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Considerations for the Child with Nonatopic Asthma
Pediatric Allergy, Immunology, and Pulmonology ( IF 0.9 ) Pub Date : 2020-03-17 , DOI: 10.1089/ped.2019.1104
Gerardo Vazquez Garcia 1 , Kathryn Blake 1
Affiliation  

Asthma guidelines provide clinicians with evidence-based management strategies for this chronic condition. The preferred therapy for patient with persistent asthma is inhaled corticosteroids. However, ∼40% of the patients with persistent asthma continue to present with symptoms while treated according to the guidelines. Multiple factors are being explored to explain the variability in response to inhaled corticosteroids including asthma phenotype and genetic predisposition among others. The nonatopic asthma phenotype has been described in the literature. These patients tend to have milder symptoms of asthma and typically outgrow their asthma by adolescence. They present with chronic asthma symptoms in the absence of a positive allergy test, either skin prick test or specific immunoglobulin E blood test. Although patients with nonatopic asthma share many characteristics with patients with atopic asthma, there are several studies that suggest a different inflammatory pathway may be involved in their pathophysiology. Therefore, it is possible that children with nonatopic asthma could respond differently to inhaled corticosteroids compared with those with atopic asthma. Currently there is a variable definition of this phenotype. Furthermore, there is a paucity of therapeutic trial directed toward the patients with nonatopic asthma specifically. Future research should be guided toward identifying the inflammatory pathways in nonatopic asthma and potential phenotype-guided therapies.

中文翻译:

非特应性哮喘儿童的注意事项

哮喘指南为临床医生提供了针对这种慢性病的循证管理策略。持续性哮喘患者的首选疗法是吸入皮质类固醇。然而,约 40% 的持续性哮喘患者在根据指南进行治疗时继续出现症状。正在探索多种因素来解释吸入皮质类固醇的反应变异性,包括哮喘表型和遗传易感性等。非特应性哮喘表型已在文献中描述。这些患者往往有较轻微的哮喘症状,并且通常在青春期时哮喘会消失。在没有阳性过敏试验(皮肤点刺试验或特异性免疫球蛋白 E 血液试验)的情况下,他们表现出慢性哮喘症状。尽管非特应性哮喘患者与特应性哮喘患者有许多共同特征,但有几项研究表明,他们的病理生理学可能涉及不同的炎症通路。因此,与特应性哮喘儿童相比,非特应性哮喘儿童对吸入皮质类固醇的反应可能不同。目前有此表型的可变定义。此外,缺乏专门针对非特应性哮喘患者的治疗试验。未来的研究应指导确定非特应性哮喘中的炎症通路和潜在的表型指导疗法。因此,与特应性哮喘儿童相比,非特应性哮喘儿童对吸入皮质类固醇的反应可能不同。目前有此表型的可变定义。此外,缺乏专门针对非特应性哮喘患者的治疗试验。未来的研究应指导确定非特应性哮喘中的炎症通路和潜在的表型指导疗法。因此,与特应性哮喘儿童相比,非特应性哮喘儿童对吸入皮质类固醇的反应可能不同。目前有此表型的可变定义。此外,缺乏专门针对非特应性哮喘患者的治疗试验。未来的研究应指导确定非特应性哮喘中的炎症通路和潜在的表型指导疗法。
更新日期:2020-03-17
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