Pre-asthma: a useful concept? A EUFOREA paper. Part 2 -Late Onset Eosinophilic Asthma Provisionally Accepted

Glenis K. Scadding^{1, 2} Claudia Gray^{3, 4} Diego M. Conti^{5, 6*} Marinda McDonald⁷ Vibeke Backer⁸ Guy Scadding⁹ Manuel Bernal-Sprekelsen^{10, 11} Eugenio De Corso¹² Zuzana Diamant^{13, 14, 15, 16} Claire Hopkins¹⁷ Milos Jesenak^{18, 19, 20} Pål Johansen^{21, 22} Jasper Kappen²³ JOAQUIM MULLOL²⁴ David Price^{25, 26} Santiago Quirce²⁷ Sietze Reitsma²⁸ Sanna K. Toppila-Salmi^{29, 30} Brent Senior³¹ Jacob Thyssen³² Ulrich Wahn³³ Peter Hellings^{34, 35, 36}

• ¹Department of Allergy & Rhinology, Royal National ENT Hospital, London, United Kingdom., United Kingdom
• ²Division of Immunity and Infection, University College, London, United Kingdom., United Kingdom
• ³Paediatric allergist, Red Cross Children’s Hospital and University of Cape Town, South Africa, South Africa
• ⁴Kidsallergy Centre, Cape Town, South Africa., South Africa
• ⁵EUFOREA, Belgium
• ⁶Escuela de Doctorado UAM, Centro de Estudios de Posgrado, Universidad Autónoma de Madrid. Calle Francisco Tomás y Valiente, nº 2. Ciudad Universitaria de Cantoblanco, 28049 Madrid, Spain., Spain
• ⁷The Allergy Clinic, Blairgowrie, Randburg, South Africa., South Africa
• ⁸Department of Otorhinolaryngology, Head & Neck Surgery, and Audiology, Rigshospitalet, Copenhagen University, Copenhagen, Denmark., Denmark
• ⁹Allergy, Royal Brompton Hospital, London, United Kingdom., United Kingdom
• ¹⁰Head of ORL-Dept., Clinic Barcelona, Barcelona, Spain, Spain
• ¹¹Chair of ORL, Univ. of Barcelona, Barcelona, Spain, Spain
• ¹²Otolaryngology Head and Neck Surgery, A. Gemelli University Hospital Foundation IRCCS, Rome, Italy., Italy
• ¹³Department of Respiratory Medicine & Allergology, Institute for Clinical Science, Skane University Hospital, Lund University, Lund, Sweden., Sweden
• ¹⁴Department of Respiratory Medicine, First Faculty of Medicine, Charles University and Thomayer Hospital, Prague, Czech Republic., Czechia
• ¹⁵Department Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands., Netherlands
• ¹⁶Dept of Microbiology Immunology & Transplantation, KU Leuven, Catholic University of Leuven, Leuven, Belgium., Belgium
• ¹⁷Department of Rhinology and Skull Base Surgery, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK., United Kingdom
• ¹⁸Department of Clinical Immunology and Allergology, University Teaching Hospital in Martin, Martin, Slovak Republic., Slovakia
• ¹⁹Department of Paediatrics, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, University Teaching Hospital in Martin, Martin, Slovak Republic., Slovakia
• ²⁰Department of Pulmonology and Phthisiology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, University Teaching Hospital in Martin, Martin, Slovak Republic., Slovakia
• ²¹Department of Dermatology, University of Zurich, Zurich, Switzerland., Switzerland
• ²²Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland, Switzerland
• ²³Department of Pulmonology, STZ Centre of Excellence for Asthma, COPD and Respiratory Allergy, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands., Netherlands
• ²⁴Rhinology Unit and Smell Clinic, ENT Department, Hospital Clínic, FRCB-IDIBAPS, Universitat de Barcelona, CIBERES, Barcelona, Catalonia, Spain., Spain
• ²⁵Observational and Pragmatic Research Institute, Singapore, Singapore., Singapore
• ²⁶Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK., United Kingdom
• ²⁷Department of Allergy, La Paz University Hospital, IdiPAZ, Madrid, Spain., Spain
• ²⁸Department of Otorhinolarynogology and Head/Neck surgery, Amsterdam University Medical Centres, location AMC, University of Amsterdam, Amsterdam, The Netherlands., Netherlands
• ²⁹Department of Otorhinolaryngology, Kuopio University Hospital and University of Eastern Finland., Finland
• ³⁰Department of Allergy, Inflammation Center, Helsinki University Hospital and University of Helsinki, Finland., Finland
• ³¹Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, USA., United States
• ³²Bispebjerg Hospital, University of Copenhagen, Dep of Dermatology, Denmark., Denmark
• ³³Professor emeritus. Former head of the dept. for pediatric pneumology and Immunology, Charite University medicine, Berlin, Germany, Germany
• ³⁴Department of Otorhinolaryngology-Head and Neck Surgery, University Hospitals, Leuven, Belgium., Belgium
• ³⁵Laboratory of Allergy and Clinical Immunology, University Hospitals Leuven, Belgium., Belgium
• ³⁶Upper Airways Research Laboratory, Department of Head and Skin, Ghent University, Ghent, Belgium., Belgium

The concept of pre-diabetes has led to provision of measures to reduce disease progression through identification of subjects at risk of diabetes. We previously considered the idea of pre-asthma in relation to allergic asthma and considered that, in addition to the need to improve population health via multiple measures, including reduction of exposure to allergens and pollutants and avoidance of obesity, there are several possible specific means to reduce asthma development in those most at risk (pre- asthma). The most obvious is allergen immunotherapy (AIT), which when given for allergic rhinitis (AR) has reasonable evidence to support asthma prevention in children (2) but also needs further study as primary prevention.
In this second paper we explore the possibilities for similar actions in late onset eosinophilic asthma.