TY - JOUR T1 - Sensitisation to staphylococcal enterotoxins and asthma severity: a longitudinal study in the EGEA cohort JF - European Respiratory Journal JO - Eur Respir J DO - 10.1183/13993003.00198-2019 SP - 1900198 AU - Ina Sintobin AU - Valerie Siroux AU - Gabriële Holtappels AU - Christophe Pison AU - Rachel Nadif AU - Jean Bousquet AU - Claus Bachert Y1 - 2019/01/01 UR - http://erj.ersjournals.com/content/early/2019/06/04/13993003.00198-2019.abstract N2 - Introduction Evidence is accumulating that Staphylococcus aureus plays an important role as disease modifier in upper and lower airway diseases. Sensitisation to Staphylococcus aureus enterotoxins (SEs) was associated with an increased risk for severe asthma in previous cross-sectional studies, but evidences from longitudinal studies are lacking. We aimed to assess associations between SE-sensitisation and the subsequent risk for asthma severity and exacerbations.Methods This is a nested case-control study from the 20-year Epidemiological study on the Genetics and Environment of Asthma-EGEA cohort, including 225 adults (75 without asthma, 76 with mild and 75 with severe asthma) in EGEA2 (2003–2007). For 173 of these individuals, SE-sensitisation was measured on samples collected 11 years earlier (EGEA1). Cross-sectional associations were conducted for EGEA1 and EGEA2. Longitudinal analyses estimated the association between SE-sensitisation in EGEA1 and the risk of severe asthma and asthma exacerbations assessed in the follow-up. Models were adjusted on gender, age, smoking, parental asthma/allergy and skin prick test to house dust mite.Results SE-sensitisation varied between 39% in controls to 58% and 76% in mild and severe asthma in EGEA1. An adjusted cross-sectional association showed that SE-sensitisation was associated with an increased risk for severe, but not for mild asthma. SE-sensitisation in EGEA1 was associated with severe asthma (adjusted-OR 2.69, 95% CI [1.18–6.15]) and asthma exacerbations (adjusted-OR 4.59, 95% CI [1.40–15.07]) assessed 10–20 years later.Conclusion For the first time, this study shows that being sensitised to SEs is associated with an increased subsequent risk of severe asthma and asthma exacerbations.FootnotesThis manuscript has recently been accepted for publication in the European Respiratory Journal. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article.Conflict of interest: Dr. SIROUX reports personal fees from AstraZeneca, outside the submitted work.Conflict of interest: Dr. Holtappels has nothing to disclose.Conflict of interest: Dr. Pison reports non-financial support from GSK France, AZ France, Boerhinger Ingelheim and Novartis, outside the submitted work.Dr. Pison reports non-financial support from GSK France, non-financial support from AZ France, non-financial support from Boerhinger Ingelheim, non-financial support from Novartis, outside the submitted work.Conflict of interest: Dr. NADIF has nothing to disclose.Conflict of interest: Dr. Bachert has nothing to disclose.Conflict of interest: Dr. BOUSQUET reports personal fees and other from Chiesi, Cipla, Hikma, Menarini, Mundipharma, Mylan, Novartis, Sanofi-Aventis, Takeda, Teva, Uriach, other from KYomed-INNOV, outside the submitted work.Conflict of interest: Dr. Sintobin has nothing to disclose. ER -