Table of Contents
ISRN Rheumatology
Volume 2014, Article ID 843804, 5 pages
Research Article

Can HLA-DRB4 Help to Identify Asthmatic Patients at Risk of Churg-Strauss Syndrome?

1Allergy and Clinical Immunology Outpatients Clinic, Azienda Ospedaliera Legnano, Ospedale di Magenta, Via Donatore di Sangue 50, Magenta, 20013 Milan, Italy
2Immunohematology Unit, Azienda Ospedaliera Legnano, Ospedale di Magenta, Via Donatore di sangue 50, Magenta, 20013 Milan, Italy
3Hygienics and Public Health Unit, Azienda Sanitaria Locale Provincia Milano1, Via Spagliardi 19, Parabiago, 20014 Milan, Italy
4Clinical Immunology Unit and Renal Unit, Department of Medicine, Azienda Ospedaliera Ospedale San Carlo Borromeo, Via Pio Secondo 3, 20153 Milan, Italy

Received 20 November 2013; Accepted 3 February 2014; Published 6 March 2014

Academic Editors: M. G. Danieli, P. A. Gatenby, and G. Murdaca

Copyright © 2014 P. Bottero et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


HLA-DRB4 gene is associated with Churg-Strauss syndrome (CSS), a systemic eosinophilic vasculitis with a prodromal phase characterized by severe asthma, eosinophilia, nasal polyposis, and sinusitis. Aim of this study was to evaluate if the presence of HLA-DRB4 in asthmatic patients is associated with a clinical picture resembling that of the prodromal phase of CSS. HLA-DRB1 was determined in a cohort of 159 asthmatic patients and its frequency was compared with that of 1808 blood donors. HLA-DRB4 presence/absence was correlated with clinical features, including sinusitis, nasal polyposis, eosinophils, antiasthmatic drugs, asthma severity, and pulmonary function tests. HLA-DRB4 gene was associated with severe persistent asthma before treatment ( ), near fatal or severe hypoxemic asthma ( ), sinusitis ( ), nasal polyposis ( ), number of patients with eosinophils >1000/μl: ( ), need of beclomethasone >1000–2000 μg/daily ( ), use of a third controller ( ), and oral prednisone ( ). HLA-DRB4 gene is associated in asthmatic patients with a clinical picture characterized by asthma severity, sinusitis, nasal polyposis, and eosinophilia closely resembling that of the prodromal phase of CSS and might be useful to suspect corticosteroids-masked cases of CSS.