Asthma Severity, Exacerbations Increase With RV Infection


Immunological and quantitative mRNA assays support a pathogenesis role for histamine-releasing factor (HRF), its interaction with HRF-reactive immunoglobulin (Ig)–E and rhinovirus (RV) in asthma severity and exacerbation.


  • Clinical data for healthy controls (HCs) were compared with data from patients with asthma for three distinct cohorts recruited from programs located in Pittsburg, Boston, and Virginia

  • Cohorts differed primarily by total number of participants, median age, description of asthma severity, RV status, and longitudinal follow-up.

  • Enzyme-linked immunoassay tests quantified for comparisons total IgE, IgGs, and IgG1 levels occurring in human sera samples and for HRF-reactive IgE, IgG1, and IgG2b in sera from mice inoculated with mouse cytomegalovirus.

  • Anti-IgE stimulation experiments characterized bronchoalveolar lavage (BAL) cell supernatants for tryptase and PGD2 by ELISA and the mRNAs for tryptase and FCER1A

  • Effect of inoculated RV infections and/or house dust mite allergen on stimulating HRF secretion from respiratory epithelial cells and in vitro–grown lung BEAS-2B cells was evaluated by Western blots.


  • HRF-reactive IgE and total IgE levels in serum were significantly higher from patients with severe asthma than from HCs and showed a rising trend as severity increased.

  • HRF-reactive IgGs and IgG1 levels in serum levels of were lower in people with asthma than in HCs.

  • People with asthma with high HRF-reactive IgE compared with those with low levels tended to release more tryptase prostaglandin D2 with anti-IgE stimulation of BAL cells.

  • RV infection induced HFR secretions from both in vivo– and in vitro–grown respiratory epithelial cells and was associated with higher levels of HRF-IgE at the time of asthma exacerbations compared with after resolution.


Inhibiting HRF and HRF-reactive IgE interactions “can be a preventative/therapeutic target” for severe and RV-induced exacerbated asthma conditions.


The study led by Yu Kawakami, MD, of La Jolla Institute for Allergy & Immunology, California, and colleagues was published in the June 2023 issue of the Journal of Allergy and Clinical Immunology.


Small sample sizes, large median age differences between cohorts and lack of data for other demographic traits and variant asthma phenotypes or endotypes in some cohorts are noted limitations that may affect result extrapolations and conclusions.


The authors report there are no conflicts of interest directly related to this study.

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