Relevance of Allergy in Adult Asthma
Recent studies on asthma have demonstrated multiple phenotypes, based on the clinical characteristics of the disease. With the current interest in personalized medicine, the question arises whether the presence of allergic sensitization has any relevance for these phenotypes and the management of asthma. This review will examine the current knowledge of asthma phenotypes and the impact of atopy on asthma diagnosis and severity in adults. In addition, this review will address whether therapies targeted at the atopic axis help improve asthma outcomes, including lung function indices and exacerbations.
KeywordsAsthma, Allergy Adult asthma Atopy Phenotype Asthma control Airway inflammation One airway hypothesis
Compliance with Ethics Guidelines
Conflict of Interest
Sameer K. Mathur has served as a consultant for TEVA, has received grant support from the National Institutes of Health, and served as vice president of the Wisconsin Allergy Society and chair of the AAAAI Asthma and Allergic Diseases in the Elderly Committee.
Ravi K. Viswanathan declares that he has no conflict 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.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 2.•Moore WC, Meyers DA, Wenzel SE, Teague WG, Li HS, Li XN, et al. Identification of asthma phenotypes using cluster analysis in the severe asthma research program. Am J Respir Crit Care Med. 2010;181(4):315–23. This article is the first to describe phenotypes of asthma derived using statistical methods that allowed the clinical features of patients to designate “clusters” of patients. PubMedCentralPubMedCrossRefGoogle Scholar
- 3.Schatz M, Hsu JW, Zeiger RS, Chen W, Dorenbaum A, Chipps BE, et al. Phenotypes determined by cluster analysis in severe or difficult-to-treat asthma. J Allergy Clin Immunol. 2013. doi: 10.1016/j.jaci.2013.10.006.
- 8.Ponte EV, Souza-Machado A, Souza-Machado C, Franco R, Cruz AA. Atopy is not associated with poor control of asthma. J Asthma Off J Assoc Care Asthma. 2012;49(10):1021–6.Google Scholar
- 13.•Simpson A, Tan VY, Winn J, Svensen M, Bishop CM, Heckerman DE, et al. Beyond atopy: multiple patterns of sensitization in relation to asthma in a birth cohort study. Am J Respir Crit Care Med. 2010;181(11):1200–6. This article provides evidence for a novel concept that patterns of allergic sensitization may have implications for risk of asthma development. PubMedCrossRefGoogle Scholar
- 19.Yarnell JW, Stevenson MR, MacMahon J, Shields M, McCrum EE, Patterson CC, et al. Smoking, atopy and certain furry pets are major determinants of respiratory symptoms in children: the International Study of Asthma and Allergies in Childhood Study (Ireland). Clin Exp Allergy J Br Soc Allergy Clin Immunol. 2003;33(1):96–100.CrossRefGoogle Scholar
- 24.Busse PJ, Cohn RD, Salo PM, Zeldin DC. Characteristics of allergic sensitization among asthmatic adults older than 55 years: results from the National Health and Nutrition Examination Survey, 2005–2006. Ann Allergy Asthma Immunol Off Publ Am Coll Allergy Asthma Immunol. 2013;110(4):247–52.CrossRefGoogle Scholar
- 30.••Abramson MJ, Puy RM, Weiner JM. Injection allergen immunotherapy for asthma. Cochrane Database Syst Rev. 2010;(8):CD001186. doi: 10.1002/14651858.CD001186.pub2. This review article evaluates all the studies examining the use of SCIT in the treatment of asthma.
- 31.••Lin SY, Erekosima N, Kim JM, Ramanathan M, Suarez-Cuervo C, Chelladurai Y, et al. Sublingual immunotherapy for the treatment of allergic rhinoconjunctivitis and asthma: a systematic review. JAMA. 2013;309(12):1278–88. This review article evaluates all the studies examining the use of SLIT in the treatment of asthma. PubMedCrossRefGoogle Scholar
- 37.Humbert M, Durham SR, Ying S, Kimmitt P, Barkans J, Assoufi B, et al. IL-4 and IL-5 mRNA and protein in bronchial biopsies from patients with atopic and nonatopic asthma: evidence against “intrinsic” asthma being a distinct immunopathologic entity. Am J Respir Crit Care Med. 1996;154(5):1497–504.PubMedCrossRefGoogle Scholar
- 38.Ying S, Humbert M, Barkans J, Corrigan CJ, Pfister R, Menz G, et al. Expression of IL-4 and IL-5 mRNA and protein product by CD4+ and CD8+ T cells, eosinophils, and mast cells in bronchial biopsies obtained from atopic and nonatopic (intrinsic) asthmatics. J Immunol. 1997;158(7):3539–44.PubMedGoogle Scholar
- 41.•Garcia G, Magnan A, Chiron R, Contin-Bordes C, Berger P, Taille C, et al. A proof-of-concept, randomized, controlled trial of omalizumab in patients with severe, difficult-to-control, nonatopic asthma. Chest. 2013;144(2):411–9. This article provides clinical evidence that the treatment of traditional allergic inflammatory pathways with omalizumab can also benefit patients without allergic sensitivity. PubMedCrossRefGoogle Scholar