SAT0177 CLINICAL AND EPIDEMIOLOGICAL RELEVANCE OF ALLERGY IN SYSTEMIC LUPUS ERYTHEMATOSUS: AN OBSERVATIONAL STUDY
Authors: Giuseppe Alvise Ramirez, Andrea Sorce, Francesca Cicero, Mona-Rita Yacoub, Valentina Canti, Giselda Colombo, Enrica Bozzolo, Lorenzo Dagna
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background:</h3> Altered innate and adaptive immune response is a hallmark of the pathogenesis of systemic lupus erythematosus (SLE). Autoimmune manifestations are a major cause of morbidity and damage accrual and constitute the main target of treatment in patients with SLE. Exposure to medications for purposes of immune suppression or treatment of complications might also synergise with an aberrant immune response and facilitate infections as well as hypersensitivity to non-harmful antigens. Epidemiological data about allergy in SLE are scanty. <h3>Objectives:</h3> To describe clinical and epidemiological features of allergy and asthma in SLE. <h3>Methods:</h3> One-hundred-thirty-five patients with SLE (classified according to the American College of Rheumatology, ACR, 1990 revised criteria) were enrolled. Retrospective data collection included autoimmune manifestations during the course of SLE and history of asthma. In addition, we recorded timing, clinical features, culprit(s) of the first three hypersensitivity reactions (HyR, together with concomitant infections, SLEDAI-2K and prednisone dose at time of each reaction. Damage accrual was quantitated by employing the SLE International Collaborating Clinics/ACR damage index (SDI). <h3>Results:</h3> A history of one or more HyR was found in 40.7% of patients. Immediate-type HyR were most significantly represented (83.6% of cases) and four cases were anaphylaxis (lifelong incidence rate of 67.04/105 persons-years). Respiratory allergy (allergic rhinitis or asthma) occurred in 19 patients (34.5%). Twenty-one out of 55 (38.3%) patients with allergy had ≥2 manifestations, five (9.1%) had ≥3 manifestations. Drugs were the most frequent culprits, accounting for 81.8% of HyR. Early-onset SLE (before the age of 21) associated with a higher risk of becoming allergic during SLE course compared with late-onset SLE (LR=8.01; p=0.005; HR=2.28, 95%CI=1.27-4.11). Patients with allergy onset after SLE (52.7% of cases) developed a second HyR more frequently and earlier (LR=11.49; p=0.001; HR=5.19, 95%CI=1.87-14.42). SLE with vasculitic manifestations also was a risk factor for developing HyR (LR=4.00; p=0.045; HR=2.13, 95%CI=1.00-4.55). Patients with allergy post-lupus had a SLEDAI-2K&gt;4 and a prednisone dose&gt;5mg/day in 51.7%, 41.7%, 50% of cases and in 37.9%, 50% and 50% of cases at first, second and third HyR respectively. Concomitant infections were detected in 20.7, 25% and 0% of cases respectively. Patients with ≥2 HyR had faster damage accrual compared to patients with ≤1 manifestations (median SDI/year=0.04, IQR=0.00-0.11 vs 0.00, IQR=0.00-0.06; p = 0.048). <h3>Conclusion:</h3> Patients with SLE have a high prevalence of allergy, which might contribute to its protean phenotype SLE deflects allergy incidence trajectories towards an increased risk. Allergy, in turn, associates with increased SLE activity, medication burden and infectious complications and might affect the risk of long-term damage accrual. <h3>References</h3> [1] Sequeira JF, et al., Lupus, 1993 [2] Hsiao YP, et al., Int. J. Environ. Res. Public Health2014 [3] Goldman JA, et al., Arthritis Rheum1976 [4] Pope J, et al. J Rheumatol, 2002 [5] Morton S, et al. Ann Rheum Dis, 1998 [6] Danza Aet al, Lupus, 2013 [7] Touma Z, et al., Curr Opin Rheumatol, 2013 [8] Sin E, et al., Autoimmun Reviews, 2016 [9] Wozniacka A, et al., Mediators Inflamm, 2003 <h3>Disclosure of Interests:</h3> None declared