Type 2 immunity in asthma

• Main Authors: Marco Caminati, Duy Le Pham, Diego Bagnasco, Giorgio Walter Canonica
• Format: Article
• Language: English
• Published: Elsevier 2018-06-01
• Series: World Allergy Organization Journal
• Subjects: Innate immunity; Adaptive immunity; Type 2 inflammation; Asthma; Severe asthma; Allergic sensitization
• Online Access: http://link.springer.com/article/10.1186/s40413-018-0192-5

Abstract Type 2-immunity represents the typical adaptive response to allergen exposure in atopic individuals. It mainly involves Th2 cells and immunoglobulin E, as the main orchestrators of type 2-inflammation. Recently, it has been highlighted that allergens may be responsible for a Th2 response beside specific IgE activation and that a number of other environmental stimuli, such as viruses and pollutants, can trigger the same pattern of inflammation beyond atopy. Emerging data sustain a substantial role of the so-called epithelial dysfunction in asthma pathogenesis, both from anatomic and functional point of view. Furthermore an increasing amount of evidence demonstrates the relevance of innate immunity in polarizing a Th2 impaired response in asthmatic patients. Under this perspective, the complex cross-talking between airway epithelium, innate and adaptive immunity is emerging as a major determinant of type 2-inflammation beyond allergens. This review will include an update on the relevance of dysregulation of innate and adaptive type 2-immunity in asthma pathogenesis, particularly severe asthma, and on the role of the allergens that are associated with severe asthma. Type 2-immunity also will be reviewed in the light of the current and upcoming targeted treatments for severe asthma.