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Tuesday, August 5, 2014

Risks for infection in patients with asthma (or other atopic conditions): is asthma more than a chronic airway disease?


There is evidence that the presence of asthma can influence patients’ susceptibility to infections, yet research in this aspect of asthma has been limited. Additionally, there is a debate in the field with current literature tending to suggest an increased risk of infection among atopic patients as due to opportunistic infections secondary to airway inflammation, especially in severe atopic diseases. Other evidence suggests that such risk and its underlying immune dysfunction may be a phenotypic or clinical feature of atopic conditions. In his review, Young J. Juhn argues that improved understanding of the effects of atopic conditions on the risk of microbial infections will bring important new perspectives to clinical practice, research, and public health concerning atopic conditions [J Allergy Clin Immunol 2014; 134(2): 247-57].
The review focuses on the effect of atopic conditions on the risk of infections, termed reverse causality. For example, asthma is associated with a broad range of common and serious viral and bacterial respiratory tract infections controlled by different types of immunity (e.g. Th1 or Th2). However, given the association of atopic dermatitis and allergic rhinitis with risks of such infections, the results may imply that immunologic dysfunctions might have a role, while the structural alterations of airways observed in asthma may also need to be taken into account. Furthermore, research suggests that the effects of asthma on risk of infection may not be limited to the airways but go beyond the airways, for example, patients with asthma have an increased risk of contracting various types of herpes viruses.

 As effects of atopic conditions on the risks of various infectious diseases emerge, it will be increasingly necessary to address a broader range of patient care issues in the current guidelines. Also, the roles of allergists, immunologists, and pulmonologists may be broader in the future. This review provides insight into the foreseeable needs and challenges of the effects of atopic conditions.

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