lvrachЛечащий ВрачLechaschi Vrach1560-51752687-1181ООО «Издательство "Открытые системы"»lvrach-392Research ArticleСтатьиНеатопическая астма. Распространенность, клиника, лечениеNon-atopic asthma: prevalence, clinical picture, treatmentМачарадзеД. Ш.MacharadzeD. Sh.noemail@neicon.ruЯнаеваХ. А.YanaevaKh. A.noemail@neicon.ruФГАОУ ВО РУДНRussian FederationМедицинский центр «Планета здоровья»Russian Federation2019230620210466Copyright © Мачарадзе Д.Ш., Янаева Х.А., 20212021Мачарадзе Д.Ш., Янаева Х.А.Macharadze D.S., Yanaeva K.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.lvrach.ru/jour/article/view/392

В статье приведены основные понятия о неатопической астме отдельно и эндотипах и фенотипах астмы у детей и взрослых; рассмотрены подходы к фармакотерапии таких пациентов. Описан клинический случай неатопической астмы у ребенка 14 лет.

The article presents the basic concepts of non-atopic asthma separately and endotypes and phenotypes of asthma in children and adults; Approaches to the pharmacotherapy of these patients are considered. A clinical case of non-atopic asthma in a 14-year-old child is described. 

АллергологияИммунологияКлиникаЛечениеНеатопическаяПерсонализированная медицинаРаспространенностьСимпозиумТерапияФенотипыbronchial asthmanon-atopicphenotypesprevalencclinical picturetreatmentpersonalized medicineReferencesPeters S. Asthma phenotypes: nonallergic (intrinsic) asthma // J Allergy Clin Immunol Pract. 2014; 2: 650-652.Peters S. Asthma phenotypes: nonallergic (intrinsic) asthma // J Allergy Clin Immunol Pract. 2014; 2: 650-652.Pekkanen J., Lampi J., Genuneit J. et al. Analyzing atopic and non-atopic asthma // Eur J Epidemiol. 2012; 27: 281-286.Pekkanen J., Lampi J., Genuneit J. et al. Analyzing atopic and non-atopic asthma // Eur J Epidemiol. 2012; 27: 281-286.Douwes J., Gibson P., Pekkanen J. et al. Non-eosinophilic asthma: importance and possible mechanisms // Thorax. 2002; 57: 643-648.Douwes J., Gibson P., Pekkanen J. et al. Non-eosinophilic asthma: importance and possible mechanisms // Thorax. 2002; 57: 643-648.Yoo H., Shin Y., Liu J. et al. Clinical significance of immunoglobulin E responses to staphylococcal superantigens in patients with aspirin-exacerbated respiratory disease // Int Arch Allergy Immunol. 2013; 162: 340-345.Yoo H., Shin Y., Liu J. et al. Clinical significance of immunoglobulin E responses to staphylococcal superantigens in patients with aspirin-exacerbated respiratory disease // Int Arch Allergy Immunol. 2013; 162: 340-345.Hancox R., Cowan D., Aldridge R. et al. Asthma phenotypes: consistency of classification using induced sputum // Respirology. 2012; 17: 461-466.Hancox R., Cowan D., Aldridge R. et al. Asthma phenotypes: consistency of classification using induced sputum // Respirology. 2012; 17: 461-466.Fleming L., Tsartsali L., Wilson N. et al. Sputum inflammatory phenotypes are not stable in children with asthma // Thorax. 2012; 67: 675-681.Fleming L., Tsartsali L., Wilson N. et al. Sputum inflammatory phenotypes are not stable in children with asthma // Thorax. 2012; 67: 675-681.Anderson G. Endotyping asthma: new insights into key pathogenic mechanisms in a complex, heterogeneous disease // Lancet. 2008; 372 (9643): 1107-1019.Anderson G. Endotyping asthma: new insights into key pathogenic mechanisms in a complex, heterogeneous disease // Lancet. 2008; 372 (9643): 1107-1019.Campo P., Rodriguez F., Sanchez-Garcia S. et al. Phenotypes and endotypes of uncontrolled severe asthma: new treatments // J Invest Allergol Clin Immunol. 2013; 23: 76-88.Campo P., Rodriguez F., Sanchez-Garcia S. et al. Phenotypes and endotypes of uncontrolled severe asthma: new treatments // J Invest Allergol Clin Immunol. 2013; 23: 76-88.Agache I., Sugita K., Morita H., Akdis M., Akdis C. A. The complex type 2 endotype in allergy and asthma: from laboratory to bedside // Curr Allergy Asthma Rep. 2015; 15 (6): 29.Agache I., Sugita K., Morita H., Akdis M., Akdis C. A. The complex type 2 endotype in allergy and asthma: from laboratory to bedside // Curr Allergy Asthma Rep. 2015; 15 (6): 29.Martin P., Matheson M., Gurrin L., Burgess J. A., Osborne N., Lowe A. J. et al. Childhood eczema and rhinitis predict atopic but not nonatopic adult asthma: a prospective cohort study over 4 decades // J Allergy Clin Immunol. 2011; 127: 1473-1479.Martin P., Matheson M., Gurrin L., Burgess J. A., Osborne N., Lowe A. J. et al. Childhood eczema and rhinitis predict atopic but not nonatopic adult asthma: a prospective cohort study over 4 decades // J Allergy Clin Immunol. 2011; 127: 1473-1479.Fahy J. Type 2 inflammation in asthma-present in most, absent in many // Nat Rev Immunol. 2015; 15: 57-65.Fahy J. Type 2 inflammation in asthma-present in most, absent in many // Nat Rev Immunol. 2015; 15: 57-65.Corren J. Asthma phenotypes and endotypes: an evolving paradigm for classification // Disc Med. 2013; 15: 243-249.Corren J. Asthma phenotypes and endotypes: an evolving paradigm for classification // Disc Med. 2013; 15: 243-249.Agache I. From phenotypes to endotypes to asthma treatment // Curr Opin Allergy Clin Immunol. 2013; 13: 249-256.Agache I. From phenotypes to endotypes to asthma treatment // Curr Opin Allergy Clin Immunol. 2013; 13: 249-256.Chien J., Lin C. Y., Yang K. D., Lin C. H., Kao J. K., Tsai Y. Increased IL-17A secreting CD4+ T cells, serum IL-17 levels and exhaled nitric oxide are correlated with childhood asthma severity // Clin Exp Allergy. 2013; 43: 1018-1020.Chien J., Lin C. Y., Yang K. D., Lin C. H., Kao J. K., Tsai Y. Increased IL-17A secreting CD4+ T cells, serum IL-17 levels and exhaled nitric oxide are correlated with childhood asthma severity // Clin Exp Allergy. 2013; 43: 1018-1020.Dejager L., Dendoncker K., Eggermont M., Souffriau J., van Hauwermeiren F., Willart M. et al. Neutralizing TNFalpha restores glucocorticoid sensitivity in a mouse model of neutrophilic airway inflammation // Mucosal Immunol. 2015; 8 (6): 1212-1225.Dejager L., Dendoncker K., Eggermont M., Souffriau J., van Hauwermeiren F., Willart M. et al. Neutralizing TNFalpha restores glucocorticoid sensitivity in a mouse model of neutrophilic airway inflammation // Mucosal Immunol. 2015; 8 (6): 1212-1225.Cosmi L., Maggi L., Santarlasci V., Capone M., Cardilicchia E., Frosali F. et al. Identification of a novel subset of human circulating memory CD4(+) T cells that produce both IL-17A and IL-4 // J Allergy Clin Immunol. 2010; 125: 222-230.Cosmi L., Maggi L., Santarlasci V., Capone M., Cardilicchia E., Frosali F. et al. Identification of a novel subset of human circulating memory CD4(+) T cells that produce both IL-17A and IL-4 // J Allergy Clin Immunol. 2010; 125: 222-230.Hasegawa Т., Uga Н., Mori А., Kurata Н. Increased serum IL-17A and Th2 cytokine levels in patients with severe uncontrolled asthma // Eur Cyt Network. 2017; 28: 8-18.Hasegawa Т., Uga Н., Mori А., Kurata Н. Increased serum IL-17A and Th2 cytokine levels in patients with severe uncontrolled asthma // Eur Cyt Network. 2017; 28: 8-18.Guibas G., Mathioudakis A., Tsoumani M., Tsabouri S. Relationship of Allergy with Asthma: There Are More Than the Allergy «Eggs» in the Asthma «Basket» // Front Pediatr. 2017, Apr 28; 5: 92.Guibas G., Mathioudakis A., Tsoumani M., Tsabouri S. Relationship of Allergy with Asthma: There Are More Than the Allergy «Eggs» in the Asthma «Basket» // Front Pediatr. 2017, Apr 28; 5: 92.Lotvall J., Akdis C. A., Bacharier L. B., Bjermer L., Casale T. B., Custovic A. et al. Asthma endotypes: a new approach to classification of disease entities within the asthma syndrome // J Allergy Clin Immunol. 2011, 127 (2): 355-360.Lotvall J., Akdis C. A., Bacharier L. B., Bjermer L., Casale T. B., Custovic A. et al. Asthma endotypes: a new approach to classification of disease entities within the asthma syndrome // J Allergy Clin Immunol. 2011, 127 (2): 355-360.Lawson J., Chu L., Rennie D., Hagel L., Karunanayake C., Pahwa P., Dosman J. Prevalence, risk factors, and clinical outcomes of atopic and nonatopic asthma among rural children // Ann Allergy Asthma Immunol. 2017; 118: 304-310.Lawson J., Chu L., Rennie D., Hagel L., Karunanayake C., Pahwa P., Dosman J. Prevalence, risk factors, and clinical outcomes of atopic and nonatopic asthma among rural children // Ann Allergy Asthma Immunol. 2017; 118: 304-310.Lukkarinen M., Koistinen A., Turunen R., Lehtinen P., Vuorinen T., Jartti T. Rhinovirus-induced first wheezing episode predicts atopic but not nonatopic asthma at school age // J Allergy Clin Immunol. 2017; 140: 988-995.Lukkarinen M., Koistinen A., Turunen R., Lehtinen P., Vuorinen T., Jartti T. Rhinovirus-induced first wheezing episode predicts atopic but not nonatopic asthma at school age // J Allergy Clin Immunol. 2017; 140: 988-995.Longo G., Conversano E., Panontin E., Ventura G., Ventura A. Nonatopic persistent asthma in children, a missed phenotype of asthma? // J Allergy Clin Immunol. 2017; 140: 1212-1213.Longo G., Conversano E., Panontin E., Ventura G., Ventura A. Nonatopic persistent asthma in children, a missed phenotype of asthma? // J Allergy Clin Immunol. 2017; 140: 1212-1213.Bacharier L., Boner A., Carlsen K. H., Eigenmann P., Frischer T., G?tz M., Helms P. J., Hunt J., Liu A., Papadopoulos N., Platts-Mills T., Pohunek P., Simons F. E., Valovirta E., Wahn U., Wildhaber J. European Pediatric Asthma Group. Diagnosis and treatment of asthma in childhood: a PRACTALL consensus report // Allergy. 2008; 63: 5-34.Bacharier L., Boner A., Carlsen K. H., Eigenmann P., Frischer T., G?tz M., Helms P. J., Hunt J., Liu A., Papadopoulos N., Platts-Mills T., Pohunek P., Simons F. E., Valovirta E., Wahn U., Wildhaber J. European Pediatric Asthma Group. Diagnosis and treatment of asthma in childhood: a PRACTALL consensus report // Allergy. 2008; 63: 5-34.Guiddir T., Saint-Pierre P., Purenne-Denis E. et al. Neutrophilic steroid-refractory recurrent wheeze and eosinophilic steroid-refractory asthma in children // J Allergy Clin Immunol Pract. 2017; 5: 1351-1361.Guiddir T., Saint-Pierre P., Purenne-Denis E. et al. Neutrophilic steroid-refractory recurrent wheeze and eosinophilic steroid-refractory asthma in children // J Allergy Clin Immunol Pract. 2017; 5: 1351-1361.Longo G., Conversano E., Panontin E., Ventura G., Ventura A. Nonatopic persistent asthma in children, a missed phenotype of asthma? // J Allergy Clin Immunol. 2017; 140: 1212-1213.Longo G., Conversano E., Panontin E., Ventura G., Ventura A. Nonatopic persistent asthma in children, a missed phenotype of asthma? // J Allergy Clin Immunol. 2017; 140: 1212-1213.Turato G., Barbato A., Baraldo S., Zanin M., Bazzan E., Lokar-Oliani K. et al. Nonatopic children with multitrigger wheezing have airway pathology comparable to atopic asthma // Am J Respir Crit Care Med. 2008; 178: 476-482.Turato G., Barbato A., Baraldo S., Zanin M., Bazzan E., Lokar-Oliani K. et al. Nonatopic children with multitrigger wheezing have airway pathology comparable to atopic asthma // Am J Respir Crit Care Med. 2008; 178: 476-482.Hallas H., Chawes B., Rasmussen M., Arianto L., Stokholm J., B?nnelykke K., Bisgaard H. Airway obstruction and bronchial reactivity from age 1 month until 13 years in children with asthma: A prospective birth cohort study // PLoS Med. 2019; 16 (1): e1002722.Hallas H., Chawes B., Rasmussen M., Arianto L., Stokholm J., B?nnelykke K., Bisgaard H. Airway obstruction and bronchial reactivity from age 1 month until 13 years in children with asthma: A prospective birth cohort study // PLoS Med. 2019; 16 (1): e1002722.Schreibern J., Br?ker B., Ehmann R., Bachert C. Nonatopic severe asthma might still be atopic: Sensitization toward Staphylococcus aureus enterotoxins.Schreibern J., Br?ker B., Ehmann R., Bachert C. Nonatopic severe asthma might still be atopic: Sensitization toward Staphylococcus aureus enterotoxins.Schatz M., Rosenwasser L. The allergic asthma phenotype // J Allergy Clin Immunol Pract. 2014; 2: 645-648.Schatz M., Rosenwasser L. The allergic asthma phenotype // J Allergy Clin Immunol Pract. 2014; 2: 645-648.Martin P. E., Matheson M. C., Gurrin L., Burgess J. A., Osborne N., Lowe A. J. et al. Childhood eczema and rhinitis predict atopic but not nonatopic adult asthma: a prospective cohort study over 4 decades // J Allergy Clin Immunol. 2011, 127 (6): 1473-1479.Martin P. E., Matheson M. C., Gurrin L., Burgess J. A., Osborne N., Lowe A. J. et al. Childhood eczema and rhinitis predict atopic but not nonatopic adult asthma: a prospective cohort study over 4 decades // J Allergy Clin Immunol. 2011, 127 (6): 1473-1479.Papadopoulos N. G., Arakawa H., Carlsen K. H., Custovic A., Gern J., Lemanske R., Le Souef P., M?kel? M., Roberts G., Wong G., Zar H., Akdis C. A., Bacharier L. B., Baraldi E., van Bever H. P., de Blic J., Boner A., Burks W., Casale T. B., Castro-Rodriguez J. A., Chen Y. Z., El-Gamal Y. M., Everard M. L., Frischer T., Geller M., Gereda J., Goh D. Y., Guilbert T. W., Hedlin G., Heymann P. W., Hong S. J., Hossny E. M., Huang J. L., Jackson D. J., de Jongste J. C., Kalayci O., A?t-Khaled N., Kling S., Kuna P., Lau S., Ledford D. K., Lee S. I., Liu A. H., Lockey R. F., L?drup-Carlsen K., L?tvall J., Morikawa A., Nieto A., Paramesh H., Pawankar R., Pohunek P., Pongracic J., Price D., Robertson C., Rosario N., Rossenwasser L. J., Sly P. D., Stein R., Stick S., Szefler S., Taussig L. M., Valovirta E., Vichyanond P., Wallace D., Weinberg E., Wennergren G., Wildhaber J., Zeiger R. S. International consensus on (ICON) pediatric asthma // Allergy. 2012 Aug; 67 (8): 976-997.Papadopoulos N. G., Arakawa H., Carlsen K. H., Custovic A., Gern J., Lemanske R., Le Souef P., M?kel? M., Roberts G., Wong G., Zar H., Akdis C. A., Bacharier L. B., Baraldi E., van Bever H. P., de Blic J., Boner A., Burks W., Casale T. B., Castro-Rodriguez J. A., Chen Y. Z., El-Gamal Y. M., Everard M. L., Frischer T., Geller M., Gereda J., Goh D. Y., Guilbert T. W., Hedlin G., Heymann P. W., Hong S. J., Hossny E. M., Huang J. L., Jackson D. J., de Jongste J. C., Kalayci O., A?t-Khaled N., Kling S., Kuna P., Lau S., Ledford D. K., Lee S. I., Liu A. H., Lockey R. F., L?drup-Carlsen K., L?tvall J., Morikawa A., Nieto A., Paramesh H., Pawankar R., Pohunek P., Pongracic J., Price D., Robertson C., Rosario N., Rossenwasser L. J., Sly P. D., Stein R., Stick S., Szefler S., Taussig L. M., Valovirta E., Vichyanond P., Wallace D., Weinberg E., Wennergren G., Wildhaber J., Zeiger R. S. International consensus on (ICON) pediatric asthma // Allergy. 2012 Aug; 67 (8): 976-997.Астафьева Н. Г., Гамова И. В., Удовиченко Е. Н. и др. Клинические фенотипы бронхиальной астмы у подростков: трудности диагностики и терапии // Лечащий Врач. 2015; (4): 20.Астафьева Н. Г., Гамова И. В., Удовиченко Е. Н. и др. Клинические фенотипы бронхиальной астмы у подростков: трудности диагностики и терапии // Лечащий Врач. 2015; (4): 20.Lawson J., Chu L., Rennie D., Hagel L., Karunanayake C., Pahwa P., Dosman J. Prevalence, risk factors, and clinical outcomes of atopic and nonatopic asthma among rural children // Ann Allergy Asthma Immunol. 2017; 118: 304-310.Lawson J., Chu L., Rennie D., Hagel L., Karunanayake C., Pahwa P., Dosman J. Prevalence, risk factors, and clinical outcomes of atopic and nonatopic asthma among rural children // Ann Allergy Asthma Immunol. 2017; 118: 304-310.Lukkarinen M., Koistinen A., Turunen R., Lehtinen P., Vuorinen T., Jartti T. Rhinovirus-induced first wheezing episode predicts atopic but not nonatopic asthma at school age // J Allergy Clin Immunol. 2017; 140: 988-995.Lukkarinen M., Koistinen A., Turunen R., Lehtinen P., Vuorinen T., Jartti T. Rhinovirus-induced first wheezing episode predicts atopic but not nonatopic asthma at school age // J Allergy Clin Immunol. 2017; 140: 988-995.Шушанова Л. В., Барычева Л. Ю., Минасян М. М., Душина Л. В. Аллергический и неаллергический фенотипы бронхиальной астмы у взрослых пациентов в Ставропольском крае // Современные проблемы науки и образования. 2018. № 6; 33-36.Шушанова Л. В., Барычева Л. Ю., Минасян М. М., Душина Л. В. Аллергический и неаллергический фенотипы бронхиальной астмы у взрослых пациентов в Ставропольском крае // Современные проблемы науки и образования. 2018. № 6; 33-36.Global Initiative for Asthma (GINA). Global Strategy for Asthma Management and Prevention (2018 update) 2018.Global Initiative for Asthma (GINA). Global Strategy for Asthma Management and Prevention (2018 update) 2018.Pavord I., Beasley R., Agusti A. et al. After asthma: redefining airways diseases // Lancet. 2018; 391: 350-400.Pavord I., Beasley R., Agusti A. et al. After asthma: redefining airways diseases // Lancet. 2018; 391: 350-400.Fitzpatrick A., Jackson D., Mauger D., Boehmer S., Phipatanakul W., William J. S. et al. Individualizing therapy for persistent asthma in young children // J AllergyClin Immunol. 2016; 138: 1608-18.Fitzpatrick A., Jackson D., Mauger D., Boehmer S., Phipatanakul W., William J. S. et al. Individualizing therapy for persistent asthma in young children // J AllergyClin Immunol. 2016; 138: 1608-18.Fitzpatrick A., Moore W. Severe Asthma Phenotypes - How Should They Guide Evaluation and Treatment? // J Allergy Clin Immunol Pract. 2017; 5: 901-908.Fitzpatrick A., Moore W. Severe Asthma Phenotypes - How Should They Guide Evaluation and Treatment? // J Allergy Clin Immunol Pract. 2017; 5: 901-908.Gibson P., Yang I., Upham J. et al. Effect of azithromycin on asthma exacerbations and quality of life in adults with persistent uncontrolled asthma (AMAZES): a randomised, double-blind, placebo-controlled trial // Lancet. 2017; 390 (10095): 659-668.Gibson P., Yang I., Upham J. et al. Effect of azithromycin on asthma exacerbations and quality of life in adults with persistent uncontrolled asthma (AMAZES): a randomised, double-blind, placebo-controlled trial // Lancet. 2017; 390 (10095): 659-668.Loureiro C., Amaral L., Ferreira J., Lima R., Pardal C., Fernandes I., Semedo L., Arrobas A. Omalizumab for Severe Asthma: Beyond Allergic Asthma // Biomed Res Int. 2018; 2018: 3254094.Loureiro C., Amaral L., Ferreira J., Lima R., Pardal C., Fernandes I., Semedo L., Arrobas A. Omalizumab for Severe Asthma: Beyond Allergic Asthma // Biomed Res Int. 2018; 2018: 3254094.Pavord I., Korn S., Howarth P. et al. Mepolizumab for severe eosinophilic asthma (DREAM): a multicentre, double-blind, placebo-controlled trial // Lancet. 2012; 380 (9842): 651-659.Pavord I., Korn S., Howarth P. et al. Mepolizumab for severe eosinophilic asthma (DREAM): a multicentre, double-blind, placebo-controlled trial // Lancet. 2012; 380 (9842): 651-659.Castro M., Mathur S., Hargreave F. et al. Reslizumab for poorly controlled, eosinophilic asthma: a randomized, placebo-controlled study // Am J Resp Crit Care Med. 2011; 184: 1125-1132.Castro M., Mathur S., Hargreave F. et al. Reslizumab for poorly controlled, eosinophilic asthma: a randomized, placebo-controlled study // Am J Resp Crit Care Med. 2011; 184: 1125-1132.

The authors declare that there are no conflicts of interest present.