Table 2.

Needs for advancing precision medicine for allergic disorders and asthma.

Identify biological factors contributing to development of allergy/asthma	More detailed understanding of genotype-phenotype relationships, and interactions with environmental exposures Barrier state differences (affecting skin, respiratory and GI systems, etc.), and how these contribute to allergy development Mechanistic effects of early vs. later allergen exposure (via skin, airways or ingestion, etc.) Mechanisms of other protective vs. pro-allergy environmental factors (pets? farm animals?)
Identify pathogenic immune system features	Which IgE antibodies actually contribute to allergy/asthma? What T cell phenotypes and cytokine profiles contribute to allergy/asthma? What basophil/mast cell populations and/or states contribute to allergy/asthma? Interactions between mast cells/basophils and IgE/IgG4/other immunoglobulin isotypes Epithelial and other cell type contributions to allergy/asthma Determine which key features of the disease process in the affected tissues can effectively be “monitored” (e.g., to assess treatment outcomes) via the analysis of cell populations and other analytes in the blood.
Identify correlates and mechanisms of immunotherapy efficacy	Differences between temporary desensitization and sustained unresponsiveness/tolerance Antibody-mediated protection/desensitization (IgG4, and others?) Are there potential T cell mechanisms of tolerance, beyond influences on antibodies? Changes in basophil/mast cell sensitivity Basis for “natural” desensitization or tolerance Key biomarkers for predicting side effects of treatments
Identify new therapeutic strategies	Modifications of current approaches (e.g., speed of updosing, multi-allergen therapies in food allergy IT) New potential targets for biologics/other mechanistic-based therapies Combination therapies (e.g., multiple biologics, biologics plus IT, small molecule drugs plus other treatments) Companion diagnostics
Evaluate cost-effectiveness of new therapeutic strategies	Evidence-based evaluation of the clinical utility of new treatment strategies Measurement of disease and treatment costs Cost to the patient Cost to the health care system Cost to society