Abstract
Biomarkers are essential to determine different phenotypes of childhood asthma, and for the prediction of response to treatments. In young preschool children with asthma, aeroallergen sensitization, and blood eosinophil count of 300/μL or greater may identify those who can benefit from the daily use of inhaled corticosteroids (ICS). We propose that every preschool child who is considered for ICS treatment should have these two features measured as a minimum before a decision is made on the commencement of long-term preventive treatment. In practice, IgE-mediated sensitization should be considered as a quantifiable variable, i.e., we should use the titer of sIgE antibodies or the size of skin prick test response. A number of other blood biomarkers may prove useful (e.g., allergen-specific IgG/IgE antibody ratios amongst sensitized individuals, component-resolved diagnostics which measures sIgE response to a large number of allergenic molecules, assessment of immune responses to viruses, level of serum CC16, etc.), but it remains unclear whether these can be translated into clinically useful tests. Going forward, a more integrated approach which takes into account multiple domains of asthma, from the pattern of symptoms and blood biomarkers to genetic risk and lung function measures, is needed if we are to move toward a stratified approach to asthma management.
Highlights
Asthma is a heterogeneous condition with a myriad of definitions in the literature [1], and is characterized by chronic airway inflammation which gives rise to a range of respiratory symptoms including wheeze, cough and shortness of breath [1]
We present the reader with an overview of further asthma domains, from lung function measurements to genetic findings
The features that predicted preferential response to regular inhaled corticosteroids (ICS) were aeroallergen sensitization and blood eosinophil counts of 300/μL [48]. This brings together allergic sensitization and elevated blood eosinophils as core biomarkers of treatment response to ICS in young children, and we would argue that every pre-school child who is considered for long-term treatment with ICS should have these two features measured before the decision is made on the commencement of long-term preventive treatment
Summary
Hans-Joachim Sonntag 1, Sarah Filippi 2,3, Spyros Pipis 4,5 and Adnan Custovic 1*. Edited by: Jose Antonio Castro-Rodriguez, Pontifical Catholic University of Chile, Chile. In young preschool children with asthma, aeroallergen sensitization, and blood eosinophil count of 300/μL or greater may identify those who can benefit from the daily use of inhaled corticosteroids (ICS). We propose that every preschool child who is considered for ICS treatment should have these two features measured as a minimum before a decision is made on the commencement of long-term preventive treatment. IgE-mediated sensitization should be considered as a quantifiable variable, i.e., we should use the titer of sIgE antibodies or the size of skin prick test response. A number of other blood biomarkers may prove useful (e.g., allergen-specific IgG/IgE antibody ratios amongst sensitized individuals, component-resolved diagnostics which measures sIgE response to a large number of allergenic molecules, assessment of immune responses to viruses, level of serum CC16, etc.), but it remains unclear whether these can be translated into clinically useful tests.
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