MAladies Chroniques pour un VIeillissement Actif en Languedoc-Roussillon, European Innovation Partnership on Active and Healthy Ageing Reference Site, Paris, France.
3
INSERM, VIMA: Ageing and Chronic Diseases Epidemiological and Public Health Approaches, U1168, Paris, France.
4
UVSQ, UMR-S 1168, Université Versailles St-Quentin-en-Yvelines, Versailles, France.
5
Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain.
6
Hospital del Mar Research Institute (IMIM), Barcelona, Spain.
7
CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.
8
Department of Experimental and Health Sciences, University of Pompeu Fabra (UPF), Barcelona, Spain.
9
Sachs' Children's Hospital, Stockholm, Sweden.
10
Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
11
Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Berlin, Germany.
12
Institute for Clinical Epidemiology and Biometry, University of Wuerzburg, Wuerzburg, Germany.
13
Division of Immunopathology, Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria.
14
Skin and Allergy Hospital, Helsinki University Hospital, Helsinki, Finland.
15
Department of Paediatrics, Oslo University Hospital, Oslo, Norway.
16
Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
17
Clinical Immunology and Allergy Unit, Department of Medicine Solna, Karolinska Institutet and University Hospital, Stockholm, Sweden.
18
Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland.
19
ENT Department, Ghent University Hospital, Gent, Belgium.
20
European Institute for Systems Biology and Medicine, Lyon, France.
21
EPAR U707 INSERM, Paris, France.
22
EPAR UMR-S UPMC, Paris VI, Paris, France.
23
Department of Dermatology and Allergy Centre, Odense University Hospital, Odense, Denmark.
24
UMR Inserm U1027, Université de Toulouse III Paul Sabatier, Toulouse, France.
25
University of Oslo, Oslo, Norway.
26
Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Crete, Greece.
27
Department of Epidemiology, Regional Health Service Lazio Region, Rome, Italy.
28
Julius Center of Health Sciences and Primary Care, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands.
29
Institute of Epidemiology, German Research Centre for Environmental Health, Helmholtz Zentrum München, Neuherberg, Germany.
30
Department of Pediatric Pulmonology and Pediatric Allergology, GRIAC Research Institute, University Medical Center Groningen, Beatrix Children's Hospital, University of Groningen, Groningen, the Netherlands.
31
Department of Immunology, Rheumatology and Allergy, Medical University of Lodz, Lodz, Poland.
32
VIB Inflammation Research Center, Ghent University, Ghent, Belgium.
33
Biomay AG, Wien, Austria.
34
Department of Public Health and Biostatistics, EA 4064, Paris Descartes University, Paris, France.
35
Paris Municipal Department of Social Action, Childhood, and Health, Paris, France.
36
EFA European Federation of Allergy and Airways Diseases Patients' Associations, Brussels, Belgium.
37
Department of Respiratory Medicine, GRIAC Research Institute, University Medical Center Groningen, Beatrix Children's Hospital, University of Groningen, Groningen, the Netherlands.
38
Inserm, U823, Grenoble, France.
39
Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, UK.
40
Allergy-Centre-Charité at the Department of Dermatology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
41
Secretary General of the Global Allergy and Asthma European Network (GA2LEN), Berlin, Germany.
42
David Hide Asthma and Allergy Research Centre, Isle of Wight, UK.
43
Department of Epidemiology, CAPHRI School of Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands.
44
National Heart and Lung Institute, Imperial College London, Royal Brompton Hospital NHS, London, UK.
45
Department of Respiratory Diseases, Montpellier University Hospital, Montpellier, France.
46
Department of Medicine and Public Health, Alma Mater Studiorum - University of Bologna, Bologna, Italy.
47
Allergology Department, Centre de l'Asthme et des Allergies, Hôpital d'Enfants Armand-Trousseau (APHP), Paris, France.
48
Institut Pierre Louis d'Epidémiologie et de Santé Publique, Equipe EPAR, Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, Paris, France.
49
Department for Pediatric Pneumology and Immunology, Charité Medical University, Berlin, Germany.
50
Département de pédiatrie, CHU de Grenoble, Grenoble Cedex 9, France.
51
Area de Salut de Menorca, ib-salut, Illes Balears, Spain.

Abstract

Allergic diseases [asthma, rhinitis and atopic dermatitis (AD)] are complex. They are associated with allergen-specific IgE and nonallergic mechanisms that may coexist in the same patient. In addition, these diseases tend to cluster and patients present concomitant or consecutive diseases (multimorbidity). IgE sensitization should be considered as a quantitative trait. Important clinical and immunological differences exist between mono- and polysensitized subjects. Multimorbidities of allergic diseases share common causal mechanisms that are only partly IgE-mediated. Persistence of allergic diseases over time is associated with multimorbidity and/or IgE polysensitization. The importance of the family history of allergy may decrease with age. This review puts forward the hypothesis that allergic multimorbidities and IgE polysensitization are associated and related to the persistence or re-occurrence of foetal type 2 signalling. Asthma, rhinitis and AD are manifestations of a common systemic immune imbalance (mesodermal origin) with specific patterns of remodelling (ectodermal or endodermal origin). This study proposes a new classification of IgE-mediated allergic diseases that allows the definition of novel phenotypes to (i) better understand genetic and epigenetic mechanisms, (ii) better stratify allergic preschool children for prognosis and (iii) propose novel strategies of treatment and prevention.

KEYWORDS:

IgE; asthma; atopic dermatitis; polysensitization; rhinitis

PMID:
25913421
DOI:
10.1111/all.12637
[Indexed for MEDLINE]

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