Atopy and Asthma


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.


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Further Reading

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

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