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Pediatric asthma and development of atopy

Custovic, Adnan; Lazic, Nevena; Simpson, Angela

Current Opinion in Allergy and Clinical Immunology: April 2013 - Volume 13 - Issue 2 - p 173–180
doi: 10.1097/ACI.0b013e32835e82b6
PEDIATRIC ASTHMA AND DEVELOPMENT OF ATOPYREVIEW: Edited by Carlos E. Baena-Cagnani and Leonard B. Bacharier

Purpose of review There is ongoing controversy about the relationship between atopy and asthma.

Recent findings In clinical practice, specific IgE and skin test results should not be reported as ‘positive’ or ‘negative’, but as the level of IgE and the size of skin test wheal diameter. In assessment of children with severe asthma, these tests are not mutually exclusive but complementary, and both should be carried out and quantified. In the near future, their diagnostic accuracy in children with wheezing may be improved by the measurement of allergen-specific IgG.

It is becoming increasingly clear that asthma is not a single disease, but a collection of several diseases with similar/same symptoms. These distinct disease entities (endotypes) may share similar observable characteristics (phenotypes), but arise via different pathophysiological mechanisms. Observable phenotypic features (e.g. sputum inflammatory phenotypes) are not stable in children with asthma. The discovery of novel, latent endotypes of asthma will require integration of a time component to take into account the phenotype instability and longitudinal changes. Not only asthma, but also ‘atopy’ encompasses a number of different endotypes which differ in their association with asthma.

Summary Novel endotypes of atopy and asthma which better reflect the unique pathophysiological processes underlying different diseases in the atopy and asthma syndromes can be defined through the fusion of computational thinking and novel mathematical approaches with biomedical science. These novel endotypes may be more relevant for epidemiological, genetic and therapeutic studies.

aUniversity of Manchester, Manchester Academic Health Science Centre, University Hospital of South Manchester NHS Foundation Trust, Manchester

bMicrosoft Research Cambridge, Cambridge, UK

Correspondence to Professor Adnan Custovic, University of Manchester, ERC Building, Second floor, Wythenshawe Hospital, Manchester M23 9LT, UK. Tel: +44 161 291 5802; fax: +44 161 291 5730; e-mail:

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