The asthma controller step-down yardstick, the role of the microbiome in asthma and the gut microbiome in food allergy

March 25, 2019

As March comes to a close and the temperature (and pollen levels!) continue to rise, I hope many of you will take the time to pick up your March copy of the Annals of Allergy, Asthma and Immunology to see what you may have missed earlier in the month. I would like to call your attention to a few features.

The first is another contribution to our new series called “Yardsticks” which provide practical, evidence-based, clinically useful information for our readers on specific aspects of allergy, asthma and immune-based diseases. This month’s Yardstick is on Asthma Controller Stepdown recommendations. This is a topic that varies significantly based upon where the clinician is located, how she or he was trained and which asthma guidelines are followed. Bradley Chipps, MD, FACAAI and colleagues provide a wealth of information based upon the relationships between disease control and stepping up or stepping down therapy. As the authors point out, there is more information about when to step up than when to step down therapy. The Yardstick provides recommendations that are well referenced and have the perspectives of these experts. It is a must read for everyone who takes care of patients with asthma -regardless of the severity.

Returning to the emphasis for this month’s issue, the microbiome and allergy, I want to be sure you have seen and read two reviews that address the microbiome in other allergic diseases. The first, authored by Andrea Kozik, PhD and Yvonne Huang, MD from the University of Michigan reviews the role of the microbiome in asthma from pathogenesis to phenotype to repose to therapy.  They explore the “critical window” that posits a relationship between the immune system and the gut/airway microbiota in early life that influences asthma risk. They further explore the evidence that supports the development of certain asthma phenotypes in relationships to certain alterations of the lower airway microbiome. They then outline the knowledge gaps and describe the need to make progress toward more precise asthma therapeutic protocol development.

The other review, authored by William Zaho, BS and colleagues explores the gut microbiome, and its potential influence on the development of food allergy. Indeed, they present evidence to support the relationships between antecedent gut dysbiosis and subsequent development of food allergy. They explore the timing of the dysbiosis and what may be responsible for it. They also describe ongoing and planned clinical trials addressing the gut microbiome using prebiotics, probiotics, symbiotics and even fecal microbial transplants. Understanding this line of research, and its potential for clinical management of patients with food allergy should be useful for all of us who currently care for these patients.

I hope everyone has a great spring month and look forward to the next issue of the Annals which should be in your mailboxes soon. Remember our website contains many features that may be of interest to you and allows electronic access to all of our features if you have a current subscription (included as a College membership benefit.  It is always good to hear your comments and suggestions.

Gailen D. Marshall, Jr., MD PhD, FACAAI