Staphylococcus Aureus Enterotoxin Sensitization Is Associated With Allergic Poly-sensitization and Allergic Multimorbidity in Adolescents

PURPOSE OF THE STUDY. In the authors’ previous study (Tromsø Study Fit Futures 2) an association was found between nasal Staphylococcus aureus carriage and allergic morbidity in adolescent patients. The authors sought to determine the relationship between S aureus enterotoxin (SE) sensitization with both allergic polysensitization and allergic disease. STUDY POPULATION. A total of 1208 high school students were invited to partake in the study, and 868 (71.9%) ultimately participated. Students had been previously recruited in 2010–2011 to the authors’ initial cohort and some had participated in the original study. METHODS. Participants initially completed a standardized, validated questionnaire (Mechanisms of the Development of Allergy) to assess for the presence of allergic disease. A nasal swab and culture were obtained to determine S aureus carriage. Total serum immunoglobulin E (IgE) and specific IgE to a panel of environmental inhalants, food allergens, and SEs were measured. Positive testing to allergens via the Phadia ImmunoCAP© system was defined as >0.35 kU/L and >0.1 kU/L for SEs. Various statistical analyses were performed including Pearson’s χ2 test for categorical variables and Student’s t test and Mann-Whitney U test for continuous variables. Multivariate logistic regression models were used to analyze associations between S aureus carriage and SE sensitization with allergic disease. Multinomial logistic regression models were used to compare S aureus carriage and SE sensitization with food and inhalant sensitizations. RESULTS. Among the 868 eligible participants, 844 (97.2%) answered the questionnaire and 825 (95.1%) underwent clinical examination. Nasal carriage of S aureus was found in 420 of 819 (51.3%) of participants, with sensitization to SE being less prevalent (26.2%). The association between SE sensitization, but not carriage, and polysensitization to inhalant and food allergens was statistically significant. Compared with patients who were not SE sensitized, individuals who were SE sensitized also had higher total IgE and median sum of specific IgE levels with inhalant allergens, but not with food allergens. SE sensitization was also significantly associated with allergic multimorbidity. CONCLUSIONS. Sensitization to SEs may have a role in both the development of polysensitization to allergens and allergic multimorbidity. REVIEWER COMMENTS. The authors in this study determined that SE sensitization is associated with severity of all