Defining

1
Defining Asthma and Allergy Phenotypes
2
Risk factors and phenotypes vary over time
H E A L T H O U T C O M E S
M A C R O S O C I A L E N V T
E N V I R O N M E N T
M I C R O S O C I A L
S U B C L I N I C A L
LIFE COURSE PERSPECTIVE
C L I N I C A L
Psycho-neuro-endocrine cascades Psycho-neuro-immun
e cascades (Physiological Reactions)
3
Allergy and Asthma are manifestations of complex
and dynamic networks
Environmental component
Genetic component
Allergen exposures Lifestyle Medications etc
SNPs, CNVs, etc.
Genes and pathways
Cell, immune, and inflammatory phenotypes, etc.
Bronchoconstriction, Mucus Secretion,
Hyperreactivity, IgE levels, Airway Structure
4
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)

5
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 ()

6

Listing phenotypes is easier than defining them
How do you define asthma?

• 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.

7

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