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Abstract Number: 1783

Salivary Gland Disease in IgG4-Related Disease Is Associated with Allergic Histories

Samantha Sanders1, Emanuel Della Torre2, Cory A. Perugino3, Aidan Long4, Hyon K. Choi4, John H. Stone5 and Zachary Wallace6, 1Harvard Medical School, Boston, MA, 2Unit of Medicine and Clinical Immunology, San Raffaele Scientific Institute, Milan, Italy, 3Ragon Institute of MGH, MIT and Harvard, Cambridge, MA, 4Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, MA, 5Rheumatology (Medicine), Massachusetts General Hospital, Harvard Medical School, Boston, MA, 6Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, MA

Meeting: 2018 ACR/ARHP Annual Meeting

Keywords: IgG4 Related Disease

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Session Information

Date: Monday, October 22, 2018

Title: Vasculitis Poster II: Behҫet’s Disease and IgG4-Related Disease

Session Type: ACR Poster Session B

Session Time: 9:00AM-11:00AM

Background/Purpose: The etiology of IgG4-related disease (IgG4-RD) remains unknown. The role of T-helper type 2 (Th2) cells in the pathogenesis of IgG4-RD is controversial. Given Th2 cells’ involvement in allergic responses and prior IgG4-RD studies suggesting their importance in the pathogenesis, it has been hypothesized that allergic mechanisms contribute to the development of IgG4-RD. We investigated the association between allergies and IgG4-RD.

Methods: The Center for IgG4-RD at Massachusetts General Hospital maintains a database of all IgG4-RD patients, including details of demographics and disease history. Allergy histories were obtained from patients via a 34-question allergist-developed survey administered at their baseline visit. Patients were considered to have a history of allergies if they reported prior symptoms or diagnosis. We included all patients who completed the allergy survey; for certain analyses, some patients were excluded because of missing data. Statistical significance was determined by Fisher’s exact test or unpaired t-test, as appropriate. P values < 0.05 were considered significant.

Results: Our study included 185 IgG4-RD patients from a database of 289 patients. Of the 185 patients, 140 (76%) reported any allergic symptom or diagnosis (Table 1). There was no significant difference with regard to age (P=0.1) or sex distribution (P=0.7) between patients with and without allergy symptoms. Skin allergies (41%), food allergies (20%), and anaphylaxis (8%) were less common than respiratory allergies (61%) in IgG4-RD. Patients with allergies tended to have any ear, nose, and throat (ENT) manifestations of IgG4-RD more often than those who did not have allergies (55% vs 36%, P=0.058). This trend was largely driven by a significant difference in the proportion of patients with salivary gland IgG4-RD (e.g., sialoadenitis) among those with allergies compared with those without a history of allergies (41% vs 22%, P=0.03). We found a similar difference when comparing salivary gland involvement between those with and without respiratory allergies (72% vs 28%, P=0.039).

Conclusion: In a large IgG4-RD cohort, we found a significant association between IgG4-related salivary gland disease and allergic histories. More generally, we found a trend towards an association between ENT involvement and allergic histories. Of the reported allergies, respiratory allergies were most common. Respiratory allergies appear more prevalent in this cohort than the general US population: 61% of cohort patients reported a history of respiratory allergies, compared to 30% of Americans who completed a similar survey (Allergy Asthma Proc 2008; 29:600). While it is possible that shared pathogenesis is responsible for these observations, a shared upper respiratory exposure may also explain our observations given the associations between head and neck disease with allergic histories.

Table 1: Characteristics of IgG4-RD relative to history of allergies

All

History of any allergies*

No history of allergies

P-value

N

185 (100%)

140 (76%)

45 (24%)

Age (yrs)

Age at first visit, mean ± SD

57.2 (±14.7)

56.8 (±15.0)

58.7 (±13.5)

0.096

Age distribution

<20

5 (3%)

5 (4%)

0 (0%)

20-29

4 (2%)

3 (2%)

1 (2%)

30-39

11 (6%)

7 (5%)

4 (8%)

40-49

28 (15%)

22 (16%)

6 (13%)

50-59

43 (23%)

33 (24%)

10 (22%)

60-69

59 (32%)

44 (31%)

15 (33%)

70-79

30 (16%)

23 (16%)

7 (16%)

80-89

5 (2%)

3 (2%)

2 (4%)

Sex

Male sex

114 (62%)

85 (61%)

29 (64%)

0.726

Allergy Specificity

History of air allergies

112 (61%)

112 (61%)

—

History of food allergies

37 (20%)

37 (20%)

—

History of skin reactions^

76 (41%)

76 (41%)

—

History of anaphylaxis

15 (8%)

15 (8%)

—

Select Organ/system involvement

Total ENT organ involvement†

94 (51%)

77 (55%)

17 (38%)

0.058

Orbits, lacrimal glands

41 (22%)

34 (24%)

7 (16%)

0.381

Salivary glands

67 (36%)

57 (41%)

10 (22%)

0.03

Other ENT

22 (12%)

18 (13%)

4 (9%)

0.784

Lymph nodes

54 (29%)

38 (27%)

16 (36%)

0.219

Lungs

26 (14%)

20 (14%)

6 (13%)

1.000

Aorta

12 (6%)

8 (6%)

4 (9%)

0.474

Retroperitoneum

23 (12%)

17 (12%)

6 (13%)

0.788

Pancreas

46 (25%)

37 (26%)

9 (20%)

0.530

Bile duct

20 (11%)

13 (9%)

7 (16%)

0.251

Kidney

23 (12%)

20 (14%)

3 (7%)

0.284

* Includes air allergies, food allergies, skin reactions, and anaphylaxis

† Includes orbits, lacrimal glands, salivary glands, and/or other ENT manifestations

^ Includes atopic dermatitis, urticaria


Disclosure: S. Sanders, None; E. Della Torre, None; C. A. Perugino, None; A. Long, None; H. K. Choi, Takeda, Selecta, Kowa, and Horizon, 5,Selecta and Horizon, 2; J. H. Stone, Roche, 2,Roche, 5; Z. Wallace, None.

To cite this abstract in AMA style:

Sanders S, Della Torre E, Perugino CA, Long A, Choi HK, Stone JH, Wallace Z. Salivary Gland Disease in IgG4-Related Disease Is Associated with Allergic Histories [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/salivary-gland-disease-in-igg4-related-disease-is-associated-with-allergic-histories/. Accessed .
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