Immunological and epithelial barrier dysfunction in EGPA: the possible role of new biomarkers

Cristiano Caruso; Ilaria Baglivo; Stefania Colantuono; Maria Antonietta Zavarella; David Longhino; Chiara Laface; Laura Bruno; Gabriele Lucca; Fabio Romano Selvi; Eleonora Di Carluccio; Gabriele Ciasca; Umberto Basile; Benedetta Niccolini; Mario Rigante; Eugenio De Corso; Antonio Gasbarrini; Giovanni Battista Capoccetta; Paola Anselmi; Aikaterini Detoraki; Elisabetta Greco; Benedetta Bondi; Vincenzo Patella; Stefano Del Giacco

doi:10.37349/eaa.2026.1009127

Exploration of Asthma & Allergy ›› 2026, Vol. 4 ›› Issue (1) :1009127 DOI: 10.37349/eaa.2026.1009127

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Immunological and epithelial barrier dysfunction in EGPA: the possible role of new biomarkers

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¹ UOSD Allergologia e Immunologia Clinica, Dipartimento Scienze Mediche e Chirurgiche Addominali ed Endocrino Metaboliche, Fondazione Policlinico A. Gemelli, IRCCS, 00168 Rome, Italy

² UOSD DH Internal Medicine and Digestive Disease, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy

³ UOC CEMAD Centro Malattie dellʼApparato Digerente, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy

⁴ Scuola di Specializzazione in Allergologia e Immunologia Clinica Università Cattolica del Sacro Cuore, 00168 Roma, Italy

⁵ Cardio—CARE, Medizincampus Davos, 7265 Davos, Switzerland

⁶ Dipartimento di Neuroscienze, Sezione di Fisica, Università Cattolica del Sacro Cuore, 00168 Rome, Italy

⁷ Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy

⁸ Dipartimento di Patologia clinica, Ospedale Santa Maria Goretti, AUSL Latina, 04100 Latina, Italy

⁹ Unit of Otorhinolaryngology, “A. Gemelli” University Hospital Foundation IRCCS, 00168 Rome, Italy

¹⁰ Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, 00168 Rome, Italy

¹¹ Department of Medical and Surgical Sciences, UOC Gastroenterologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy

¹² UOC Pronto Soccorso, Medicina d’Urgenza e Medicina Interna, Ospedale Isola Tiberina Gemelli Isola, 00186 Rome, Italy

¹³ Department of Internal Medicine and Clinical Complexity, Azienda Ospedaliera Universitaria Federico II, 80131 Naples, Italy

¹⁴ UOC Reumatologia, Dipartimento di Medicina dei Sistemi, Università di Roma “Tor Vergata”, 00133 Roma, Italy

¹⁵ Allergy and Respiratory Diseases, IRCCS Policlinico San Martino, University of Genoa, 16132 Genova, Italy

¹⁶ Division of Allergy and Clinical Immunology, Department of Medicine, ʻSanta Maria della Speranzaʼ Hospital, 84061 Battipaglia, Salerno, Italy

¹⁷ Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy

^*Ilaria Baglivo, UOSD Allergologia e Immunologia Clinica, Dipartimento Scienze Mediche e Chirurgiche Addominali ed Endocrino Metaboliche, Fondazione Policlinico A. Gemelli, IRCCS, 00168 Rome, Italy.ilaria.baglivo@guest.policlinicogemelli.it

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Abstract

Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare systemic vasculitis with heterogeneous clinical manifestations. Identifying reliable biomarkers is crucial to predicting disease evolution and guiding therapy. We analyzed clinical, biological, and functional data from 33 patients with EGPA in the vasculitic phase. Blood eosinophil count (BEC), eosinophilic cationic protein (ECP), antineutrophil cytoplasmic antibodies (ANCAs), specific IgE to staphylococcal enterotoxins (SE-IgE), and serum free light chains (FLCs) were evaluated. Severe eosinophilic asthma (SEA) and chronic rhinosinusitis with nasal polyps (CRSwNPs) were present in 100% and 88.5% of patients, respectively. Median BEC was 1950 cells/mm³, with elevated ECP (60.0 µg/L). SE-IgE was detected in 54.2% of patients. A significant negative correlation emerged between λ FLCs and oral corticosteroid (OCS) dose ( r=–0.58, p=0.009). Forced expiratory volume in 1 second (FEV₁) was significantly lower in C-ANCA+ patients ( p=0.006). ECP and SE-IgE may serve as markers of eosinophilic activity and epithelial barrier damage in EGPA. λ FLCs might be a useful indicator of OCS exposure and treatment response. These biomarkers could support the evaluation of disease evolution and treatment response.

Keywords

EGPA / eosinophils / free light chains / eosinophilic cationic protein / anti-staphylococcal enterotoxins IgE

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Cristiano Caruso, Ilaria Baglivo, Stefania Colantuono, Maria Antonietta Zavarella, David Longhino, Chiara Laface, Laura Bruno, Gabriele Lucca, Fabio Romano Selvi, Eleonora Di Carluccio, Gabriele Ciasca, Umberto Basile, Benedetta Niccolini, Mario Rigante, Eugenio De Corso, Antonio Gasbarrini, Giovanni Battista Capoccetta, Paola Anselmi, Aikaterini Detoraki, Elisabetta Greco, Benedetta Bondi, Vincenzo Patella, Stefano Del Giacco. Immunological and epithelial barrier dysfunction in EGPA: the possible role of new biomarkers. Exploration of Asthma & Allergy, 2026, 4 (1) : 1009127 DOI:10.37349/eaa.2026.1009127

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