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Asthma Biomarkers: Do They Bring Precision Medicine Closer to the Clinic?
Ioana Agache,Liliana Rogozea 대한천식알레르기학회 2017 Allergy, Asthma & Immunology Research Vol.9 No.6
Measurement of biomarkers has been incorporated within clinical research of asthma to characterize the population and to associate the disease with environmental and therapeutic effects. Regrettably, at present, there are no specific biomarkers, none is validated or qualified, and endotype-driven choices overlap. Biomarkers have not yet reached clinical practice and are not included in current asthma guidelines. Last but not least, the choice of the outcome upholding the value of the biomarkers is extremely difficult, since it has to reflect the mechanistic intervention while being relevant to both the disease and the particular person. On the verge of a new age of asthma healthcare standard, we must embrace and adapt to the key drivers of change. Disease endotypes, biomarkers, and precision medicine represent an emerging model of patient care building on large-scale biologic databases, omics and diverse cellular assays, health information technology, and computational tools for analyzing sizable sets of data. A profound transformation of clinical and research pattern from population to individual risk and from investigator-imposed subjective disease clustering (hypothesis driven) to unbiased, data-driven models is facilitated by the endotype/biomarker-driven approach.
Critical Points on the Use of Biologicals in Allergic Diseases and Asthma
Ioana Agache,Catalina Cojanu,Alexandru Laculiceanu,Liliana Rogozea 대한천식알레르기학회 2020 Allergy, Asthma & Immunology Research Vol.12 No.1
Improved understanding of the contribution of immune-inflammatory mechanisms in allergic diseases and asthma has encouraged development of biologicals and small molecules specifically targeting the innate and adaptive immune response. There are several critical points impacting the efficacy of this stratified approach, from the complexity of disease endotypes to the effectiveness in real-world settings. We discuss here how these barriers can be overcome to facilitate the development of implementation science for allergic diseases and asthma.
The Concept of One Health for Allergic Diseases and Asthma
Agache Ioana,Laculiceanu Alexandru,Spanu Daniela,Grigorescu Dan 대한천식알레르기학회 2023 Allergy, Asthma & Immunology Research Vol.15 No.3
The worldwide prevalence of allergic disease is rising as a result of complex gene-environment interactions that shape the immune system and host response. Climate change and loss of biodiversity are existential threats to humans, animals, plants, and ecosystems. While there is significant progress in the development of targeted therapeutic options to treat allergies and asthma, these approaches are inadequate to meet the challenges faced by climate change. The exposomic approach is needed with the recognition of the bidirectional effect between human beings and the environment. All stakeholders need to work together toward mitigating the effects of climate change and promoting a One Health concept in order to decrease the burden of asthma and allergy and to improve immune health. Healthcare professionals should strive to incorporate One Health counseling, environmental health precepts, and advocacy into their practice.
Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines—2016 revision
Broż,ek, Jan L.,Bousquet, Jean,Agache, Ioana,Agarwal, Arnav,Bachert, Claus,Bosnic-Anticevich, Sinthia,Brignardello-Petersen, Romina,Canonica, G. Walter,Casale, Thomas,Chavannes, Niels H.,Correia Elsevier 2017 The journal of allergy and clinical immunology Vol.140 No.4
<P><B>Background</B></P> <P>Allergic rhinitis (AR) affects 10% to 40% of the population. It reduces quality of life and school and work performance and is a frequent reason for office visits in general practice. Medical costs are large, but avoidable costs associated with lost work productivity are even larger than those incurred by asthma. New evidence has accumulated since the last revision of the Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines in 2010, prompting its update.</P> <P><B>Objective</B></P> <P>We sought to provide a targeted update of the ARIA guidelines.</P> <P><B>Methods</B></P> <P>The ARIA guideline panel identified new clinical questions and selected questions requiring an update. We performed systematic reviews of health effects and the evidence about patients' values and preferences and resource requirements (up to June 2016). We followed the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) evidence-to-decision frameworks to develop recommendations.</P> <P><B>Results</B></P> <P>The 2016 revision of the ARIA guidelines provides both updated and new recommendations about the pharmacologic treatment of AR. Specifically, it addresses the relative merits of using oral H<SUB>1</SUB>-antihistamines, intranasal H<SUB>1</SUB>-antihistamines, intranasal corticosteroids, and leukotriene receptor antagonists either alone or in combination. The ARIA guideline panel provides specific recommendations for the choice of treatment and the rationale for the choice and discusses specific considerations that clinicians and patients might want to review to choose the management most appropriate for an individual patient.</P> <P><B>Conclusions</B></P> <P>Appropriate treatment of AR might improve patients' quality of life and school and work productivity. ARIA recommendations support patients, their caregivers, and health care providers in choosing the optimal treatment.</P>