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Patients with symptoms suggestive of asthma but negative bronchodilator testing are commonly seen in usual practice. In this population, the association of high FeNO levels and BHR to atopy, as well as to AERD, suggests the presence eosinophilic inflammation in both the upper and lower airways and supports the "one airway" hypothesis.

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A 56-year-old woman presented to the emergency room after two weeks of experiencing progressive dyspnea and a dry cough. She had a 35-year history of Crohn's disease and had had a colectomy at 28 years of age. She had suffered recurrent episodes of pouchitis, which, due to infliximab, was in clinical remission. Two months after starting treatment, she developed painful subcutaneous nodules on the lower limbs and around the elbows, arthralgia in the knees, increasing fatigue, and occasional fever. Her gastroenterologist discontinued anti-TNF treatment and referred her for a skin biopsy; this showed granulomatous inflammatory infiltrates in the deep subcutaneous fat, with giant cells, histiocytes, and few lymphocytes (Figure 1) Necrosis was not present. The differential diagnosis included atypical erythema nodosum, atypical sarcoidosis, and cutaneous Crohn's disease.Blood tests revealed a sedimentation rate of 30 mm/h, a Creactive protein level of 20 mg/L, an elevated angiotensin-converting enzyme (ACE) level of 134 U/L (N < 8-52) , and positive antinuclear antibodies, with antideoxyribonucleic acid antibodies of 33 U/mL (N < 30). In the extractable nuclear antigen (ENA) profile, the centromere B