The Editor takes a closer look at some of this month's articles

Abstract

Clinical & Experimental AllergyVolume 41, Issue 8 p. 1047-1047 Free Access The Editor takes a closer look at some of this month's articles First published: 13 July 2011 https://doi.org/10.1111/j.1365-2222.2011.03826.xAboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Pre-school wheeze: biomarkers of corticosteroid responsiveness Pre-school wheeze is common and includes non-asthma viral-induced wheeze, which is not corticosteroid responsive and classical atopic asthma which generally is [1]. The question is how to distinguish between the different phenotypes so that the right treatment is matched to the right patient. Exhaled nitric oxide is linked to eosinophilic airway inflammation, which is probably the best marker of corticosteroid responsiveness, at least in adults [2]. Exhaled breath condensate is also widely used as a non-invasive marker of airway inflammation [3]. Van der Kant and colleagues (pp. 1076–1083) have investigated whether either of these measurements are helpful in guiding corticosteroid therapy in 93 pre-school wheezers. They were not helpful, dealing another blow to the idea that currently available non-invasive measurements can be used to guide treatment. Back to the drawing board. [ Kim van der Kant (author) ] [ see figure 4 in Spycher BD, et al. [1] ] Basophil sensitivity: a biomarker of allergen responsiveness in asthma? Atopy is undoubtedly an important contributor to asthma. However, while in some patients there is a clear-cut relationship between exposure and symptoms, this is far from being universal. In addition, allergen avoidance studies have not provided compelling evidence that allergy is the key driver of asthma. An objective test that reliably predicted the airway response to allergen would be very helpful to guide allergen avoidance both in clinical trials and clinical practice. Allergen challenge is too invasive to use routinely and so Dahlén and colleagues (pp. 1091–1097) have asked whether basophil threshold sensitivity (CD-sens) to in vitro challenge correlates with allergen PD20. They found that it does, with a particularly strong correlation in those patients who were relatively insensitive to allergen challenge. Studies are now needed to validate the clinical relevance of this observation by showing that patients with a high basophil sensitivity get more symptoms and do better with allergen avoidance than those whose basophil responsiveness is more sluggish. [ Barbro Dahlén (author) ] [ See fig 1A (pp. 1091–1097) ] Specific IgE: concentrations are not closely related to clinical response Huss-Marp and colleagues (pp. 1116–1124) have addressed the same question as Dahlén et al. using specific IgE as the biomarker and nasal, conjunctival and skin challenge as the clinical outcome. They point out that for a given level of exposure to grass pollen symptoms of rhinitis are very variable. They asked whether this observation could be explained by the amount of circulating specific IgE. They measured specific IgE levels to timothy grass in 104 patients with seasonal allergic rhinitis and related this to the dose threshold for challenge. There was no relationship with uncorrected levels of specific IgE and only a weak correlation between the skin test and conjunctival challenge and the specific IgE/total IgE ratio. Therefore specific IgE, although essential for diagnosis is not very good at assessing severity, at least to aeroallergens. The full implications of this study are discussed in an excellent editorial by Robert Hamilton. [ Johannes Huss-Marp (author) ] [ Nasal provocation (courtesy Johannes Huss-Marp) ] References 1 Spycher BD, Silverman M, Kuehni CE. Phenotypes of childhood asthma: are they real? Clin Exp Allergy 2010; 40: 1130– 41. CASWeb of Science®Google Scholar 2 Gibson PG. Using fractional exhaled nitric oxide to guide asthma therapy: design and methodological issues for ASthma TReatment ALgorithm studies. Clin Exp Allergy 2009; 39: 478– 90. CASPubMedWeb of Science®Google Scholar 3 Kostikas K, Koutsokera A, Papiris S, Gourgoulianis KI, Loukides S. Exhaled breath condensate in patients with asthma: implications for application in clinical practice. Clin Exp Allergy 2008; 38: 557– 65. CASPubMedWeb of Science®Google Scholar Volume41, Issue8August 2011Pages 1047-1047 ReferencesRelatedInformation