The Emerging Role of the Type 2 Inflammatory Cascade in Atopic Diseases

Published July 2, 2019
Supplements and Featured Publications, Therapeutic Advances in the Management of Type 2 Inflammatory Disease,

Latest News: TYPE 2 INFLAMMATION MAY BE A CLEAR CONNECTION. Look for signs of Type 2 inflammation when evaluating your patients. Type 2 inflammation is characterized by immune dysregulation and epithelial barrier dysfunction—both provide evidence of Type 2 pathway activation in disease.1,2 References: 1. Gandhi NA, Bennett BL, Graham NMH, Pirozzi G, Stahl N, Yancopoulos GD. Targeting key proximal drivers of type 2 inflammation in disease. Nat Rev Drug Discov. 2016;15(1):35-50. 2. Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention, 2020. Accessed August 31, 2020.

Atopic diseases pose a considerable and growing public health burden, affecting millions of patients worldwide, with the greatest impact on children and young adults. Often, multiple atopic conditions coexist in affected patients,1 which suggests that an integrated approach to diagnosis and treatment may be beneficial for both patients and healthcare practitioners. Recent research and development of new pharmacologic agents to treat allergic conditions have focused on the type 2 inflammatory response, which is a pathologic process common to several inflammatory and infectious conditions.2 Type 2 inflammation is characterized by high levels of immunoglobulin E (IgE) and eosinophils and is regulated by certain immune mediators.3

This article reviews the clinical and economic burden of asthma, atopic dermatitis (AD), and chronic rhinosinusitis with nasal polyps (CRSwNP), all of which are type 2 inflammatory diseases. It also explores the type 2 inflammatory cascade in each of these conditions and the basis for type 2 inflammation as an underlying process in atopic diseases more generally.

The Clinical and Economic Burden of Atopic DiseasesAsthma

Asthma is a chronic respiratory condition that affects patients across the lifespan, from childhood to old age.4 Patients with asthma experience exacerbations, which are periods of reversible airway obstruction that lead to symptoms such as chest tightness, coughing, wheezing, shortness of breath, and sputum production.4-6 In the past, asthma was viewed as a single disease entity characterized by airway inflammation, reversible airflow obstruction, and bronchial hyperresponsiveness.7,8 Over time, however, this understanding has evolved. Asthma is now recognized as a heterogenous disease that varies in etiology, symptom triggers, clinical presentation, and response to treatment.9,10 In particular, recent evidence points to defective epithelial barrier function and junctional complexes as a prominent feature of airway inflammation in asthma.