From clinical phenotype to treatable mechanisms in allergic/atopic diseases: asthma and rhinitis

Allergic asthma and rhinitis are the most common respiratory diseases. The past vision of single diseases responding to a single treatment is definitely over. Different phenotypes of asthma, i.e. asthma with their own clinical, biological and functional characteristics have been identified. Allergic asthma is the most common of these phenotypes. Other phenotypes, such as obese asthma, non-allergic eosinophilic asthma, which have their own characteristics, have also been described. In addition to this phenotypic vision, it should be noted that the clinical presentation can be modified by co-morbidities, which further complicates the vision of asthma. The contribution of phenotypes has led to a better understanding of the physiopathological mechanisms of allergic asthma, which is now known to be linked to inflammation involving type 2 auxiliary lymphocytes (Th2). Cytokines such as interleuldns (IL-) 4, 5 and 13 and also immunoglobulin E (IgE) play an important role in this inflammation known as "Th2". From a therapeutic point of view, inhaled corticosteroid therapy remains the major treatment for asthma, but it is combined with personalised care according to the co-morbidities. In severe asthma. biotherapies directed against inflammatory mediators have been developed to offer a treatment adapted to each patient. Personalised medicine for each patient in allergic rhinitis and asthma is now a necessity, leading to the concept of precision medicine that every doctor should apply. (C) 2020 Elsevier Masson SAS. All rights reserved.