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.

Allergy Royal Brompton Hospital London United Kingdom

Centre of Academic Primary Care Division of Applied Health Sciences University of Aberdeen Aberdeen United Kingdom

Department Clinical Pharmacy and Pharmacology University of Groningen University Medical Center Groningen Groningen Netherlands

Department for Pediatric Pneumology and Immunology Charite University Medicine Berlin Germany

Department of Allergy and Rhinology Royal National ENT Hospital London United Kingdom

Department of Allergy Inflammation Center Helsinki University Hospital and University of Helsinki Helsinki Finland

Department of Allergy La Paz University Hospital IdiPAZ Madrid Spain

Department of Clinical Immunology and Allergology University Teaching Hospital in Martin Martin Slovak Republic

Department of Dermatology Bispebjerg Hospital University of Copenhagen Copenhagen Denmark

Department of Dermatology University Hospital of Zurich Zurich Switzerland

Department of Dermatology University of Zurich Zurich Switzerland

Department of Microbiology Immunology and Transplantation KU Leuven Catholic University of Leuven Leuven Belgium

Department of Otolaryngology Head and Neck Surgery University of North Carolina at Chapel Hill Chapel Hill NC United States

Department of Otorhinolaryngology Head and Neck Surgery and Audiology Rigshospitalet Copenhagen University Copenhagen Denmark

Department of Otorhinolaryngology Head and Neck Surgery University Hospitals Leuven Belgium

Department of Otorhinolaryngology Kuopio University Hospital and University of Eastern Finland Kuopio Finland

Department of Otorhinolarynogology and Head Neck Surgery Amsterdam University Medical Centres University of Amsterdam Amsterdam Netherlands

Department of Paediatrics Jessenius Faculty of Medicine in Martin Comenius University in Bratislava University Teaching Hospital in Martin Martin Slovak Republic

Department of Pulmonology and Phthisiology Jessenius Faculty of Medicine in Martin Comenius University in Bratislava University Teaching Hospital in Martin Martin Slovak Republic

Department of Pulmonology STZ Centre of Excellence for Asthma COPD and Respiratory Allergy Franciscus Gasthuis and Vlietland Rotterdam Netherlands

Department of Respiratory Medicine 1st Faculty of Medicine Charles University and Thomayer Hospital Prague Czech Republic

Department of Respiratory Medicine and Allergology Institute for Clinical Science Skane University Hospital Lund University Lund Sweden

Department of Rhinology and Skull Base Surgery Guy's and St Thomas' Hospital NHS Foundation Trust London United Kingdom

Division of Immunity and Infection University College London United Kingdom

Escuela de Doctorado UAM Centro de Estudios de Posgrado Universidad Autónoma de Madrid Calle Francisco Tomás y Valiente no 2 Ciudad Universitaria de Cantoblanco Madrid Spain

Kidsallergy Centre Cape Town South Africa

Laboratory of Allergy and Clinical Immunology University Hospitals Leuven Leuven Belgium

Observational and Pragmatic Research Institute Singapore Singapore

Otolaryngology Department Clinic Barcelona Barcelona Spain

Otolaryngology Department University of Barcelona Barcelona Spain

Otolaryngology Head and Neck Surgery A Gemelli University Hospital Foundation IRCCS Rome Italy

Paediatric Allergist Red Cross Children's Hospital and University of Cape Town Cape Town South Africa

Rhinology Unit and Smell Clinic ENT Department Hospital Clínic FRCB IDIBAPS Universitat de Barcelona CIBERES Barcelona Spain

The Allergy Clinic Blairgowrie Randburg South Africa

The European Forum for Research and Education in Allergy and Airway Diseases Scientific Expert Team Members Brussels Belgium

Upper Airways Research Laboratory Department of Head and Skin Ghent University Ghent Belgium

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