TOBIN Intelligence Library · evidence review
Asthma & Allergic Airway Disease
Airway inflammation is mapped against indoor and outdoor exposures, immune phenotype, microbial ecology and nutrient status, with guideline therapy always in the foreground.
What is well established
3 links- Allergen and fine-particulate exposure → Type 2 airway inflammationA
Allergen challenge and pollution exposure studies consistently show eosinophilic airway inflammation and exacerbation risk.
Established causal · Multiple high-quality guidelines or meta-analyses
- Mast-cell and eosinophil activation → Bronchial hyperresponsivenessA
Mediator release drives smooth-muscle constriction, edema and mucus production.
Established causal · Multiple high-quality guidelines or meta-analyses
- Vitamin D insufficiency → Exacerbation frequencyB
Meta-analyses show reduced exacerbations with repletion in deficient patients.
Randomized evidence · Moderate clinical evidence
What is suspected, not proven
1 links- Indoor mold and water-damage history → Respiratory symptom burdenB
Dampness indices associate with asthma symptoms; specific causal agents are rarely isolated.
Open question: the association may reflect confounding or reverse causation; intervention trials would settle it.
iDetection of an exposure does not establish that it caused a disease. This platform separates exposure, association, plausible mechanism, clinical evidence and demonstrated causation.
Domain emphasis
Respiratory virome and airway bacteriome are assessed as exacerbation triggers; colonization is distinguished from active infection before antimicrobials are considered.
Related Quadpandemics
I · Estrogen & Endocrine Disruption
Endocrine-active chemicals are widely measurable in the population; their health effects must be evaluated exposure by exposure.
III · Allergy & Immune Dysregulation
Allergic and immune-complex disease is the fastest-rising chronic burden of the century.
IV · Anxiety, Depression & Neurobehavioral Health
Mood symptoms are assessed responsibly — never automatically attributed to toxins or hormones.
Labs that inform this review
- hs-CRP (< 1.0 mg/L) — Non-specific inflammatory burden. Values above 10 mg/L usually indicate an acute process needing evaluation.
- Anti-TPO antibodies (< 35 (assay-specific) IU/mL) — Thyroid peroxidase antibodies — the main marker of autoimmune (Hashimoto's) thyroiditis. Positive antibodies in pregnancy or with rising TSH deserve clinician follow-up.
- Thyroglobulin antibodies (≤ 4 (assay-specific) IU/mL) — Second autoimmune thyroid marker; occasionally positive when anti-TPO is negative. Review with a clinician alongside TSH and free T4.
- Lp-PLA2 activity (≤ 123 nmol/min/mL) — Vascular-specific inflammatory enzyme (PLAC test, FDA-cleared). Review with a clinician as part of cardiovascular risk.
Score cutoffs used
- hs-CRP AHA/CDC: <1 lower, 1–3 average, >3 higher cardiovascular-inflammatory risk; >10 suggests acute process
- ALT ACG: upper limit of normal ≈ 29–33 U/L (men), 19–25 (women)
- GGT Typical laboratory upper limit ≈ 50 U/L
- Ferritin AGA 2020: ferritin <45 ng/mL supports iron deficiency; WHO <15 depleted
- Eosinophils (absolute) >500 cells/µL eosinophilia; ≥1500 hypereosinophilia
- Total IgE Adult reference typically <100 IU/mL; context-dependent
- White blood cells Reference ≈ 4.0–11.0 ×10³/µL
- Blood lead CDC blood lead reference value 3.5 µg/dL (2021)
- Blood mercury EPA reference dose ≈ 5.8 µg/L blood equivalent
- Anti-TPO antibodies Common cutoff >34–35 IU/mL (assay-specific); marks Hashimoto's risk (ATA)
- Thyroglobulin antibodies Common cutoff ≤4 IU/mL (Roche) — assay-specific; positive in ~60–80% of Hashimoto's
- Lp-PLA2 activity PLAC Activity test (FDA-cleared): >123 nmol/min/mL higher risk
Key formulas and thresholds
Published clinical cutoffs- HOMA-IR = fasting glucose (mg/dL) × fasting insulin (µIU/mL) ÷ 405 — above 2.5 suggests insulin resistance (Matthews 1985).
- BMI = weight (kg) ÷ height (m)² — 25–29.9 overweight, 30 or more obesity (WHO); lower cutoffs (23/27.5) for many Asian populations.
- Waist-to-height ratio = waist ÷ height — 0.5 or more signals central adiposity (NICE 2022).
- TG/HDL ratio = triglycerides ÷ HDL (mg/dL) — above 3 is associated with insulin resistance (observational).
- hs-CRP (mg/L): concern above 1, scored 100 at 10 — AHA/CDC: <1 lower, 1–3 average, >3 higher cardiovascular-inflammatory risk; >10 suggests acute process
- ALT (U/L): concern above 33, scored 100 at 200 — ACG: upper limit of normal ≈ 29–33 U/L (men), 19–25 (women)
- GGT (U/L): concern above 50, scored 100 at 200 — Typical laboratory upper limit ≈ 50 U/L
- Ferritin (ng/mL): concern below 30, scored 100 at 5; concern above 300, scored 100 at 1000 — AGA 2020: ferritin <45 ng/mL supports iron deficiency; WHO <15 depleted
- Eosinophils (absolute) (cells/µL): concern above 500, scored 100 at 3000 — >500 cells/µL eosinophilia; ≥1500 hypereosinophilia
- Total IgE (IU/mL): concern above 100, scored 100 at 1000 — Adult reference typically <100 IU/mL; context-dependent
- White blood cells (×10³/µL): concern above 11, scored 100 at 20 — Reference ≈ 4.0–11.0 ×10³/µL
- Blood lead (µg/dL): concern above 1, scored 100 at 10 — CDC blood lead reference value 3.5 µg/dL (2021)
- Blood mercury (µg/L): concern above 5, scored 100 at 20 — EPA reference dose ≈ 5.8 µg/L blood equivalent
- Anti-TPO antibodies (IU/mL): concern above 34, scored 100 at 500 — Common cutoff >34–35 IU/mL (assay-specific); marks Hashimoto's risk (ATA)
- Thyroglobulin antibodies (IU/mL): concern above 4, scored 100 at 200 — Common cutoff ≤4 IU/mL (Roche) — assay-specific; positive in ~60–80% of Hashimoto's
- Lp-PLA2 activity (nmol/min/mL): concern above 123, scored 100 at 225 — PLAC Activity test (FDA-cleared): >123 nmol/min/mL higher risk
iThese thresholds organize where to look; they do not diagnose. Laboratory ranges, age, sex and pregnancy change interpretation.