The unified immune system: Respiratory tract–nasobronchial interaction mechanisms in allergic airway disease

Braunstahl, Gert‐Jan

doi:10.1016/j.jaci.2004.10.041

Cited by 98 publications

(82 citation statements)

References 93 publications

(95 reference statements)

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“…7,23 The measurement of inflammatory parameters in the nasal and in the bronchial compartments may provide information about the general inflammatory status and about the requirement of a local anti-inflammatory therapy in the absence of clinical evidence.…”

Section: Discussionmentioning

confidence: 99%

“…26 Moreover, the trend to the increase of oral FE NO in AD and AR with respect to controls supports the hypothesis that this marker might predict and monitor the increased risk to develop bronchial inflammation in atopic children 4 even in the absence of symptoms of asthma. 23 The concept of an association between the FE NO and the airway inflammation in children is supported by the presence, in AR, of a significant increase of nasal FE NO and of a positive correlation between the nasal FE NO and the levels of nasal IL-5 in EBC. Accordingly, we also found a positive correlation between the nasal FE NO and the duration of rhinitis.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Noninvasive methods for the detection of upper and lower airway inflammation in atopic children

Profita

Grutta²,

Carpagnano

et al. 2006

Journal of Allergy and Clinical Immunology

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Noninvasive methods for the detection of upper and lower airway inflammation in atopic children

Profita

Grutta²,

Carpagnano

et al. 2006

Journal of Allergy and Clinical Immunology

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“…The above-mentioned studies demonstrate that AR is not just a local disease but that the entire respiratory tract is involved, even in the absence of clinical asthma [21].…”

Section: Pathophysiologic Evidencementioning

confidence: 98%

“…The common AR and asthma immunopathology and immunopathophysiology has been shown in a number of studies and several mechanisms have been held responsible for this interaction: the respiratory (unprotected lower airways due to reduced filter and air-conditioning function of the nose), neural (nasobronchial reflex), and circulatory pathway [21]. The latter, concerning the systemic dissemination of inflammation, is considered the most relevant factor.…”

Section: Pathophysiologic Evidencementioning

confidence: 99%

Pediatric Allergic Rhinitis and Asthma: Can the March be Halted?

et al. 2013

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The strong epidemiologic and pathophysiologic link between allergic rhinitis (AR) and asthma has led to the concept of 'united airways disease' or 'respiratory allergy', implying that allergy, in its widest sense, underlies this clinical syndrome. Progression from AR to asthma is frequent and part of the 'atopic march'. Since pediatric immune responses are more adaptable and therefore may be more amenable to treatment, interventions at early childhood are characterized by a higher chance to affect the natural history of respiratory allergy. Although current treatments are quite effective in alleviating respiratory allergy symptoms, it has proven much more difficult to confirm any influence on the progression of the disease. Much more promising is the field of specific allergen immunotherapy, where current evidence, although not yet of ideal robustness, points towards a disease-modifying effect. In addition, newer or emerging, possibly more effective or more targeted interventions are promising in the preventive sense.

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“…3,4 As a result, the term 'one airway' or 'united airways' have been established. [5][6][7] In fact, up to 40% of allergic rhinitis (AR) patients report asthma symptoms and up to 80% of asthmatics have symptomatic AR. 8 Chronic rhinosinusitis (CRS) and asthma severity also co-associate.…”

Section: Introductionmentioning

confidence: 99%

Upper and lower airway remodelling mechanisms in asthma, allergic rhinitis and chronic rhinosinusitis: The one airway concept revisited

Samitas

Carter

Kariyawasam

et al. 2017

Allergy

211

156

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Allergic rhinitis (AR), chronic rhinosinusitis (CRS) and asthma often co-exist. The one airway model proposes that disease mechanisms occurring in the upper airway may mirror lower airway events. Airway remodelling is the term used to describe tissue structural changes that occur in a disease setting and reflect the dynamic process of tissue restructuring during wound repair. Remodelling has been long identified in the lower airways in asthma and is characterized by epithelial shedding, goblet cell hyperplasia, basement membrane thickening, subepithelial fibrosis, airway smooth muscle hyperplasia and increased angiogenesis. The concept of upper airway remodelling has only recently been introduced, and data so far are limited and often conflicting, an indication that more detailed studies are needed. Whilst remodelling changes in AR are limited, CRS phenotypes demonstrate epithelial hyperplasia, increased matrix deposition and degradation along with accumulation of plasma proteins. Despite extensive research over the past years, the precise cellular and molecular mechanisms involved in airway remodelling remain incompletely defined. This review describes our current rather limited understanding of airway remodelling processes in AR, CRS and asthma and presents mechanisms both shared and distinct between the upper and lower airways. Delineation of shared and disease-specific pathogenic mechanisms of remodelling between the sinonasal system and the lung may guide the rational design of more effective therapeutic strategies targeting upper and lower airways concomitantly and improving the health of individuals with inflammatory airway diseases.

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The unified immune system: Respiratory tract–nasobronchial interaction mechanisms in allergic airway disease

Cited by 98 publications

References 93 publications

Noninvasive methods for the detection of upper and lower airway inflammation in atopic children

Noninvasive methods for the detection of upper and lower airway inflammation in atopic children

Pediatric Allergic Rhinitis and Asthma: Can the March be Halted?

Upper and lower airway remodelling mechanisms in asthma, allergic rhinitis and chronic rhinosinusitis: The one airway concept revisited

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