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The Complex Type 2 Endotype in Allergy and Asthma: From Laboratory to Bedside

  • Asthma (WJ Calhoun and S Peters, Section Editors)
  • Published:
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Abstract

Better management of allergic diseases needs a sharpened understanding of disease heterogeneity and mechanisms in relation to clinically significant outcomes. Phenotypes describing observable clinical and morphologic characteristics and unique responses to treatment have been developed; however, they do not relate to disease mechanisms. Recently, extended heterogeneous and disease-related metabolic, inflammatory, immunological, and remodeling pathways have been described, and reproducible patterns are defined as disease endotypes. An endotype might consist of several intricated mechanisms that cannot be clearly separated into “pure single molecular mechanism” thus being a “complex endotype.” The description of an endotype may rely on biomarkers, which can be the signature of a complex underlying pathway or a key molecule associated with or directly playing a role in a particular disease endotype. The Th2 type inflammation can be defined as a complex endotype in asthma and linked to mechanisms of disease development and response to treatment and to disease outcomes such as exacerbations and remodeling. The type 2 complex endotype in allergies and asthma includes innate lymphoid cells, T helper 2 cells, tissue eosinophilia, and IgE production. Currently, emerging endotype-driven strategies in asthma, particularly the development of biologicals that target a single molecular pathway, are being focused for solving individualized clinical problems on disease outcomes. Progress is also being made for endotyping rhinitis, chronic rhinosinusitis, and atopic dermatitis.

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Abbreviations

ADMA:

Asymmetric dimethylarginine

CLC:

Charcot-Leyden crystal protein

CPA3:

Carboxypeptidase A3

DNA-SE1L3:

Deoxyribonuclease I-like 3

DC:

Dendritic cells

Eos:

Eosinophils

FeNO:

Fractional exhaled NO

ICS:

Inhaled corticosteroids

ILC:

Innate lymphoid cells

l-Arg:

l-Arginine

NKT cells:

Natural killer T cells

PG:

Prostaglandin

SARP:

Severe Asthma Respiratory Program

Th:

T helper cell

TSLP:

Thymic stromal lymphopoietin

VOCs:

Volatile organic compounds

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Conflict of Interest

Ioana Agache, Kazunari Sugita, Hideaki Morita, Mübeccel Akdis, and Cezmi A. Akdis declare that they have no conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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Authors and Affiliations

  1. Department of Allergy and Clinical Immunology, Faculty of Medicine, Transylvania University of Brasov, Brasov, Romania

    Ioana Agache

  2. Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland

    Kazunari Sugita, Hideaki Morita, Mübeccel Akdis & Cezmi A. Akdis

  3. Christine Kühne – Center for Allergy Research and Education (CKCARE), Davos, Switzerland

    Kazunari Sugita, Hideaki Morita, Mübeccel Akdis & Cezmi A. Akdis

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  1. Ioana Agache
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  2. Kazunari Sugita
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  3. Hideaki Morita
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  4. Mübeccel Akdis
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  5. Cezmi A. Akdis
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Correspondence to Ioana Agache.

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This article is part of the Topical Collection on Asthma

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Agache, I., Sugita, K., Morita, H. et al. The Complex Type 2 Endotype in Allergy and Asthma: From Laboratory to Bedside. Curr Allergy Asthma Rep 15, 29 (2015). https://doi.org/10.1007/s11882-015-0529-x

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