Possibilities and promise: Leveraging advances in transcriptomics for clinical decision making in allergic diseases

Transcriptomics has revolutionized our understanding of the pathobiologic heterogeneity underlying complex allergic diseases, leading to both the discovery of multiple inflammatory allergic disease endotypes and the development of targeted biologic therapies. In addition, transcriptomic endotypes have been associated with disease severity, exacerbation propensity, and responsiveness to nontargeted therapies, suggesting an unrealized potential for transcriptomic assays and endotyping to be used as diagnostic, predictive, and prognostic biomarkers. In this review, we discuss current and emerging transcriptomic technologies and how they have been used to uncover allergic disease endotypes and generate other clinically relevant findings. We then discuss how transcriptomics could be leveraged in the clinic for the delivery of personalized, rational patient care, and we consider strategies for and impediments to their future clinical deployment.