Asthma, allergy, and psychiatric disease

T rue to the diverse issues that comprise and challenge the field of allergy and immunology, this issue of the Proceedings features a spectrum of articles that, although seemingly disparate and unrelated, fo-cuses on seven major areas of research that coalesce into a cohesive framework that we hope will be of clinical utility for the readership. These are summarized below in the following order: asthma, psychiatric associations of allergic disease, drug allergy, allergic dermatoses, autoimmune associations in allergic disease , rhinitis, and food allergy. Lang 1 leads off with a timely review of severe asthma, an area of particular interest to clinicians because of the substantial unmet need of morbidity and cost attributable to poor asthma control. Based on his assessment of the literature, Lang 1 suggests a revised paradigm for asthma management that entails categorizing patients with asthma via the use of biomarkers and prescribing mechanism-specific therapy with the goal of achieving improved asthma care outcomes. Biomarkers that Lang 1 discusses include blood eosin-ophils, sputum eosinophils, periostin, exhaled nitric oxide, and serum immunoglobulin E (IgE). Extending the knowledge of asthma biomarkers beyond the review by Lang 1 are two additional articles within this issue. The first of these focuses on the antimicrobial proteins of leukocyte granules, which have long been considered as important elements of innate host defense. In recent years, evidence has been accumulating that indicates that some eosinophil gran-ule– derived antimicrobial proteins may also act as che-moattractants for various types of leukocytes. Among these is eosinophil-derived neurotoxin (EDN), which, together with eosinophil cationic protein, belongs to the ribonuclease A (RNase) superfamily. Research regarding EDN and eosinophil cationic protein provides a molecular basis for a better understanding of the links of eosinophils and IgE with asthma. In this vein, Gon et al. 2 report their efforts to elucidate the correlation between the serum EDN level and markers of severity in adult asthma. They indicate that the serum EDN level may be a useful marker for monitoring persistent airflow limitation in adult patients with allergic asthma who are positive for house-dust–specific IgE antibodies. Also within this issue, Aydın et al. 3 report on the potential utility of total serum IgE as a biomarker for responsiveness to omalizumab in patients with allergic bronchopulmonary aspergillosis. They report that patients with allergic bronchopulmo-nary aspergillosis, characterized by a total IgE level of Ͻ1000 IU/mL, seem to be more responsive to omali-zumab than those …