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Defining
Asthma and Allergy
Phenotypes
Risk factors and phenotypes vary over time
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LIFE COURSE PERSPECTIVE
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Psycho-neuro-endocrine cascades
Psycho-neuro-immune cascades
(Physiological Reactions)
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Allergy and Asthma are manifestations
of complex and dynamic networks
Genetic
component
SNPs, CNVs, etc.
Environmental
component
Allergen exposures
Lifestyle
Medications
Genes and pathways
etc…
Cell, immune, and inflammatory phenotypes, etc.
Bronchoconstriction, Mucus Secretion,
Hyperreactivity, IgE levels, Airway Structure
Phenotypes Mentioned on Day 1
- Response to methacholine, histamine, allergen
- Skin tests
- Levels of chemical mediators (“smoked drum”)
- Airway epithelium, histology, remodelling, function
- Rhinitis
- Age of Onset, Persistant vs Intermittent Patterns
- Wheezing
- Severity, hospitalizations, medication use
- BMI
- Skin phenotypes (atopic dermatitis)
Phenotypes Mentioned on Day 1 (more)
- Cellular Phenotypes (Eosinophils, B cells, T cells, etc.)
- IgE levels
- TH1 vs TH2
- IgE production
- Chemical Mediators
- Nitric Oxide
- Proteomics (…)
- Transcriptomics (…)
- Metabolomics (…)
Listing phenotypes is easier than
defining them
How do you define asthma?
- Questionnaire:
Do you have asthma?
Have you has asthma in the past?
- Physician Diagnosis
- Medical records
- Use of asthma medications
- Registry/Health Care Databases
- etc.
Having standard definitions
is more important than having
perfect definitions
Francine Kauffman