[Does "intrinsic" asthma exist?].

Many asthmatics are not atopic. As compared to atopic ("extrinsic") asthma, nonatopic ("intrinsic") asthma occurs later in life, mostly in females, and nasal polyposis, aspirin sensitivity and corticodependence are common. In this patient population, there is no history of allergy, skin prick testing is negative for all aeroallergens tested and total as well as specific immunoglobulin E serum levels are within the normal range. Ten to forty percent of asthmatics are "intrinsic". It is important to define whether an asthmatic patient is atopic or not in order to recommend allergen avoidance in atopics. In the absence of allergy, it will be important to avoid bronchial irritants such tobacco, and in some patients aspirin and non steroidal anti-inflammatory agents. We will review recent findings obtained in a well defined population of atopic and nonatopic asthmatics. Analysis of bronchial mucosal expression of "pro-eosinophilic" and "pro-atopic" markers [IL-3, -4, -5, -13, GM-CSF, RANTES, MCP-3, IgE and high affinity IgE receptor (Fc epsilon RI)] demonstrates that there were more similarities than differences in immunopathology between atopic and nonatopic asthma.