Neutrophilic Steroid-Refractory Recurrent Wheeze and Eosinophilic Steroid-Refractory Asthma in Children

Tamazoust Guiddir (1, 2) , Philippe Saint-Pierre (3) , Elsa Purenne-Denis (1) , Nathalie Lambert (1, 2) , Yacine Laoudi (1) , Rémy Couderc (1) , Rahelé Gouvis-Echraghi (1) , Flore Amat (1, 2) , Jocelyne Just (1, 2)

1 CHU Trousseau [APHP]
2 UPMC - Université Pierre et Marie Curie - Paris 6
3 UT3 - Université Toulouse III - Paul Sabatier

Background Little is known about inflammatory pathways of severe recurrent wheeze in preschool children and severe asthma in children. Objectives The aim of the Severe Asthma Molecular Phenotype cohort was to characterize phenotypes of severe recurrent wheeze and severe asthma during childhood in terms of triggers (allergic or not), involved cells (eosinophil or neutrophil), and corticoid responsiveness. Methods Children with moderate-to-severe asthma and preschool children with moderate-to-severe recurrent wheeze were enrolled prospectively. They underwent standardized clinical and blood workup, and bronchoalveolar lavage (BAL) evaluation. Cluster analysis was applied to 350 children with 34 variables. Results Three clusters were identified: cluster 1, Neutrophilic steroid-refractory recurrent wheeze phenotype, with 138 children uncontrolled despite high-dose inhaled corticosteroids (ICS) (92%, P < .001), with more history of pneumonia (31%, P < .001), more gastroesophageal reflux disease (37%, P < .001), and the highest blood neutrophil count (mean 4.524 cells/mm3, P = .05); cluster 2, Severe recurrent wheeze with sensitization to a single aeroallergen (12%, P = .002), with 104 children controlled with high-dose ICS (63%, P < .001); cluster 3, Eosinophilic steroid-refractory asthma phenotype, with 108 children uncontrolled despite high-dose ICS (76%, P < .001) with more allergic rhinitis, atopic dermatitis, and food allergies (82%, 40%, 31%, P < .001, respectively). They also had a higher blood eosinophil count and a higher percentage of BAL eosinophil (506/mm3, 2.6%, P < .001 respectively). Conclusions Inflammation pathway of asthma and recurrent wheeze are related to eosinophil cells in older children and neutrophil cells in younger children. These results could improve personalized treatments.

Mots clés: Severe asthma; Severe recurrent wheeze phenotypes; Children; Bacterial infection; Gastroesophageal reflux; Multiple allergies

Domaines: Allergologie

Tamazoust Guiddir, Philippe Saint-Pierre, Elsa Purenne-Denis, Nathalie Lambert, Yacine Laoudi, et al.. Neutrophilic Steroid-Refractory Recurrent Wheeze and Eosinophilic Steroid-Refractory Asthma in Children. Journal of Allergy and Clinical Immunology: In Practice, 2017, ⟨10.1016/j.jaip.2017.02.003⟩. ⟨hal-01511148⟩