الفهرس 
Introduction
Respiratory allergic diseasesOnly 14 pages are availabe for public view
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Abstract
The increasing prevalence of food allergy is a growing clinical and public health problem. Food allergy is
frequently underestimated among asthmatic population.
Phenotyping of allergic diseases in order to understand disease mechanisms, prognosis and optimize management has been the focus of attention in the previous decade.
Phenotyping by the presence or absence of atopy has been proposed. Little is known about the relation between a certain causative food substance and clinical phenotypes of allergy. So in our study we aimed to phenotype respiratory allergic diseases according to food allergens detected.
General data of the study population:
1- 189 patients with adult onset asthmaand/or were enrolled in the study. Main age was 34.28 year (±10.16). The majority were females (67.7%). The mean BMI was 26.32(±2.73).
Only 40.2% showed positive family history to asthma and/or other atopic disease and only 9% had past history of
any other medical disorder. The mean FEV1 for study population was 91% (±8.54%).
2- The main presenting symptoms for asthma patients were cough (56.1%), dyspnea (40.7%), wheezes (37%), SOB
(22.8%), expectoration (15.9%). While in patients with allergic rhinitis the main presenting symptoms were nasal obstruction (38.1%), nasal itching (30.2%), rhinorrea (18%), sneezing (16.9%), postnasal discharge (6.3%), nasal intonation(4.8%).
3- (92.1%) of patients reported that inhalants triggered their symptoms. This included dust exposure (74.1%), passive smoking (40.7%), exercise (30.7%), cold air(22.8%)
petsand domestic animals exposure (10.1%).
4- 2.6% reported that use of NSAIDs worsen their symptoms and (13.8%) patients had GERD symptoms at the time of inclusion in the study.
5- The control of the disease was assessed according to CARAT (Control Allergic Rhinitis Asthma Test). The patients achieving ≥24 is considered well controlled. The mean difference of study population was 23.96 (±4.7). The severity of the disease was evaluated according to the degree of health care utilization (unscheduled doctor visits,
ER visits , number of hospitalizations) mean 0.98 (±1.4) 6- The frequency of food allergens tested by SPT was milk (23.8%),fish andshrimps (20.6%) ,eggs(19.6%) , nuts (18%), banana (17.5%) ,salonecae (16.4%) ,wheat (13.2%) , coca (10.6%), and mugworts (7.4%).
Subphenotypes of study population:
1- Cluster 1: (Older overweight females, ↓FEV1, strong family history of atopy and sputum eosinophilia, sensitivity to NSAIDs ). It consisted of 32 patients (16.9%). This group was predominantly females (65.6%) slightly overweight BMI (26.4 ± 2.85). The main age of this group was (49.28 ± 5.39)and 53% of them had positive family history of atopic diseases .FEV1 was around (88% ± 8.9) Their sputum induction showed predominantly eosinophils 3.2% (±0.67).This cluster showed good control of their symptoms CARAT mean of (24.1 ± 1 ) with no seasonal variation in (62.5%). Their symptoms had a longer duration (12.59 ± 6.73) in comparison to other clusters.
2- Cluster 2: (Overweight females, ↓FEV1 , less sputum eosinophils ,high health care utilization, associated GERD
symptoms, fluctuating symptoms with hormonal changes).
This cluster included 78 patients (41.3%). This cluster also was predominantly females (67.9%) with the main age of (35.82 ± 4.12). This group was slightly overweight BMI (26.7± 2.98)
with positive FH of atopic diseases (41%). The FEV1 mean of this group was (89% ± 9.55). 15.1% of females recorded worsening of their symptoms during mensis and19.2% of this cluster reported having GERD symptoms which however both did not show statistical significant.This cluster was the highest
in health care utilization this showed a statistical significant (p value 0.008) and in addition to low eosinophils (1.44 %± 0.51) found in their induced sputum. This group also showed moderate disease control compared to other clusters (23.5 ± 5.7) but this was statistically non significant. 3- Cluster 3: (Younger females, high normal Body weight, normal FEV1, good asthma control ,least health utilization ,normal sputum). This cluster included 77 patients (40.7%), also was predominantly females (70.1%). The mean age of this group was younger than the 2 previous groups (25.54 ± 3). This group had a high normal BMI (25.9 ± 2.3) and less incidence of FH of atopy (35%). The FEV1 mean of this group was better than the 2 previous groups (94% ±6.1) (p value 0.0001). This group had the best disease control according to CARAT mean of (24.38 ±3.8) although it was not statistically significant (P value 0.685). and the least utilization of health services (0.6 ± 1.01) compared to the previous 2 clusters (P value 0.008). Their sputum showed no signs of inflammation, eosinphils represented (0.69% ±0.4)
4- Cluster 4 : (elderly male with long history allergic rhinitis and milk allergy ,normal lung functions ,moderate disease control). This was a very small cluster consisted of only 2 patients representing (1.1%) of whole patient sample.
This 2 patient had a very advanced age (74± 3.5%), both were males with average normal BMI (23.8 ± 7.2). Both had allergic rhinitis for very long duration (30 ± 0) , both had excellent FEV1 (97% ± 7.1) and both had no family history of atopic diseases. Both patients has moderate disease control CARAT mean is 23, no use of health care services.
Phenotypes according to food allergen:
Our study failed to establish especial clinical characteristics for each food allergen tested. In each cluster all
food allergens tested were represented but in variable percentages.
In addition all patients had similar presenting symptoms [for asthma patients are cough (56.1%), dyspnea (40.7%), wheezes (37%) and for allergic rhinitis the main presenting symptoms are nasal obstruction (38.1%), nasal itching (30.2%), rhinorrea (18%)]. There were no differences between clusters regarding presenting symptoms.