The present paper addresses severe asthma which is limited to 5-10% of the overall population of asthmatics.\nHowever, it accounts for 50% or more of socials costs of the disease, as it is responsible for hospitalizations and\nEmergency Department accesses as well as expensive treatments.\nThe recent identification of different endotypes of asthma, based on the inflammatory pattern, has led to the\ndevelopment of tailored treatments that target different inflammatory mediators. These are major achievements\nin the perspective of Precision Medicine: a leading approach to the modern treatment strategy.\nOmalizumab, an anti-IgE antibody, has been the only biologic treatment available on the market for severe\nasthma during the last decade. It prevents the linkage of the IgE and the receptors, thereby inhibiting mast\ncell degranulation. In clinical practice omalizumab significantly reduced the asthma exacerbations as well as\nthe concomitant use of oral glucocorticoids.\nIn the ââ?¬Å?Th2-high asthmaââ?¬Â phenotype, the hallmarks are increased levels of eosinophils and other markers (such as\nperiostin). Because anti-IL-5 in this condition plays a crucial role in driving eosinophil inflammation, this cytokine\nor its receptors on the eosinophil surface has been studied as a potential target for therapy.\nTwo different anti-IL-5 humanized monoclonal antibodies, mepolizumab and reslizumab, have been proven effective in\nthis phenotype of asthma (recently they both came on the market in the United States), as well as an anti-IL-5\nreceptor alpha (IL5RÃ?±), benralizumab.\nOther monoclonal antibodies, targeting different cytokines (IL-13, IL-4, IL-17 and TSLP) are still under evaluation,\nthough the preliminary results are encouraging.\nFinally, AIT, Allergen Immunotherapy, a prototype of Precision Medicine, is considered, also in light of the recent\nevidences of Sublingual Immunotherapy (SLIT) tablet efficacy and safety in mite allergic asthma patients.\nGiven the high costs of these therapies, however, there is an urgent need to identify biomarkers that can predict\nthe clinical responders.
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