THE IMPORTANCE OF DIFFERENTIAL DIAGNOSIS BETWEEN ALLERGIC AND NON-ALLERGIC ASTHMA: AN INTEGRATIVE REVIEW

Abstract

Asthma is a chronic respiratory disease characterized by airway inflammation and variable airflow obstruction. Allergic asthma is generally associated with IgE-mediated sensitization to environmental allergens (such as dust mites, pollen, and animal dander), whereas non-allergic asthma involves inflammatory mechanisms independent of IgE and may be related to viral infections, occupational irritants, pollution, and hormonal factors. The objective of this integrative review is to analyze the importance of differential diagnosis between allergic and non-allergic asthma, emphasizing its implications for clinical management and individualized therapeutic choices. The search was conducted in the SciELO, BVS, and PubMed databases, considering publications from 2019 to 2024. Descriptors in Portuguese and English were used — “asma alérgica,” “asma não alérgica,” “diagnóstico diferencial,” “allergic asthma,” “non-allergic asthma,” and “differential diagnosis” — combined with the Boolean operator AND. Filters were applied to select full-text articles, studies involving human populations, and publications in Portuguese, English, or Spanish, including original articles, systematic reviews, and relevant narrative reviews. From the total number of studies initially identified, after removing duplicates and applying inclusion and exclusion criteria, 10 articles were selected for the final analysis. The reviewed studies showed consistent differences between the two phenotypes: immunological alterations and positive IgE responses were predominant in allergic asthma, while non-allergic asthma frequently presented airway neutrophilia, poorer response to inhaled corticosteroids in some cases, and association with non-atopic triggers. These findings reinforce that differential diagnosis between allergic and non-allergic asthma is crucial in clinical practice to optimize treatment, reduce exacerbations, and improve patients’ quality of life, in addition to supporting decisions on personalized therapies and preventive measures.