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Review
. 2022 Mar 25:3:852067.
doi: 10.3389/falgy.2022.852067. eCollection 2022.

Impact of Therapeutics on Unified Immunity During Allergic Asthma and Respiratory Infections

Armando S Flores-Torres  1   2 , Amali E Samarasinghe  1   2
Affiliations
Review

Impact of Therapeutics on Unified Immunity During Allergic Asthma and Respiratory Infections

Armando S Flores-Torres et al. Front Allergy. .

Abstract

Asthma is a common chronic respiratory disease that affects millions of people worldwide. Patients with allergic asthma, the most prevalent asthma endotype, are widely considered to possess a defective immune response against some respiratory infectious agents, including viruses, bacteria and fungi. Furthermore, respiratory pathogens are associated with asthma development and exacerbations. However, growing data suggest that the immune milieu in allergic asthma may be beneficial during certain respiratory infections. Immunomodulatory asthma treatments, although beneficial, should then be carefully prescribed to avoid misuse and overuse as they can also alter the host microbiome. In this review, we summarize and discuss recent evidence of the correlations between allergic asthma and the most significant respiratory infectious agents that have a role in asthma pathogenesis. We also discuss the implications of current asthma therapeutics beyond symptom prevention.

Keywords: allergic asthma; asthma therapy; eosinophils; microbiome; respiratory infection; respiratory virus.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Differing effects of respiratory infections on asthma. Viral, bacterial and fungal respiratory infections are associated with asthma onset and exacerbation. The immune response in allergic asthma is defective against respiratory viruses and bacteria in some scenarios and promote antiviral and antibacterial immunity in other contexts. Allergy and respiratory pathogens may also synergize to increase inflammation and damage in asthma. On the contrary, some bacteria are able to suppress allergic inflammation. Specific bacteria are linked to T2-low asthma, steroid resistance and immune response impairment. Fungal sensitization/infection in allergic asthma is associated with disease severity and higher corticosteroid requirement.
Figure 2
Figure 2
Complex interactions between asthma, asthma therapeutics, and vaccination. Corticosteroids are commonly used for asthma symptom control/prevention, but they alter the airway microbiome. Biologic therapy approved for asthma targets T2 immune response, but their effect during respiratory infections remains unclear. Antivirals may be useful for some asthma patients. Antibiotics cause alterations in the microbiome, are implicated in asthma development and severity, and cause impaired immune responses during viral and bacterial respiratory infections. Influenza vaccine is recommended for patients with asthma, although the usefulness of pneumococcal vaccination is controversial.
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