Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
Allergology and Immunology, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Berlin, Germany.
Allergy. 2023 May;78(5):1169-1203. doi: 10.1111/all.15679. Epub 2023 Apr 10.
Asthma, rhinitis, and atopic dermatitis (AD) are interrelated clinical phenotypes that partly overlap in the human interactome. The concept of "one-airway-one-disease," coined over 20 years ago, is a simplistic approach of the links between upper- and lower-airway allergic diseases. With new data, it is time to reassess the concept. This article reviews (i) the clinical observations that led to Allergic Rhinitis and its Impact on Asthma (ARIA), (ii) new insights into polysensitization and multimorbidity, (iii) advances in mHealth for novel phenotype definitions, (iv) confirmation in canonical epidemiologic studies, (v) genomic findings, (vi) treatment approaches, and (vii) novel concepts on the onset of rhinitis and multimorbidity. One recent concept, bringing together upper- and lower-airway allergic diseases with skin, gut, and neuropsychiatric multimorbidities, is the "Epithelial Barrier Hypothesis." This review determined that the "one-airway-one-disease" concept does not always hold true and that several phenotypes of disease can be defined. These phenotypes include an extreme "allergic" (asthma) phenotype combining asthma, rhinitis, and conjunctivitis. Rhinitis alone and rhinitis and asthma multimorbidity represent two distinct diseases with the following differences: (i) genomic and transcriptomic background (Toll-Like Receptors and IL-17 for rhinitis alone as a local disease; IL-33 and IL-5 for allergic and non-allergic multimorbidity as a systemic disease), (ii) allergen sensitization patterns (mono- or pauci-sensitization versus polysensitization), (iii) severity of symptoms, and (iv) treatment response. In conclusion, rhinitis alone (local disease) and rhinitis with asthma multimorbidity (systemic disease) should be considered as two distinct diseases, possibly modulated by the microbiome, and may be a model for understanding the epidemics of chronic and autoimmune diseases.
哮喘、鼻炎和特应性皮炎（AD）是相互关联的临床表型，在人类相互作用组中部分重叠。20 多年前提出的“一个气道一种疾病”概念是上下气道过敏性疾病之间联系的一种简单方法。随着新数据的出现，现在是重新评估该概念的时候了。本文回顾了以下内容：（i）导致过敏性鼻炎及其对哮喘的影响（ARIA）的临床观察；（ii）多敏化和多种疾病的新见解；（iii）用于新型表型定义的移动健康进展；（iv）在典型流行病学研究中的证实；（v）基因组发现；（vi）治疗方法；（vii）鼻炎和多种疾病发病的新概念。最近的一个概念是将上下气道过敏性疾病与皮肤、肠道和神经精神多种疾病结合起来，即“上皮屏障假说”。本综述认为，“一个气道一种疾病”的概念并不总是成立的，可以定义几种疾病表型。这些表型包括一个极端的“过敏”（哮喘）表型，它结合了哮喘、鼻炎和结膜炎。单纯性鼻炎和鼻炎与哮喘的多种疾病代表两种不同的疾病，它们有以下区别：（i）基因组和转录组背景（单纯性鼻炎为局部疾病，Toll 样受体和 IL-17；过敏和非过敏多种疾病为全身性疾病，IL-33 和 IL-5）；（ii）过敏原致敏模式（单一或低敏与多敏）；（iii）症状严重程度；（iv）治疗反应。总之，单纯性鼻炎（局部疾病）和鼻炎与哮喘的多种疾病（系统性疾病）应被视为两种不同的疾病，可能受微生物组的调节，并可能成为理解慢性和自身免疫性疾病流行的模型。
