Asthma, Infections and Immunodeficiency

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

General

This is a comprehensive narrative review, but with limited originality given the nature of the manuscript.

The importance of the paper is also limited by the methodology of selection and analysis of the references.

 

Major

1. The criteria to select the paper included in the review are not provided. Therefore, a bias in the selection cannot be excluded.
2. It is not mentioned whether the quality of the paper selected was evaluated, thus preventing the evaluation of the most relevant findings.
3. It is not clearly distinguished among risk factor for the development of asthma, factors due to the disease or its severity, factors that can exacerbate asthma or increase its severity.
4. The text is often redundant. There are parts that could be omitted or condensed: Para 2. –lines 43-60; para 4.1.1-4.1.2 –lines 195-231; 4.2.2 –lines 421-437; para 5 –lines 363-690.

Author Response

"Please see the attachment"

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

Summary: review of interaction of infection, immunodeficiencies and asthma

Well done review

Specific comments
line 84
there is already some real life evidence of wheezing reduction with the new monoclonals against RSV
In addition, the issue of antibiotic exposure and asthma incidence is probably worth mentioning

line 107, you wrote VRS, i think you meant RSV

Line 397
You discuss epithelial cells, but with their injury there is release of alarmins that drive asthma in both Th2 and nonTh2 disease; this is worthy of mention also

in conclusion, a statement like: While not routinely recommended, recognition of the role of immunodeficiences and testing on an individual case is advised could be considered/adpated

Overall:
A huge deficiency in this paper is recommendations for how a clinician should test when immunodeficiencies are considered, You only mention immunoglobulin, but flow cytometry for T cell disorders, measurement of complement levels and other deficiencies should be reviewed
Also, while the microbiome/exposure discussions was interesting/fascinating, how does that also potentially change management?

Author Response

"Please see the attachment"

Author Response File: Author Response.pdf

Round 2

Reviewer 1 Report

Comments and Suggestions for Authors

The authors considered the issues raised by the reviewer. However, little changes have been made into the revised manuscript.

Therefore, the overall evaluation of the paper is similar to that of the original version.

In particular:

• An attempt to distinguish among risk factor for the development of asthma, factors that are a consequence of the disease or its severity, factors that can modify the course of pre-existent asthma should have been made.
• The chapter 5 on drug treatment of asthma appears out of place in a Review entitled ‘Asthma, Infections and Immunodeficiency’

Author Response

Please see the attachment

Author Response File: Author Response.pdf

Round 3

Reviewer 1 Report

Comments and Suggestions for Authors

There are not further comments to the R2 version of the manuscript. It can be accepted, but the priority remains rather low given the limited originality and importance of this narrative review.