Associations of Four sensitization patterns revealed by Latent Class Analysis with Clinical symptoms: A multi-center study of China

Xiangqing Hou; Wenting Luo; Liting Wu; Yuemin Chen; Guoping Li; Rongfang Zhang; Hong Zhang; Jing Wu; Yun Sun; Lina Xu; Peiru Xu; Yongmei Yu; Dongming Huang; Chuangli Hao; Baoqing Sun

doi:10.1016/j.eclinm.2022.101349

Associations of Four sensitization patterns revealed by Latent Class Analysis with Clinical symptoms: A multi-center study of China

EClinicalMedicine. 2022 Mar 21:46:101349. doi: 10.1016/j.eclinm.2022.101349. eCollection 2022 Apr.

Authors

Xiangqing Hou¹, Wenting Luo², Liting Wu², Yuemin Chen², Guoping Li³, Rongfang Zhang⁴, Hong Zhang⁵, Jing Wu⁶, Yun Sun⁷, Lina Xu⁸, Peiru Xu⁹, Yongmei Yu¹⁰, Dongming Huang¹¹, Chuangli Hao⁸, Baoqing Sun²

Affiliations

¹ Faculty of Health Sciences, University of Macau 999078, Macau, China.
² Department of Allergy and Clinical Immunology, State Key Laboratory of Respiratory Disease, National Clinical Research Center of Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou 510120, Guangdong, China.
³ Department of Pulmonary and Critical Care Medicine, Laboratory of Allergy and Precision Medicine, Chengdu Institute of Respiratory Health, the Third People's Hospital of Chengdu, Branch of National Clinical, 610000, Chengdu, China.
⁴ Department of Pediatrics, Gansu Provincial Maternity and Child Care Hospital 730400, Gansu, China.
⁵ Department of Pediatrics, Gansu Provincial Hospital 730400, Gansu, China.
⁶ Department of Allergy and Clinical Immunology, Inner Mongolia Cancer Hospital 021000, Inner Mongolia, China.
⁷ Department of Pediatrics, Yinchuan Maternal and Child Health Care Hospital 750001, Yinchuan, China.
⁸ Department of Respirology, Children's Hospital, Soochow University 215025, Suzhou, China.
⁹ Department of Pediatrics, First Affiliated Hospital of Xinjiang Medical University 830000, China.
¹⁰ Department of Pediatrics, First Affiliated Hospital of Kunming Medical University 650000, Kunming, China.
¹¹ Department of Pediatrics, Bo'ai Hospital of Zhongshan City 511462, Zhongshan, China.

Abstract

Background: Because of the significant regional differences in the distribution of allergens, the relationship between anaphylaxis and allergic sensitization is complex in China. Using this large-scale epidemiologic survey, we explore the potential patterns of sensitization to common allergens in mainland China and investigate their relationship with various clinical symptoms.

Method: The participants were recruited from 13 medical centers in mainland China from October 2019 to June 2021. Skin prick test (SPT) results that cover 18 common allergens were utilized to diagnose atopic sensitization. The demographic characteristics and clinical information were collected through questionnaires during routine medical follow-up. Latent class analysis (LCA) was conducted to determine the optimal sensitization patterns. The logistic regression was used to assess the associations of different sensitization patterns with allergy symptoms.

Findings: A total of 1089 patients who had a positive SPT to at least one of 18 allergens were included for formal analysis. An optimal LCA model with 4 classes was obtained in this study, and the corresponding labels were as follows: Class1, house dust mite sensitization; Class2, low pollen sensitization; Class3, middle pollen sensitization; Class4, high pollen sensitization. The prevalence of different classes varied widely in geographical distribution, which was characterized by Class1 being very common in south and east as well as Class2 in north and west of China. Compared with patients in Class1, those in middle and high pollen sensitization clusters had the higher odds ratios (ORs) of allergic rhinitis and allergic conjunctivitis when controlling for other confounders. However, there was no significant difference between low pollen sensitization and house dust mite sensitization groups in the risks for various clinical performances except dermatitis. Additionally, the adjusted ORs (95% confidence interval) of allergic conjunctivitis and dermatitis for participants in pollen sensitization clusters (Class2, 3 and 4) were 1.56 (1.18, 2.06) and 1.43 (1.09, 1.88) respectively compared with those in Class1.

Interpretation: In this study, we identified four sensitization clusters with specific risks of various clinical symptoms using common allergens by adopting LCA. Our findings may contribute to improved diagnosis and potential immunotherapy approaches to allergy in mainland China.

Funding: This study was supported by the National Natural Science Foundation of China (81802076 and 81871736), the Guangzhou Science and Technology Foundation (202102010327), the Foundation of SKLRD (MS-2019-06 and Z-2022-09), and the Foundation of GYYY (ZH201904) and ZNSA-2020012.

Keywords: 95% CI, 95% confidence interval; AIC, Akaike Information Criterion; AR, allergic rhinitis; AS, asthma; BIC, Bayesian Information Criterion; CAIC, the “consistent AIC”; CRD, component-resolved diagnosis; IgE, Immunoglobulin E; LCA, latent class analysis; SPT, skin prick test; SSA-BIC, the adjusted BIC using Rissanen's sample size adjustment; clinical symptoms; latent class analysis; sIgE, specific IgE; sensitization patterns; skin prick test.