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Respir Med. 2016 Mar;112:39-44. doi: 10.1016/j.rmed.2016.01.014. Epub 2016 Jan 22.

What are the characteristics of asthma patients with elevated serum IgG4 levels?

Author information

1
CHRU Tours, Service de Pneumologie, F-37044 Tours, France.
2
CHRU Tours, Service de Pneumologie, F-37044 Tours, France; Université François Rabelais, UMR 1100, F-37032 Tours, France; INSERM, Centre d'Etude des Pathologies Respiratoires, UMR 1100/EA6305, F-37032 Tours, France.
3
CHRU Tours, Service de néphrologie, F-37044 Tours, France.
4
CHRU Tours, Service de Pneumologie, F-37044 Tours, France; Université François Rabelais, UMR 1100, F-37032 Tours, France; INSERM, Centre d'Etude des Pathologies Respiratoires, UMR 1100/EA6305, F-37032 Tours, France. Electronic address: laurent.guilleminault@univ-tours.fr.

Abstract

INTRODUCTION:

IgG4 has recently been a subject of great interest in human pathology. No data are available about the characteristics of asthma patients with elevated IgG4 levels.

POPULATION AND METHODS:

An observational study was conducted from January 2006 to March 2015 in a difficult-to-treat population of asthma patients. Twenty-six difficult-to-treat asthma patients with elevated serum IgG4 levels (IgG4/IgG ratio up to 10%) were compared with a control population of 98 difficult-to-treat asthma patients with normal serum IgG4. Blood eosinophilia, total IgE and FeNO were compared between groups to better characterize asthma patients with elevated serum IgG4 levels.

RESULTS:

Median IgG4 concentrations were 1.72 g/l [1.19-2.36] and 0.22 g/l [0.10-0.49] in the elevated IgG4 group and normal Ig4 group, respectively. Median blood eosinophilia was more than three times higher in patients with elevated serum IgG4 levels than in controls (0.75 10(9)/L [IQR 0.54-1.78] vs 0.22 10(9)/L [IQR 0.09-0.54] respectively, p < 0.0001). Total IgE was twice as high (264.5 kUI/l [IQR 166.3-779] vs 126 kUI/l [IQR 26-350] respectively; p < 0.05) and FeNO was nearly twice as high (61 [IQR 41-111] ppb vs 35 [IQR 23-51] ppb, p < 0.001). Allergic broncho-pulmonary aspergillosis (ABPA) and eosinophilic granulomatosis with polyangiitis (EGPA) were observed in the asthma patients with elevated serum IgG4. Ten patients had unexplained increased blood eosinophilia.

CONCLUSION:

Asthma patients with elevated IgG4 levels have significantly higher blood eosinophilia, total IgE and FeNO. ABPA and EGPA are observed in patients with elevated serum IgG4.

KEYWORDS:

Allergic broncho-pulmonary aspergillosis; Asthma; Eosinophilic granulomatosis with polyangiitis; IgG4

PMID:
26823212
DOI:
10.1016/j.rmed.2016.01.014
[Indexed for MEDLINE]
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