When resilience hides risk: translating peri-adolescent asthma neuroimmunology to tropical pediatric care

Caulfield et al. report that peri-adolescent social instability in an experimental asthma model exacerbates airway inflammation while attenuating anxiety-like behavior and prefrontal stress-regulation gene expression. This letter discusses the translational implications of this dissociation for pediatric asthma in tropical middle-income settings. We argue that behavioral resilience may obscure persistent inflammatory vulnerability in children exposed to perennial allergens, helminth co-exposure, pollution, social adversity, and fragmented longitudinal care. We propose that future translational studies in Latin America integrate social adversity, tropical allergen and helminth exposure, inflammatory biomarkers, cortisol dynamics, lung function, exacerbation history, and clinically indicated imaging. This broader neuroimmune-respiratory framework may help avoid symptom-based reassurance when objective inflammatory risk persists.