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Allergy Frontiers: Therapy and Prevention pp 347–363Cite as

Early Immunological Influences on Asthma Development: Opportunities for Early Intervention

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Part of the book series: Allergy Frontiers ((ALLERGY,volume 5))

The prevalence of atopic disease, in particular atopic asthma, has increased markedly in developed countries over the last 20 years. The rate of this increase has slowed significantly over the last few years and may be approaching a plateau, suggesting that the bulk of subjects with susceptible genotypes in current birth cohorts may already be responding maximally to the environmental factors which are responsible for driving the disease process. The resulting impact of these environmentally induced changes in asthma prevalence on health care systems in the developed countries is extremely high. An increasingly wide body of epide-miological evidence suggests that the countries of the developing world are no longer immune to this epidemic, as lifestyle changes associated with economic expansion recreate the patterns of environmental risk factors which drive disease in the developed world. The long term solution to this problem clearly does not lie in the development of more and better symptomatic treatments, but instead requires a more radical series of approaches aimed at reduction of the overall burden of disease [1].

This chapter reviews developments in the recent literature on asthma etiology, which collectively suggest a range of testable strategies for primary and secondary prevention of atopic asthma. The recent key findings are those emerging from cross-sectional and prospective cohort studies on atopic disease pathogenesis in pediatric populations.These indicate that the major gene x environment interactions responsible for disease inception occur during early childhood, when the immune functions underlying the inflammatory effector mechanisms which ultimately drive disease pathogenesis are undergoing final maturation. It is clear that the kinetics of this immune maturation process varies markedly within human populations, and these variations represent important determinants of susceptibility to development of atopic diseases. This chapter briefly summarizes the evidence supporting this general concept, and discusses intervention strategies aimed at prophylaxis of atopy, which arise from these findings.

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  1. Telethon Institute for Child Health Research, Centre for Child Health Research, The University of Western Australia, Perth, Western Australia

    Patrick G. Holt

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  1. Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, Japan

    Ruby Pawankar

  2. University of Southampton Southampton General Hospital, Tremona Road, Southampton, UK

    Stephen T. Holgate

  3. Children's Mercy Hospitals and Clinics UMKC School of Medicine, 2401 Gillham Road, Kansas City, MO, 64108, USA

    Lanny J. Rosenwasser

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Holt, P.G. (2009). Early Immunological Influences on Asthma Development: Opportunities for Early Intervention. In: Pawankar, R., Holgate, S.T., Rosenwasser, L.J. (eds) Allergy Frontiers: Therapy and Prevention. Allergy Frontiers, vol 5. Springer, Tokyo. https://doi.org/10.1007/978-4-431-99362-9_21

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