Atopy and Asthma

Abstract

Atopy is the genetic propensity to develop an immunoglobulin E antibody response to common allergens. The most common clinical manifestations of atopy are allergic rhinitis, asthma and atopic dermatitis. Asthma is a complex disorder of the airways, involving airway hyperresponsiveness, airflow obstruction that is at least partially reversible, and inflammation of the airways. Although atopy has been identified as the strongest predisposing factor for the development of asthma, not all asthma is allergic in nature. The overall prevalence of asthma has been increasing worldwide for the last few decades, and continues to increase globally. Guidelines for the evaluation and treatment of asthma were developed in the early 1990s, and are revised periodically as research into effectiveness of available medications emerges, and development of new therapies arise.

Key Concepts

  • Immunoglobulin E (IgE), produced by atopic individuals, plays a key role in allergic disorders, with atopic asthma being a prime example of IgE‐mediated inflammation.
  • Asthma is a common but complex disorder of the airways, involving variable and recurrent symptoms, airway obstruction, inflammation and bronchial hyperresponsiveness.
  • Symptoms of asthma include coughing, wheezing, shortness of breath and feelings of chest tightness or pain with breathing.
  • Numerous comorbidities may complicate and exacerbate asthma.
  • Onset of asthma usually begins early in life, although adult‐onset of asthma may occur.
  • Genetic predisposition and environmental factors play a role in the development of asthma.
  • The diagnosis of asthma depends on the appropriate historical symptoms, physical examination, objective measurement of lung function and response to bronchodilator.
  • Treatment of asthma centres around control of chronic inflammation, avoidance of triggering factors and treatment of acute bronchospasm when needed.
  • Asthma severity is stratified based on factors regarding symptom frequency and severity, occurrence of nocturnal symptoms, frequency of short‐acting beta‐agonist use, interference with normal activity and objective measurement of pulmonary function. Risk assessment includes frequency of systemic corticosteroid use, and frequency and severity of asthma exacerbations.
  • Individuals over 65 may have a decreased perception of breathlessness and air hunger. Therefore, the use of clinical symptoms to diagnose and treat seniors may underestimate the severity of airways obstruction.

Keywords: atopy; allergy; asthma; airway hyperresponsiveness; inflammation; bronchospasm; immunoglobulin E; interleukins; leucotrienes; T‐helper lymphocytes

Figure 1. Mechanisms of allergic reaction. IL, interleukin; GM‐CSF, granulocyte–macrophage colony‐stimulating factor; IgE, immunoglobulin E; TNFα, tumour necrosis factor α; LTC4, leucotriene C4; PGD2, prostaglandin D2; HETEs, hydroxyeicosatetraenoic acids; PAF, platelet‐activating factor.
Figure 2. A step‐care approach to manage asthma in adults and children. Preferred treatments are in bold type. Note: Patients at any level of severity can have mild, moderate or severe exacerbations. Some patients with intermittent asthma may experience severe and life‐threatening exacerbations separated by long periods of normal lung function and no symptoms. Adapted from National Asthma Education and Prevention Program.
close

References

Asher MI, Montefort S, Bjorksten B, et al. (2006) Worldwide trends in the prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and eczema in childhood: ISSAC phases one and three repeat multicountry cross‐sectional surveys. Lancet 368: 733–743.

Castro‐Rodriguez JA and Rodrigo GJ (2012) A systematic review of long‐acting β2‐agonists versus higher doses of inhaled corticosteroids in asthma. Pediatrics 130: 650–657.

Cayrol C and Girard J‐P (2014) IL‐33: an alarmin cytokine with crucial roles in innate immunity, inflammation and allergy. Current Opinion in Immunology 31: 31–37.

Dweik RA, Boggs PB, Erzurum SC, et al. (2011) An official ATS clinical practice guideline: interpretation of exhaled nitric oxide levels (FeNO) for clinical applications. American Journal of Respiratory and Critical Care Medicine 184: 602–615.

Foresi A, Morelli MC and Catina E (2000) Low‐dose budesonide with the addition of an increased dose during exacerbations is effective in long‐term asthma control. On behalf of the Italian Study Group. Chest 117 (2): 440–446.

Fugita H, Soyka MB, Akdis M and Akdis CA (2012) Mechanisms of allergen‐specific immunotherapy. Clinical and Translational Allergy 2: 2.

Global Initiative for Asthma (GINA). Global Strategy for Asthma Management and Prevention (2014) http://www.ginasthma.org.

Kerstjens HAM, Engel M, Dahl R, et al. (2012) Tiotropium in asthma poorly controlled with standard combination therapy. New England Journal of Medicine 367: 1198–1207.

Kuna P, Peters MJ, Manjra AI, et al. (2007) Effect of budesonide/formoterol maintenance and reliever therapy on asthma exacerbations. International Journal of Clinical Practice 61: 725–736.

Makrinioti H, Toussaint M, Jackson DJ, et al. (2014) Role of interleukin 33 in respiratory allergy and asthma. Lancet Respiratory Medicine 2: 226–237.

Moorman JE, Akinbami LJ, Bailey CM, et al. (2012) National Surveillance of Asthma: United States, 2001‐2010. Vital and Health Statistics Series 3 (35): 1–31.

Murphy SL, Xu J, Kochnek KD (2013) Deaths: Final data for 2010. National Center for Health Statistics. National statistics reports No. 4.

National Asthma Education and Prevention Program (2007) Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma. Bethesda, MD: National Institutes of Health Publication no 07‐4051.

Oborne J, Mortimer K, Hubbard RB, et al. (2009) Quadrupling the dose of inhaled corticosteroid to prevent asthma exacerbations. American Journal of Respiratory and Critical Care Medicine 180: 598–602.

Patel SP, Jarvelin M‐J and Little MP (2008) Systematic review of worldwide variations of the prevalence of wheezing symptoms in children. Environmental Health 7: 57–66.

Pawankar R, Canonica GW, Holgate ST, et al. (eds) (2013) WAO White Book on Allergy 2013 Update. Milwaukee, WI: World Allergy Organization

Raissy HH, Kelly HW, Harkins M and Szefler SJ (2013) Inhaled corticosteroids in lung diseases. American Journal of Respiratory and Critical Care Medicine 187 (8): 798–803.

Rodrigo GJ, Moral VP, Marcos LG, et al. (2009) Safety of regular use of long‐acting beta agonists as monotherapy or added to inhaled corticosteroids in asthma. A systematic review. Pulmonary Pharmacology & Therapeutics 22: 9–19.

Schaub B, Lauener R and von Mutius E (2006) The many faces of the hygiene hypothesis. Journal of Allergy and Clinical Immunology 117 (5): 969–977.

deShazo RD and Stupka JE (2009) Asthma in seniors: part 2. Treatment. Seeing through the glass darkly. American Journal of Medicine 122 (2): 109–113.

Strachan DP (1989) Hay fever, hygiene and household size. British Medical Journal 299: 1259–1260.

Strachan DP (2000) Family size, infection and atopy: the first decade of the “hygiene hypothesis”. Thorax 55 (S1): S2–S10.

Stupka JE and deShazo RD (2009) Asthma in seniors: part 1: evidence for underdiagnosis, undertreatment, and increasing morbidity and mortality. American Journal of Medicine 122 (1): 6–11.

Zhang L, Prietsch SOM and Ducharme FM (2014) Inhaled corticosteroids in children with persistent asthma: effects on growth (Review). Cochrane Database of Systematic Reviews 7: CD009471.

Further Reading

Adkinson NF Jr, Bochner BS, Burks AW, et al. (eds) (2014) Middleton's Allergy Principles and Practice, 8th edn. Philadelphia, PA: Elsevier Saunders.

Fleischer DM, Spergel JM, Assa'ad AH and Pongracic JA (2013) Primary prevention of allergic disease through nutritional interventions. Journal of Allergy and Clinical Immunology: In Practice 1 (1): 29–36.

Heederik D and von Mutius E (2012) Does diversity of environmental microbial exposure matter for the occurrence of allergy and asthma? Journal of Allergy and Clinical Immunology 130 (1): 44–50.

Miller RL and Peden DB (2014) Environmental effects on immune responses in patients with atopy and asthma. Journal of Allergy and Clinical Immunology 134 (5): 1001–1008.

Nurmatov U, Devereux G and Sheikh A (2011) Nutrients and foods for the primary prevention of asthma and allergy: Systematic review and meta‐analysis. Journal of Allergy and Clinical Immunology 127 (3): 724–733.

Okada H, Kuhn C, Feillet H and Bach J‐F (2010) The ‘hygiene hypothesis’ for autoimmune and allergic diseases: an update. Clinical and Experimental Immunology 160: 1–9.

Robinson DS (2010) The role of the T cell in asthma. Journal of Allergy and Clinical Immunology 126 (6): 1081–1091.

Sly PD, Kusel M and Holt PG (2010) Do early‐life viral infections cause asthma? Journal of Allergy and Clinical Immunology 125 (6): 1202–1205.

Von Mutius E (2009) Gene environment interactions in asthma. Journal of Allergy and Clinical Immunology 123: 3–11.

Contact Editor close
Submit a note to the editor about this article by filling in the form below.

* Required Field

How to Cite close
Yates, Anne B, and deShazo, Richard D(Sep 2015) Atopy and Asthma. In: eLS. John Wiley & Sons Ltd, Chichester. http://www.els.net [doi: 10.1002/9780470015902.a0002161.pub4]