Intrinsic Asthma

Rackemann, Francis M.; Burrage, Walter S.; Irwin, John W.

doi:10.1080/00325481.1950.11693978

Cited by 13 publications

(5 citation statements)

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“…Because the original classification of intrinsic asthma by Rackemann, it has been recognized that there is less familial association with intrinsic asthma than with extrinsic asthma [9]. This may be expected in view of the strong genetic predisposition to atopy and allergy, but it also indicates that environmental factors may be more important in the causation of intrinsic asthma.…”

Section: Clinical Phenotypesmentioning

confidence: 99%

Intrinsic asthma: not so different from allergic asthma but driven by superantigens?

Barnes

2009

Clin Experimental Allergy

110

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The mechanisms of intrinsic or non-allergic asthma remain uncertain as allergens have no obvious role in driving the inflammatory process in the airways. However, IgE synthesis occurs in the airways, despite negative skin prick tests and serum-specific IgE. Furthermore, the inflammatory process in the airways is very similar between allergic and non-allergic asthma, with increased T-helper type 2 (Th2) cells, mast cell activation and infiltration of eosinophils. This pattern of inflammation is associated with a similar expression of inflammatory mediators, including Th2 cytokines and eosinophilotactic chemokines. There is increasing evidence that microbial superantigens, particularly Staphylococcal enterotoxins are important in amplifying inflammation in atopic dermatitis and chronic rhinosinusitis, in atopic and non-atopic patients. Superantigens may also be important in intrinsic asthma as airway epithelial cells may be colonized by Staphylococci and other superantigen-producing microbes. Superantigens produced locally in the airways may lead to class switching of local B cells, resulting in polyclonal IgE production in the airways and also specific IgE against the superantigen (which functions as a 'superallergen'). This leads to sensitization of mast cells, which can be activated by the usual asthma triggers, such as exercise. Superantigens also cause clonal expansion of T cells, resulting in increased Th2 cells and CD8(+) cells, while suppressing regulatory T cells. Superantigens may also reduce responsiveness to corticosteroids, resulting in more severe asthma. Finally, cytotoxic autoantibodies may also be implicated as IgG antibodies directed against epithelial proteins, such as cytokeratin-18, have been detected in intrinsic asthma, possibly as a result of epithelial damage and this may make epithelial cells more susceptible to microbial colonization. The therapeutic implications are that antibodies against local IgE and microbial superantigens or antibiotic therapy to eradicate the relevant superantigen-producing microorganisms may improve the efficacy of conventional therapy with corticosteroids.

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Section: Clinical Phenotypesmentioning

confidence: 99%

Intrinsic asthma: not so different from allergic asthma but driven by superantigens?

Barnes

2009

Clin Experimental Allergy

110

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“…Zudem fehlen, im Gegensatz zum Asthma, bei der COPD oft nächtliche respiratorische Symptome (schon 1947 schrieb Francis M. Rackemann: "Emphysema sleeps well. In asthma, however, the nights are bad" [147]). Es ist aber zu berücksichtigen, dass auch Mischbilder aus Asthma und COPD vorliegen können.…”

Section: Erwachsenenalterunclassified

S2k-Leitlinie zur fachärztlichen Diagnostik und Therapie von Asthma 2023

et al. 2023

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ZusammenfassungDas Management von Asthma hat sich in den letzten Jahrzehnten fundamental gewandelt. Die vorliegende Leitlinie zur Diagnostik und Therapie von Asthma wurde für pneumologisch tätige Fachärztinnen und Fachärzte entwickelt, welche detaillierte und evidenzbasierte Informationen zu den neuen diagnostischen und therapeutischen Optionen von Asthma benötigen. Die Leitlinie zeigt die neue Bedeutung der Biomarker, insbesondere der Bluteosinophilen und des exhalierten NO (FeNO), in den diagnostischen Algorithmen von Asthma. Als erste Asthma-Leitlinie weltweit benennt die vorliegende Leitlinie die nachhaltige Symptomprävention und die Asthma-Remission als Asthma-Therapieziele, welche durch den Einsatz individuell angepasster, krankheitsmodifizierender Medikamente (wie inhalative Steroide, Allergenimmuntherapie oder Biologika) erreicht werden können. Die zentrale Bedeutung der Behandlung von typischen Asthma-Komorbiditäten wird zudem betont. Schließlich wird auch auf besondere Herausforderungen im Asthma-Management eingegangen, wie bspw. die Therapie von Asthma in der Schwangerschaft, die Behandlung von schwerem Asthma oder die Diagnostik und Therapie von arbeitsbedingten Asthma-Formen.

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“…Early work conceptualized asthma as extrinsic (allergic) and intrinsic (nonallergic) [59]. However, the recent use of unbiased approaches to classify disease using three large datasets and cluster analysis [60][61][62] has highlighted the different types of disease under the umbrella term asthma (Figure 28.5).…”

Section: Adult Asthmamentioning

confidence: 99%