Pulmonology Unit, Hospital Regional Universitario de Malaga, 29010 Malaga, Spain.
Allergy Unit, Hospital Regional Universitario de Malaga, 29010 Malaga, Spain.
Int J Mol Sci. 2022 Apr 27;23(9):4838. doi: 10.3390/ijms23094838.
Asthma is a heterogeneous disease in terms of both phenotype and response to therapy. Therefore, there is a great need for clinically applicable tools allowing for improved patient classification, and selection for specific management approaches. Some interventions are highly helpful in selected patients (e.g., allergen immunotherapy or aspirin desensitization), but they are costly and/or difficult to implement. Currently available biomarkers measurable in peripheral blood or exhaled air display many limitations for asthma phenotyping and cannot identify properly the specific triggers of the disease (e.g., aeroallergens or NSAID). The united airway concept illustrates the relevant epidemiological and pathophysiological links between the upper and lower airways. This concept has been largely applied to patient management and treatment, but its diagnostic implications have been less often explored. Of note, a recent document by the European Academy of Allergy and Clinical Immunology proposes the use of nasal allergen challenge to confirm the diagnosis of allergic asthma. Similarly, the nasal challenge with lysine acetylsalicylate (L-ASA) can be used to identify aspirin-sensitive asthma patients. In this review, we will summarize the main features of allergic asthma and aspirin-exacerbated respiratory disease and will discuss the methodology of nasal allergen and L-ASA challenges with a focus on their capacity to phenotype the inflammatory disease affecting both the upper and lower airways.
哮喘在表型和治疗反应方面均具有异质性。因此，非常需要临床适用的工具来改善患者分类，并选择特定的管理方法。一些干预措施对某些患者非常有帮助（例如，过敏原免疫治疗或阿司匹林脱敏），但它们成本高且/或难以实施。目前可在周围血液或呼出气中测量的生物标志物在哮喘表型方面存在许多局限性，并且无法正确识别疾病的特定触发因素（例如，过敏原或非甾体抗炎药）。联合气道概念说明了上呼吸道和下呼吸道之间相关的流行病学和病理生理学联系。该概念已在很大程度上应用于患者管理和治疗，但对其诊断意义的探索较少。值得注意的是，最近欧洲过敏与临床免疫学学会的一份文件提出使用鼻过敏原挑战来确认过敏性哮喘的诊断。同样，可以使用赖氨酸乙酰水杨酸（L-ASA）鼻挑战来识别阿司匹林敏感的哮喘患者。在这篇综述中，我们将总结过敏性哮喘和阿司匹林加重的呼吸道疾病的主要特征，并讨论鼻过敏原和 L-ASA 挑战的方法学，重点是它们对影响上呼吸道和下呼吸道的炎症性疾病进行表型分析的能力。
