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Allergy. 2019 Apr 6. doi: 10.1111/all.13806. [Epub ahead of print]

Towards clinically applicable biomarkers for asthma - An EAACI position paper.

Author information

1
Dept of Respiratory Medicine & Allergology, Institute for Clinical Science, Skane University Hospital, Lund, Sweden.
2
Dept of Clinical Pharmacy & Pharmacology, UMCG and QPS-NL, Groningen, The Netherlands.
3
Dept of Respiratory Medicine, First Faculty of Medicine, Charles University and Thomayer Hospital, Prague, Czech Republic.
4
Dept. of Respiratory Medicine, Amsterdam, UMC, University of Amsterdam, Amsterdam, The Netherlands.
5
Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
6
Department of Pediatrics, Division of Pediatric Allergy and Asthma, Gazi University School of Medicine, Ankara, Turkey.
7
Section of Paediatrics, Department of Medicine, Imperial College London, London, United Kingdom.
8
Experimental Asthma and Allergy Research, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
9
7th Respiratory Medicine Department and Asthma Centre, Athens Chest Hospital, Athens, Greece.
10
Section of Allergology, dept. Internal Medicine, Erasmus Medical Center, Rotterdam, the Netherlands.
11
Department of Medical Sciences and Public Health, University of Cagliari, Italy.
12
Children's Center, Protestant Hospital Bethel, Bielefeld; and Allergy Center, Ruhr University, Bochum, Germany.
13
Belfast City Hospital, Regional Respiratory Centre, Belfast, United Kingdom of Great Britain and Northern Ireland.
14
Department of Biomedical Sciences - Humanitas University, Milan, Italy.
15
Personalized Medicine, Asthma and Allergy - Humanitas Research Hospital, Milan, Italy.
16
Division of Pediatric Allergy, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
17
Respiratory Medicine Department, University of Ioannina Medical School, Ioannina, Greece.
18
Section of Occupational and Environmental Medicine, Sahlgrenska Academy, University of Gothenburg.
19
Institute of Technology, University of Tartu, Tartu, Estonia.
20
Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences Centre, University of Manchester and University Hospital of South Manchester NHS Foundation Trust, Manchester, United Kingdom.
21
Dept of Allergy and Clinical Immunology, Faculty of Medicine, Transylvania University, Brasov, Romania.
22
Allergy and Clinical Immunology Research Group, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium.

Abstract

Inflammation, structural and functional abnormalities within the airways are key features of asthma. Although these processes are well-documented, their expression varies across the heterogeneous spectrum of asthma. Type 2 inflammatory responses are characterized by increased levels of eosinophils, FeNO and type 2 cytokines in blood and/or airways. Presently, type 2 asthma is the best-defined endotype, typically found in patients with allergic asthma, but surprisingly also in non-allergic patients with (severe) asthma. The etiology of asthma with non-type 2 inflammation is less clear. During the past decade, targeted therapies, including biologicals and small molecules, have been increasingly integrated into treatment strategies of severe asthma. These treatments block specific inflammatory pathways or single mediators. Single or composite biomarkers help to identify patients who will benefit from these treatments. So far, only a few inflammatory biomarkers have been validated for clinical application. The European Academy of Allergy & Clinical Immunology (EAACI) Task Force on Biomarkers in Asthma was initiated to review different biomarker sampling methods and to investigate clinical applicability of new and existing inflammatory biomarkers (point-of-care) to support diagnosis, targeted treatment and monitoring of severe asthma. Subsequently, we discuss existing and novel targeted therapies for asthma as well as applicable biomarkers. This article is protected by copyright. All rights reserved.

KEYWORDS:

FeNO; IgE; endotype; eosinophil; phenotype; precision medicine

PMID:
30953574
DOI:
10.1111/all.13806

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