哮喘联盟

   摘要
   哮喘和过敏性疾病习惯上被宽泛定义，且进行非特异治疗，包括糖皮质激素和支气管扩张剂。由于近期关于哮喘和过敏性疾病的聚类分析、分子表型、生物标志物和针对性及非针对性治疗的不同反应，他们之间的异质性越来越得到认可。这些开创性研究使得特定表型的分子靶点治疗得以成功。本综述对分子靶点治疗特定的过敏性疾病和哮喘表型的随机双盲、安慰剂对照试验进行概况总结。IgE是第一个成功应用在过敏性疾病和哮喘患者中的分子靶点。本综述发现以典型的2型细胞因子IL-4, IL-5和 IL-13 为靶点的治疗取得一致的效果，特别在TH2/ 2 型炎症(“2型高”)哮喘患者。但是，非2型炎症哮喘患者的靶点治疗还未成功。我们得出结论应该进一步完善哮喘和过敏性疾病2型患者的2型治疗，并研究新的适合非2型炎症患者的治疗方法。

 

（杨冬 审校）
J Allergy Clin Immunol. 2015 Feb;135(2):299-310. doi: 10.1016/j.jaci.2014.12.1871.


 

Asthma phenotypes and the use of biologic medications in asthma and allergic disease: The next steps toward personalized care.
 

Fajt ML1, Wenzel SE2.

ABSTRACT
Traditionally, asthma and allergic diseases have been defined by broad definitions and treated with nonspecific medications, including corticosteroids and bronchodilators. There is an increasing appreciation of heterogeneity within asthma and allergic diseases based primarily on recent cluster analyses, molecular phenotyping, biomarkers, and differential responses to targeted and nontargeted therapies. These pioneering studies have led to successful therapeutic trials of molecularly targeted therapies in defined phenotypes. This review analyzed randomized double-blind, placebo-controlled trials of molecularly targeted therapies in defined allergic disease and asthma phenotypes. IgE was the first successful biological target used in patients with allergic disease and asthma. This review shows that therapies targeting the canonical type 2 cytokines IL-4, IL-5, and IL-13 have shown consistent efficacy, especially in asthmatic patients with evidence of TH2/type 2 inflammation ("type 2 high"). As of yet, there are no successful trials of targeted therapies in asthmatic patients without evidence for type 2 inflammation. We conclude that further refinement of type 2 therapies to specific type 2 phenotypes and novel approaches for patients without type 2 inflammation are needed for asthma and allergic disease treatment.

J Allergy Clin Immunol. 2015 Feb;135(2):299-310. doi: 10.1016/j.jaci.2014.12.1871.