Abstract
Severe asthma in children is associated with significant morbidity and lung function decline. It represents a highly heterogeneous disorder with multiple clinical phenotypes. As its management is demanding, the social and economic burden are impressive. Several co-morbidities may contribute to worsen asthma control and complicate diagnostic and therapeutic management of severe asthmatic patients. Allergen sensitization and/or allergy symptoms may predict asthma onset and severity. A better framing of “allergen sensitization” and understanding of mechanisms underlying progression of atopic march could improve the management and the long-term outcomes of pediatric severe asthma. This review focuses on the current knowledge about interactions between severe asthma and allergies.
Highlights
Atopic sensitization is a well-established, but not exclusive, risk factor for severe asthma both in children [1, 2] and adults [3], all over the world [1,2,3,4]
Its role in determining asthma severity has been considered limited in the past years, some reports confirm that allergy may play a significant role especially in childhood, when early atopic sensitization is crucial to determine the severity of disease
This review aims to focus the role of allergy in pediatric severe asthma
Summary
Atopic sensitization is a well-established, but not exclusive, risk factor for severe asthma both in children [1, 2] and adults [3], all over the world [1,2,3,4]. Though most asthmatic children achieve symptoms’ control through occasional bronchodilator (BD) use or low to medium dose of inhaled corticosteroids (ICSs), a small but significant subset of patients remains with uncontrolled asthma despite treatment with high-dose inhaled glucocorticoids (Table 1) or requiring such a treatment to remain well-controlled [5] This group of children with chronic symptoms and episodic exacerbation requiring short-acting beta agonists (SABA) is defined as affected by “difficult-to-treat asthma.”. In 2014, a task force of the European Respiratory Society (ERS) and the American Thoracic Society (ATS) updated the definition of severe asthma in pediatric patients According to the latter, children affected by severe asthma require treatment with high-dose ICSs and either a long-acting beta-agonist (LABA) or a leukotriene antagonist for the previous year or systemic corticosteroids for at least 50% of the previous year to prevent uncontrolled asthma or asthma that remains uncontrolled despite this therapy [5]
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