The Type 2 Inflammation Connection

Published on: March 11, 2020

Tammy, living with asthma and allergies in the US

People living with type 2 inflammatory diseases often feel limited by unpredictable symptoms and isolated in their experiences. Living with these chronic diseases—often more than one—and searching for control, they have looked for answers and found few.

Recent scientific developments have shown that excessive type 2 inflammation, an overactive immune system response, underlies different atopic, allergic and inflammatory diseases.^1-3 The lack of awareness of type 2 inflammation means people may not fully understand their disease(s), how they are connected, and the treatment options available to them.

See the faces and hear the stories of people living with these diseases around the world:

Tammy (asthma + allergies, US)

Tammy experienced her first asthma attack as an infant. For years, her asthma and allergies persisted, but it wasn’t until she was pregnancy with her daughter that they became uncontrollable. When her symptoms worsen, she stays inside, watching life from a distance. While her conditions are not her fault, Tammy feels guilty for how they’ve impacted her family, especially her daughter who has often ended up taking on the caregiver role—instead of the other way around.

Jori (œsinophilic esophagitis, US)

In high school, Jori was painfully aware that she was different from her peers. As a 15-year-old freshman in high school, she weighed only 60 pounds and her height was below average. Managing EoE has been a challenge her whole life as she faces the daily stress of navigating meals. Though coping with her disease has gotten easier through practice and support from family and friends, Jori can’t help but imagine how different her days would be if she didn’t have to worry about food.

Malena (atopic dermatitis atopique, Argentina)

For Malena, a bad day with AD starts from the moment she wakes up. Her skin is dry, and she starts itching immediately, causing “suffering inside and out.” On the worst days, her skin is so cracked and painful that she needs up in a fetal position, enduring a constant cycle of itching, oozing and scabbing. When she was young, other kids didn’t want to be near her because they thought her AD was contagious.

Peter (Asthma, United Kingdom)

Peter’s journey with asthma has been long and “irritating.” Though he’s been living with the disease for over 60 years, he didn’t receive a proper diagnosis of severe refractory asthma until he saw a specialist five years ago. As a child, Peter spent a lot of time in the hospital for chest infections caused by his asthma. He describes his early years as a period of “knowledge darkness for his family.” But his diagnosis has given him validation—now he knows there is something deeper happening in his body, opening up a new path for life with the condition.

Rainer (atopic dermatitis + asthma + nasal polyps, Germany)

When Rainer thinks about his diseases, the word “isolating” comes to mind. As a child, Rainer tried many different therapies for his AD and often ended up hospitalized. Eventually this led his family—with advice from their doctor—to uproot their entire lives and move to the Southern Black Forest in an effort to avoid triggers. Now 43, Rainer has found some stability and control over his diseases, and while isolation can still be a factor, he feels optimistic about the future.

Laura (aspirin exaxerbated respiratory disease + asthma + nasal polyps, US)

When Laura’s AERD symptoms are uncontrolled, she feels completely different. The person who loves to go out and be active fades, and the tired, sneezing and wheezing person returns. At first, she thought she had bad allergies, but the emergence of NP and constant gasping for air showed that she was experiencing something else. Her constant cold symptoms are only occasionally alleviated by medicine and inhalers.

About eosinophilic esophagitis (EOE)

EOE is a chronic inflammatory disease of the esophagus, the tube connecting the throat to the stomach.⁴ The most common symptom is difficulty in swallowing food, often necessitating dietary restrictions or the use of a feeding tube.⁵

About atopic dermititis (AD)

AD, a form of eczema, is a chronic inflammatory disease with recurrent symptoms often appearing as a rash on the skin.⁶ Signs and symptoms can include intense, persistent itching and skin dryness, cracking, redness, crusting and oozing.⁷

About asthma

Asthma is a chronic inflammatory disease of the lower airways, with symptoms including coughing, wheezing and difficulty breathing.⁸ These symptoms can wax and wane, and in some people, they worsen in response to triggers such as allergens, pollutants or exercise. Asthma varies in severity, and cases classified as severe can be much harder to control.⁹

About nasal polyps (NP)

NP are non-cancerous growths on the lining of the sinuses and nasal passages caused by chronic, excessive inflammation¹⁰ —for example in chronic rhinosinusitis (i.e., CRSwNP).^11,12 NP can lead to breathing difficulties, nasal congestion and discharge, reduction or loss of sense of smell and taste, and facial pressure.¹³

About aspirin exacerbated respiratory disease (AERD)

AERD, sometimes called NSAID-AERD, is an intolerance or sensitivity to aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs). People with AERD can have reactions to these medicines, including increased nasal congestion, frontal headache or sinus pain, wheezing, chest tightness, skin flushing, rash, abdominal pain and occasionally vomiting. AERD is a part of “Samter’s Triad,” in which patients with AERD often also have coexisting asthma and NP.¹⁴

About food and environmental allergies

Food and environmental allergies are a set of sensitivities to allergens present in foods like peanuts, wheat, soy and others, or environmental allergens such as timothy grass pollen or tree pollen. Symptoms of these allergies can include rashes on the skin, congestion, trouble breathing, tightness of the chest or throat, and a serious allergic reaction known as anaphylaxis.¹⁵

References

¹ N. A. Gandhi, B. L. Bennett and N. M. Graham, “Targeting key proximal drivers of type 2 inflammation in disease,” Nature Reviews Drug Discovery,vol. 15, no. 1, pp. 35-50, 16 October 2016.
² S. Carr, E. Chan, and W. Watson, “Eosinophilic esophagitis,” Allergy, Asthma & Clinical Immunology, vol. 14, no. Suppl 1, p. 58, 2018.
³ J. W. Steinke and J. M. Wilson, “Aspirin-exacerbated respiratory disease: pathophysiological insights and clinical advances.,” Journal of Asthma and Allergy, vol. 9, pp. 37-43, 2016.
⁴ https://www.aaaai.org/conditions-and-treatments/conditions-dictionary/Eosinophilic-Esophagitis. Accessed September 2019.
⁵https://www.aaaai.org/conditions-and-treatments/related-conditions/eosinophilic-esophagitis. Accessed September 2019.
⁶ https://www.aaaai.org/conditions-and-treatments/conditions-dictionary/atopic-dermatitis-(eczema). Accessed September 2019.
⁷ Mount Sinai. Patient Care Atopic Dermatitis 2016. http://www.mountsinai.org/patient-care/health-library/diseases-andconditions/atopic-dermatitis#risk. Accessed Sept. 9th, 2019.
⁸ https://www.aaaai.org/conditions-and-treatments/conditions-dictionary/Asthma. Accessed September 2019.
⁹Global Initiative for Asthma (GINA). Global Strategy for Asthma Management and Prevention. 2018. Available at: http://ginasthma.org/download/832/. Accessed July 2018.
¹⁰Gandhi NA, Pirozzi G., Graham NMH. Commonality of the IL-4/IL-13 pathway in atopic diseases. Expert Review of Clinical Immunology. 2017;13:5:425-437.
¹¹https://www.aaaai.org/conditions-and-treatments/conditions-dictionary/Nasal-Polyps. Accessed September 2019.
¹²Newton JR, Ah-See KW. A review of nasal polyposis. Ther Clin Risk Manag. 2008;4(2):507-12.
¹³Newton JR, Ah-See KW. A review of nasal polyposis. Ther Clin Risk Manag. 2008;4(2):507-12.
¹⁴https://my.clevelandclinic.org/health/diseases/16759-asa-triad. Accessed September 2019.
¹⁵https://www.aaaai.org/conditions-and-treatments/conditions-dictionary/food-allergies. Accessed September 2019.