Mucosal Lining Fluid Biomarkers in Asthma: Basis for Rational Use of New Targeted Therapies?

http://dx.doi.org/10.1016/j.ebiom.2017.04.016 2352-3964/© 2017 The Author. Published by Elsevier B.V Asthma is a frequent, disabling chronic disease which is characterized by respiratory symptoms (wheeze, breathlessness, chest tightness and cough) and chronic airway inflammation. It affects more than 300 million people world-wide and represents a heavy economic burden to health care systems (Kaur et al., 2015). The syndrome asthma is caused by several underlying diseases and trigger factors of which the most frequent ones are IgE-associated allergies and respiratory virus infections (Kim et al., 2010). Although there are obviously a range of different pathomechanisms operative in asthma, for decades the treatment has been based mainly on symptomatic therapy aimed at bronchodilation and reducing inflammation (i.e., pharmacological bronchodilation and corticosteroids). However, the introduction of IgE-targeting therapies for the treatment of allergic asthma has emphasized the need to identify patients by accurate stratification to allow accurate administration of anti-IgE and other new IgE targeting therapies (Incorvaia et al., 2017; Lupinek et al., 2017). Through the characterization of the diseases-causing allergens by molecular cloning techniques, new forms of molecular allergy diagnosis based on allergen molecules have emerged (Lupinek et al., 2014). The new molecular tests allow not only to discriminate between clinically relevant and irrelevant IgEsensitizations but also to establish IgE reactivity profiles associated with allergic asthma (Resch et al., 2015) and, even to predict the development of respiratory allergy early in childhood (Westman et al., 2015). Furthermore, it seems possible for allergen-derivatives lacking IgE reactivity to discriminate mechanisms of allergen-IgE-mediated allergic inflammation from non-IgE-mediated allergic inflammation, which may help to direct IgE-mast cell-targeting treatments and T cell targeting therapies (Campana et al., 2016). In patients suffering from allergic asthma, allergen-specific immunotherapy (AIT) is currently emerging as an alternative to symptomatic treatment. In fact, several clinical studies have shown that AIT is effective for asthma (Yukselen, 2016). Moreover, new forms of AIT based on recombinant hypoallergenic allergen-derivatives have been shown