A new definition of severe asthma and how lymphoid cells relate to allergy
While the December 2017 Annals of Allergy, Asthma and Immunology is the final issue of the year, it has some great articles for the practicing clinician. These articles will increase your knowledge base as well as provide guidance for various aspects of patient care. Two articles in particular meet these important metrics.
One is the report of an expert panel authored by Dr. Michael Blaiss and colleagues that outlines their perspective on guiding principles to develop a useful definition of severe asthma. It could be used by patients, clinicians and payers as newer therapies such as biologics and bronchial thermoplasty are considered for specific patients. The panel described their consensus on definitions of asthma severity, phenotypes (using biomarkers when available) and their approach to the use of newer therapies for these typically challenging patients.
Another review article with important information is on innate lymphoid cells (ILC) and how they relate to allergy, authored by Drs. Matthew Stier and Stokes Peebles. This well-written article covers development of the lineages, how and where they mature, and their functional significance in normal and allergic immune responses. It also covers the current understanding of how to identify them with cellular markers and their collective and individual impact on host immune mechanisms. As we are learning, it is no longer sufficient to identify immune imbalances associated with allergic and asthma pathology as "Th1" or "Th2" as we develop and implement newer therapies for the spectrum of diseases in our patients.
As always, I welcome your comments.
Gailen D. Marshall, Jr., MD, PhD, FACAAI