Defining Asthma and Allergy Phenotypes. M A C R O S O C I A L E N V T M I C R O S O C I A L LIFE COURSE PERSPECTIVE Psycho-neuro-endocrine cascades Psycho-neuro-immune.

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Defining Asthma and Allergy Phenotypes

M A C R O S O C I A L E N V T M I C R O S O C I A L LIFE COURSE PERSPECTIVE Psycho-neuro-endocrine cascades Psycho-neuro-immune cascades (Physiological Reactions) SUBCLINICALSUBCLINICAL CLINICALCLINICAL HEALTHOUTCOMESHEALTHOUTCOMES ENVIRONMENTENVIRONMENT Risk factors and phenotypes vary over time

Genetic component Environmental component SNPs, CNVs, etc. Genes and pathways Allergen exposures Lifestyle Medications etc… Cell, immune, and inflammatory phenotypes, etc. Bronchoconstriction, Mucus Secretion, Hyperreactivity, IgE levels, Airway Structure Allergy and Asthma are manifestations of complex and dynamic networks

Phenotypes Mentioned on Day 1 - Response to methacholine, histamine, allergen - Skin tests - Levels of chemical mediators (“smoked drum”) - Airway epithelium, histology, remodelling, function - Rhinitis - Age of Onset, Persistant vs Intermittent Patterns - Wheezing - Severity, hospitalizations, medication use - BMI - Skin phenotypes (atopic dermatitis)

Phenotypes Mentioned on Day 1 (more) - Cellular Phenotypes (Eosinophils, B cells, T cells, etc.) - IgE levels - TH1 vs TH2 - IgE production - Chemical Mediators - Nitric Oxide - Proteomics (…) - Transcriptomics (…) - Metabolomics (…)

- Questionnaire: Do you have asthma? Have you has asthma in the past? - Physician Diagnosis - Medical records - Use of asthma medications - Registry/Health Care Databases - etc. Listing phenotypes is easier than defining them How do you define asthma?

Having standard definitions is more important than having perfect definitions Francine Kauffman