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The Impact of Upper Airway Allergic Inflammation on Asthma


K. Frank Austen, Brigham and Women's Hospital, Boston, Massachusetts
Ronald Walls, University of Sydney and Concord Hospital, Concord, Australia

Concepts in medicine come and go. For a time they are held as fundamental truths until we question them and where necessary modify them in the light of newer knowledge. Asthma was considered at one time to be a nervous disorder, and more recently an intrinsic disease of lower respiratory airways in which there was no role for allergy. Now, with the rapid advances in our understanding of immunologic processes, has come a realization that allergic mechanisms play a major role in the genesis of asthma as well as upper respiratory disease.

One of the newer concepts which has gained currency over the past 5 years, has been that of the commonality of upper and lower airways, known by a number of catchy names, one of which is “united airways”. In this symposium we will review critically this relationship, consider the evidence for it, and explore the underlying mechanisms. We will also assess its implications for day to day clinical practice. This latter task is particularly important since we have a duty to apply new understandings of immunopathology to everyday clinical practice. Our panel is well equipped to undertake this task, having made major contributions to the immunopathology of asthma and allergy. More than that, they have practical experience in applying modern concepts to clinical practice.

We have another challenge to address the rise in allergic diseases in countries which are embracing the Western way of life. We need to make the application of concepts such as this, accessible to clinical practice in a cost-effective way. Many of these countries such as those in the Asia-Pacific region and in Africa, have other overbearing medical problems such as infectious diseases and HIV, and we need to ensure that the problems we have in Western countries, including asthma, do not steal up on them. Being a World Allergy Forum, we must keep these issues in mind.


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