Allergy and Immunology Division, Department of Pediatric, Perelman School of Medicine, University of Pennsylvania, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
Epidemiology of Allergic and Respiratory Diseases Department, IPLESP, INSERM and Sorbonne University, Medical School Saint-Antoine, Paris, France.
Curr Opin Allergy Clin Immunol. 2019 Dec;19(6):654-664. doi: 10.1097/ACI.0000000000000591.
To analyze the status of precision medicine in atopic diseases.
Atopic diseases are increasingly recognized as heterogeneous in nature and they can be quite different in severity, response to therapy, triggers, genetic back ground, ancestral risk and type of inflammation. This significant variability in the landscape of atopic diseases is not reflected in the common treatment guidelines that follow 'one fits all' approach for their management. Such an approach is largely based on minimal 'phenotype' elements, such as severity of disease and response to therapy and does not reflect the information accumulate in the last 20 years about particular pathogenic pathways (endotypes) leading to disease (phenotypes) based on biomolecular analysis of the single individuals. Accumulating data have defined asthma allergic rhinitis, food allergy based on their endotypes and clinically relevant phenotypes. In general, atopic diseases can be largely classified as high or low Th2 inflammatory status, which may explain the severity and response to therapy.
Precision medicine is aiming to use known endotype phenotype to guide specific individualized treatment. The work aimed in deep characterization of diseases to guide the disease management is crucial in light of the availability of ever more precise treatment able to target specific pathways.
分析变应性疾病精准医学的现状。
变应性疾病的性质日益被认为具有异质性，其严重程度、对治疗的反应、诱因、遗传背景、祖先风险和炎症类型可能存在很大差异。这种变应性疾病领域的显著可变性并没有反映在常见的治疗指南中，这些指南采用“一刀切”的方法来管理它们。这种方法主要基于最小的“表型”要素，如疾病的严重程度和对治疗的反应，而不反映过去 20 年来基于个体的生物分子分析积累的关于导致疾病（表型）的特定发病途径（内型）的信息。越来越多的数据根据其内型和临床相关表型定义了哮喘、变应性鼻炎和食物过敏。一般来说，变应性疾病可大致分为高或低 Th2 炎症状态，这可能解释了疾病的严重程度和对治疗的反应。
精准医学旨在利用已知的内型-表型来指导特定的个体化治疗。鉴于越来越多的能够靶向特定途径的精确治疗方法的出现，深入描述疾病以指导疾病管理的工作至关重要。
