ABSTRACT
Concepts of disease severity, activity, control and responsiveness to treatment are linked but different. Severity refers to the loss of function of the organs induced by the disease process or to the occurrence of severe acute exacerbations. Severity may vary over time and needs regular follow-up. Control is the degree to which therapy goals are currently met. These concepts have evolved over time for asthma in guidelines, task forces or consensus meetings. The aim of this paper is to generalize the approach of the uniform definition of severe asthma presented to WHO for chronic allergic and associated diseases (rhinitis, chronic rhinosinusitis, chronic urticaria and atopic dermatitis) in order to have a uniform definition of severity, control and risk, usable in most situations. It is based on the appropriate diagnosis, availability and accessibility of treatments, treatment responsiveness and associated factors such as comorbidities and risk factors. This uniform definition will allow a better definition of the phenotypes of severe allergic (and related) diseases for clinical practice, research (including epidemiology), public health purposes, education and the discovery of novel therapies.
Subject(s)
Asthma/physiopathology , Hypersensitivity/complications , Practice Guidelines as Topic/standards , Severity of Illness Index , Asthma/therapy , Chronic Disease , Comorbidity , Dermatitis, Atopic/complications , Humans , Hypersensitivity/epidemiology , Rhinitis/complications , Rhinitis/epidemiology , Sinusitis/complications , Sinusitis/epidemiology , Urticaria/complications , Urticaria/epidemiologyABSTRACT
The case of a patient who developed sarcoidosis with chronic joint symptoms at the age of four and still has active disease twenty years later despite three years of corticosteroid therapy is reported. During the course of the disease, specific histologic features of sarcoidosis were evidenced twice in synovial specimens, twice in skin biopsy specimens, and once in bronchial tissue. Deformations and joint lesions developed in the hands and feet. The combination of arthritis, skin lesions, and uveitis occurs both in juvenile-onset sarcoidosis and in chronic juvenile joint diseases, raising significant diagnostic problems which can be solved by histologic studies of synovial or skin biopsy specimens.
