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Longo et al1Longo G. Conversano E. Panontin E. Ventura G. Ventura A. Nonatopic persistent asthma in children, a missed phenotype of asthma?.J Allergy Clin Immunol. 2017; 140: 1212-1213Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar raise an interesting issue regarding the differentiation of eosinophilic asthma that may be nonatopic in nature. As indicated in our study, the likelihood of a favorable response to daily inhaled corticosteroid therapy in young children with emerging asthma was associated with either a blood eosinophil count of greater than or equal to 300 cells/mm3 or allergic sensitization as defined by multiallergen testing.2Fitzpatrick A.M. Jackson D.J. Mauger D.T. Boehmer S.J. Phipatanakul W. Sheehan W.J. et al.Individualizing therapy for persistent asthma in young children.J Allergy Clin Immunol. 2016; 138: 1608-1618.e12Abstract Full Text Full Text PDF PubMed Scopus (168) Google Scholar The combination of these 2 features enhanced the likelihood of a favorable response as compared with our other 2 treatment strategies, either daily oral montelukast or inhaled corticosteroid administered with albuterol at the time of symptoms. We did not specifically look at the type of nonatopic persistent asthma described by Longo et al3Longo G. Panontin E. Ventura G. Non atopic persistent asthma in children.Thorax. 2009; 64: 459Crossref PubMed Scopus (0) Google Scholar in their previous publication. Indeed, young children with what we call “emerging asthma” can have many different patterns that are associated with respiratory distress but only a proportion go on to develop persistent asthma by age 6 years.4Castro-Rodriguez J.A. Holberg C.J. Wright A.L. Martinez F.D. A clinical index to define risk of asthma in young children with recurrent wheezing.Am J Respir Crit Care Med. 2000; 162: 1403-1406Crossref PubMed Scopus (941) Google Scholar We took the approach of trying to understand the population that responded best to each treatment option. We found that a proportion of them responded best to daily inhaled corticosteroid therapy and they had the features described previously. Unfortunately, we have not yet been able to define specific features for those who responded most favorably to daily montelukast or the intermittent inhaled corticosteroid strategy. Of interest, there was a group of children that responded at the same level for all 3 treatment strategies, either equally well or equally poorly. The absence of a placebo arm did not allow us to determine the comparative level of control in the absence of any treatment. We are conducting further studies to determine whether there is a unique metabolomic or proteomic profile that may be associated with each treatment group and whether this profile could be more sensitive and specific than our available biomarkers for use in selecting treatment options in this young age group. Nonatopic persistent asthma in children, a missed phenotype of asthma?Journal of Allergy and Clinical ImmunologyVol. 140Issue 4PreviewWe read with great interest the study by Fitzpatrick et al,1 showing how, in preschool children with persistent asthma, the type 2 inflammation biomarkers (ie, aeroallergen sensitization and/or increased blood eosinophilic counts) are strong predictors of a positive therapeutic response to daily inhaled corticosteroid treatment. To our knowledge, Fitzpatrick et al's study is the first to extrapolate and clearly identify a particular phenotype of persistent eosinophilic asthma, without pneumoallergen sensitization. Full-Text PDF