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IgE-Mediated Systemic Anaphylaxis And Its Association With Gene Polymorphisms Of ACE, Angiotensinogen And Chymase

Authors Varney VA, Nicholas A, Warner A, Sumar N

Received 21 April 2019

Accepted for publication 5 September 2019

Published 8 October 2019 Volume 2019:12 Pages 343—361

DOI https://doi.org/10.2147/JAA.S213016

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Amy Norman

Peer reviewer comments 2

Editor who approved publication: Dr Amrita Dosanjh


VA Varney,1,2 A Nicholas,2 A Warner,2 N Sumar2

1Department of Medicine, St Helier Hospital, Carshalton, Surrey SM5 1AA, UK; 2Department of Allergy and Immunology, St Helier Hospital, Carshalton, Surrey SM5 1AA, UK

Correspondence: VA Varney
Department of Medicine, St Helier Hospital, Wrythe Lane, Carshalton, Surrey SM5 1AA, UK
Tel +44 20 8296 2401
Email veronica.varney@btinternet.com

Background: The renin-angiotensin system (RAS) protects the circulation against sudden falls in systemic blood pressure via generation of angiotensin II (AII). Previously, we demonstrated that patients with anaphylaxis involving airway angioedema and cardiovascular collapse (AACVS) had significantly increased “I” gene polymorphisms of the angiotensin-converting-enzymes (ACE). This is associated with lower serum ACE and AII levels and was not seen in anaphylaxis without collapse nor atopics and healthy controls.
Objectives: To examine the angiotensinogen (AGT-M235T) and chymase gene (CMA-1 A1903G) polymorphisms in these original subjects.
Method: 122 patients with IgE-mediated anaphylaxis, 119 healthy controls and 52 atopics had polymorphisms of the AGT gene and chymase gene examined by polymerase chain reactions and gel electrophoresis. Their previous ACE genotypes were included for the analysis.
Results: AGT-MM genes (associated with low AGT levels) were significantly increased in anaphylaxis (Terr’s classification). When combined with ACE, anaphylaxis showed increased MM/II gene pairing (p<0.0013) consistent with lower RAS activity. For chymase, there was increased pairing of MM/AG (p<0.005) and AG/II and AG/ID (p<0.0073) for anaphylaxis consistent with lower RAS activity. A tri-allelic ensemble of the 6 commonest gene combinations for the healthy controls and anaphylaxis confirmed this difference (p=0.0001); for anaphylaxis, genes were predominately MM/AG/II or ID, while healthy controls were DD/MT/AG or GG patterns.
Conclusion: Our gene polymorphisms show lower RAS activity for anaphylaxis especially AACVS. Animal models of anaphylaxis are focused on endothelial nitric oxide (eNO) which is shown to be the mediator of fatal shock and prevented by eNO-blockade. The interaction of AII and eNO controls the microcirculation in man. High serum AII levels reduce eNO activity, so higher RAS-activity could protect against shock. Our data shows low RAS activity in anaphylaxis especially AACVS, suggesting the influence of these genes on shock are via AII levels and its effects on eNO.

Keywords: IgE-mediated anaphylaxis, angiotensinogen M235T, chymase CMA1-1903, angioedema, ACE genotype, endothelial nitric oxide

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