Prise en charge de l’allergie chez les patients asthmatiques sévères: Management of allergy in severe asthma patients

Abstract

Allergic asthma is the most common phenotype in asthma including severe asthma. Allergy work-up in patients with asthma regardless of severity is therefore a crucial part of the management. A complete history associated with skin prick tests are systematic in all asthma patients. The certainty of a link between allergy and asthma symptoms is complex in clinical practice. Allergic comorbidities such as allergic rhinitis, atopic dermatitis or food allergy are common in severe asthma patients, especially the youngest ones. A global management integrating the treatment of these allergic comorbidities is essential to improve the quality of life in asthma patients.Major advances regarding the underlyning pathophysiological mechanisms of severe asthma have led to expand the therapeutic arsenal. Despite approval of biological therapies, non-pharmacological intervention of the environment should not be forgotten. Regarding biological therapies, omalizumab, an anti-IgE antibody, has been used for nearly 20 years in severe allergic asthma. It also has beneficial effect on some allergic comorbidities such as allergic rhinitis and food allergy. Anti-interleukin 5 (IL5) (mepolizumab) or anti-IL5 receptor (benralizumab) antibodies are used in patients with severe asthma and blood eosinophil count ≥ 0.3 G / l. Dupilumab, anti-interleukin 4 receptor antibody, has been recently approved in severe asthma. It is already used in severe atopic dermatitis and studies in other allergic comorbidities are underway.© 2020 SPLF. Published by Elsevier Masson SAS. All rights reserved.