Related Experiment Video
Updated: Nov 22, 2025
Bronchial Thermoplasty: A Novel Therapeutic Approach to Severe Asthma
Published on: November 4, 2010
Considerations for the Child with Nonatopic Asthma
Gerardo Vazquez Garcia1, Kathryn Blake1
1Division of Pulmonology, Nemours Children's Specialty Care, Jacksonville, Florida.
Insights
Many persistent asthma patients do not respond to inhaled corticosteroids. Nonatopic asthma, characterized by lack of allergies, may involve different inflammatory pathways, suggesting varied treatment responses and the need for targeted therapies.
Area of Science:
- Pulmonology
- Allergy and Immunology
- Clinical Medicine
Background:
- Persistent asthma management relies on inhaled corticosteroids (ICS) per guidelines.
- Approximately 40% of persistent asthma patients remain symptomatic despite guideline-adherent ICS treatment.
- Variability in ICS response is linked to factors like asthma phenotype and genetics.
Purpose of the Study:
- To explore the distinct characteristics of the nonatopic asthma phenotype.
- To investigate potential differences in ICS response between nonatopic and atopic asthma.
- To highlight the need for phenotype-specific research and therapies in asthma.
Main Methods:
- Literature review and analysis of existing studies on asthma phenotypes.
- Comparison of clinical presentations and potential pathophysiological differences between nonatopic and atopic asthma.
- Examination of current therapeutic strategies and research gaps for nonatopic asthma.
Main Results:
- Nonatopic asthma is defined by chronic asthma symptoms without allergic sensitization (negative skin prick tests or IgE blood tests).
- These patients often exhibit milder symptoms and may outgrow asthma by adolescence.
- Evidence suggests potentially different inflammatory pathways in nonatopic asthma compared to atopic asthma.
Conclusions:
- Children with nonatopic asthma might respond differently to inhaled corticosteroids than those with atopic asthma.
- Current definitions of nonatopic asthma are inconsistent, and specific therapeutic trials are lacking.
- Future research should focus on elucidating nonatopic asthma's inflammatory pathways and developing targeted treatments.
Abstract:
Asthma guidelines provide clinicians with evidence-based management strategies for this chronic condition. The preferred therapy for patient with persistent asthma is inhaled corticosteroids. However, ∼40% of the patients with persistent asthma continue to present with symptoms while treated according to the guidelines. Multiple factors are being explored to explain the variability in response to inhaled corticosteroids including asthma phenotype and genetic predisposition among others. The nonatopic asthma phenotype has been described in the literature. These patients tend to have milder symptoms of asthma and typically outgrow their asthma by adolescence. They present with chronic asthma symptoms in the absence of a positive allergy test, either skin prick test or specific immunoglobulin E blood test. Although patients with nonatopic asthma share many characteristics with patients with atopic asthma, there are several studies that suggest a different inflammatory pathway may be involved in their pathophysiology. Therefore, it is possible that children with nonatopic asthma could respond differently to inhaled corticosteroids compared with those with atopic asthma. Currently there is a variable definition of this phenotype. Furthermore, there is a paucity of therapeutic trial directed toward the patients with nonatopic asthma specifically. Future research should be guided toward identifying the inflammatory pathways in nonatopic asthma and potential phenotype-guided therapies.
Related Concept Videos
01:29Asthma-I: Introduction
01:30Asthma-IV: Nursing Management
First, in...
01:24Asthma-III: Symptoms and Complications
Classification of Asthma
01:30Asthma-IV: Diagnostic and Management
Clinical Assessment for Asthma:
This is the first step in diagnosing and managing asthma. It includes:
01:20Asthma: Pathogenesis and Management
Asthma is classified as allergic and non-allergic. Allergens such as dust mites, pollen, and pet dander trigger allergic asthma, while factors like cold air, intense emotions, or exercise can induce non-allergic asthma.
01:25Antiasthma Drugs: Mast Cell Stabilizers and Anti-IgE Drugs
Mast cell stabilizers, such as cromolyn (also known as sodium cromoglycate) and nedocromil (Tilade), are effective drugs in asthma management. These stabilizers hinder histamine release by skillfully obstructing the activation of mast cells and other cellular entities. Notably, they navigate this task without...