Lee Eun, Hong Soo-Jong
Department of Pediatrics, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea.
Department of Pediatrics, Childhood Asthma Atopy Center, Environmental Health Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Korean J Pediatr. 2019 Sep;62(9):325-333. doi: 10.3345/kjp.2018.07395. Epub 2019 Apr 23.
Allergic diseases, including allergic rhinitis, asthma, and atopic dermatitis, are common heterogeneous diseases that encompass diverse phenotypes and different pathogeneses. Phenotype studies of allergic diseases can facilitate the identification of risk factors and their underlying pathophysiology, resulting in the application of more effective treatment, selection of better treatment responses, and prediction of prognosis for each phenotype. In the early phase of phenotype studies in allergic diseases, artificial classifications were usually performed based on clinical features, such as triggering factors or the presence of atopy, which can result in the biased classification of phenotypes and limit the characterization of heterogeneous allergic diseases. Subsequent phenotype studies have suggested more diverse phenotypes for each allergic disease using relatively unbiased statistical methods, such as cluster analysis or latent class analysis. The classifications of phenotypes in allergic diseases may overlap or be unstable over time due to their complex interactions with genetic and encountered environmental factors during the illness, which may affect the disease course and pathophysiology. In this review, diverse phenotype classifications of allergic diseases, including atopic dermatitis, asthma, and wheezing in children, allergic rhinitis, and atopy, are described. The review also discusses the applications of the results obtained from phenotype studies performed in other countries to Korean children. Consideration of changes in the characteristics of each phenotype over time in an individual's lifespan is needed in future studies.
过敏性疾病,包括过敏性鼻炎、哮喘和特应性皮炎,是常见的异质性疾病,涵盖多种表型和不同的发病机制。过敏性疾病的表型研究有助于识别危险因素及其潜在的病理生理学,从而应用更有效的治疗方法,选择更好的治疗反应,并预测每种表型的预后。在过敏性疾病表型研究的早期阶段,通常根据临床特征进行人工分类,如触发因素或特应性的存在,这可能导致表型的分类存在偏差,并限制对异质性过敏性疾病的特征描述。随后的表型研究使用相对无偏的统计方法,如聚类分析或潜在类别分析,为每种过敏性疾病提出了更多样化的表型。由于过敏性疾病表型在疾病过程中与遗传和所接触的环境因素存在复杂的相互作用,并可能影响疾病进程和病理生理学,其分类可能会随着时间的推移而重叠或不稳定。在这篇综述中,描述了过敏性疾病(包括儿童特应性皮炎、哮喘和喘息、过敏性鼻炎和特应性)的不同表型分类。该综述还讨论了在其他国家进行的表型研究结果在韩国儿童中的应用。未来的研究需要考虑个体一生中每种表型特征随时间的变化。