Toward precision medicine and health: Opportunities and challenges in allergic diseases

Abstract

“Precision Medicine” (also called “Personalized”, “Stratified” or “P4” Medicine) can be defined as the tailoring of preventive measures and medical treatments to the characteristics of each patient to obtain the best clinical outcome for each person while, ideally, also enhancing the cost-effectiveness of such interventions for individuals and society. Clearly, the “best clinical outcome” in allergic diseases is not to get them in the first place. To emphasize the importance of disease prevention, a critical component of Precision Medicine can be referred to as “Precision Health”, defined herein as the use of all available information pertaining to specific individuals (including family history, individual genetic and other biometric information, and exposures to risk factors for developing or exacerbating disease), as well as features of their environments, to sustain and enhance health and prevent the development of disease. In this article, I will provide a personal perspective on how the “Precision Health-Precision Medicine” approach can be applied to the related goals of preventing the development of allergic disorders and providing the most effective diagnosis, “disease monitoring”, and care for those who suffer from these prevalent diseases. I will also mention some of the existing and potential challenges to achieving these ambitious goals.

Immune monitoring for precision medicine in allergy and asthma

“…In their seminal description of therapeutic immunization with grass pollen extract of subjects suffering from grass pollen allergic rhinitis, Noon and Freeman recognized that the allergen therapy needed to match the cause of the patient’s disease[1–3]. Accordingly, as recently reviewed[4], a foundation of “Precision Medicine” in modern allergology is the initial identification of the patient’s allergic sensitivities prior to forming a plan of treatment, and the assessment of how those sensitivities may be altered by immunotherapy (IT).…”

“…1). The traditional randomized clinical trial[4,5] will still remain the gold standard for assessing the safety and efficacy of any medical intervention. However, recent studies suggest that improved immune monitoring assays may be able to improve our ability to diagnose and evaluate immunological diseases, and predict therapeutic outcomes and side effects.…”

Precíziós és perszonalizált medicina

“…-Ajánlások történnek a kezelések endotípustól függő, eltérő módozataira az asztma, az allergiás rhinitis és az atopiás dermatitis betegségtípusokon belül [4]. -Az allergiás betegségek megelőzésének, diagnózisá-nak, követésének és kezelésének korábbinál hatéko-nyabb, új útjainak bemutatására formálódnak megkö-zelítések [6]. -Az allergia "molekuláris diagnózisának" és a "precízi-ós medicina" szemléletnek összekapcsolása indult el [7].…”

Identificação de proteínas IgE- reativas do camarão sete-barbas (Xiphopenaeus kroyeri)

“…Consequentemente, identificar primeiro o alérgeno além de outros fatores que conduzem a doença em indivíduos alérgicos de forma individual antes de definir o tratamento mais adequado representa um dos melhores exemplos da importância crítica deste princípio geral 54 .…”

“…Para este fim, a classificação de fenótipos de doença em subclasses denominadas endótipos, isto é, a identificação de características definidas por mecanismos específicos, leva em consideração as variações associadas nas vias genéticas, farmacológicas, fisiológicas, biológicas e imunológicas com cada fenótipo. O tratamento dirigido a um indivíduo com base no perfil endotípico, em vez de no perfil fenotípico, passou a ser denominado por consenso como medicina de precisão ou personalizada 54,55 .…”