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Blood Biomarkers of Sensitization and Asthma
Hans-Joachim Sonntag1, Sarah Filippi2,3, Spyros Pipis4,5
1Respiratory Division, National Heart and Lung Institute, Imperial College London, London, United Kingdom.
Insights
Identifying aeroallergen sensitization and high blood eosinophil counts can predict which preschool children with asthma may benefit from inhaled corticosteroids (ICS). Measuring these biomarkers is crucial before starting long-term ICS treatment for better asthma management.
Area of Science:
- Pediatric Pulmonology
- Allergy and Immunology
- Biomarker Research
Background:
- Biomarkers are vital for classifying childhood asthma phenotypes and predicting treatment responses.
- In preschool children, specific biomarkers can identify candidates for inhaled corticosteroids (ICS).
Purpose of the Study:
- To propose essential biomarker measurements for guiding ICS treatment decisions in preschool children with asthma.
- To advocate for a minimum standard of biomarker assessment before initiating long-term ICS therapy.
Main Methods:
- Assessing aeroallergen sensitization through quantifiable measures like specific IgE (sIgE) antibody titers or skin prick test responses.
- Measuring blood eosinophil counts, with a threshold of 300 cells/μL identified as significant.
- Exploring potential utility of other blood biomarkers, including allergen-specific antibody ratios and component-resolved diagnostics.
Main Results:
- A combination of aeroallergen sensitization and a blood eosinophil count ≥300/μL may identify preschool children likely to respond to daily ICS.
- Current evidence supports these two biomarkers as a minimum requirement for treatment consideration.
Conclusions:
- Aeroallergen sensitization and blood eosinophil counts are key initial biomarkers for guiding ICS therapy in young children with asthma.
- Further research into integrated approaches combining multiple biomarkers, genetics, and lung function is needed for personalized asthma management.
Abstract:
Biomarkers are essential to determine different phenotypes of childhood asthma, and for the prediction of response to treatments. In young preschool children with asthma, aeroallergen sensitization, and blood eosinophil count of 300/μL or greater may identify those who can benefit from the daily use of inhaled corticosteroids (ICS). We propose that every preschool child who is considered for ICS treatment should have these two features measured as a minimum before a decision is made on the commencement of long-term preventive treatment. In practice, IgE-mediated sensitization should be considered as a quantifiable variable, i.e., we should use the titer of sIgE antibodies or the size of skin prick test response. A number of other blood biomarkers may prove useful (e.g., allergen-specific IgG/IgE antibody ratios amongst sensitized individuals, component-resolved diagnostics which measures sIgE response to a large number of allergenic molecules, assessment of immune responses to viruses, level of serum CC16, etc.), but it remains unclear whether these can be translated into clinically useful tests. Going forward, a more integrated approach which takes into account multiple domains of asthma, from the pattern of symptoms and blood biomarkers to genetic risk and lung function measures, is needed if we are to move toward a stratified approach to asthma management.
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