Staphylococcus aureus sensitization and allergic disease in early childhood: Population-based birth cohort study

Background

Staphylococcus aureus–secreted enterotoxins (SEs) may be involved in the pathophysiology of atopic diseases.

Objective

We investigated the role of SEs in allergic diseases during early childhood (using the mixture of SE-specific IgEs [SE-mix] as a marker).

Methods

Children (N = 510) were followed from birth to age 5 years (repeated questionnaires, IgE to inhalant and food allergens, lung function [spirometry, plethysmography], airway reactivity [dry air challenge]). We measured SE-mix specific IgE (SE-A, SE-C, toxic shock syndrome toxin 1) by using fluorescence immunoassay.

Results

We found no association between rhinitis and SE-mix sensitization. Children with eczema were more frequently SE-mix–sensitized than children without (17.4% vs 8.3%; P = .02). SE-mix sensitization rate increased significantly with increasing eczema severity (no eczema, mild, moderate/severe: 8.3%, 14.8%, 42.9%; P = .003) and remained independently associated with eczema in a multivariate model adjusting for total IgE (adjusted odds ratio, 2.19; 95% CI, 1.05-4.56; P = .04). SE-mix sensitization was associated with current wheeze in the univariate but not the multivariate model. Among wheeze phenotypes, persistent wheezers were most commonly sensitized to SE-mix (never, transient, late-onset, persistent: 8.5%, 3.8%, 7.7%, 17.6%; P = .05). Among wheezers, those SE-mix–sensitized had significantly higher airway reactivity compared with those nonsensitized (mean FEV₁ change, mL [95% CI]: −59 [−121, 3] vs 19 [−10.2, 48.9]; P = .04), with little difference after adjusting for atopy.

Conclusion

We found differences in SE-mix IgE antibodies between healthy 5-year-old children and children with eczema and wheeze. The proportion of patients sensitized to SE-mix increases with increasing disease severity.

Clinical implications

Staphylococcal enterotoxins are potential modifiers of childhood wheeze and eczema.

Key words: Staphylococcus aureus, superantigens, early life, wheeze, eczema

Abbreviations used: MAAS, Manchester Asthma and Allergy Study, SE, Staphylococcus aureus–secreted enterotoxin, SE-mix, Mixture of SE-specific IgEs, sR_aw, Specific airway resistance, TSST-1, Toxic shock syndrome toxin 1