Early Immunological Influences on Asthma Development: Opportunities for Early Intervention

  • Patrick G. Holt
Part of the Allergy Frontiers book series (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.


Respiratory Syncytial Virus Allergic Rhinitis Allergy Clin Immunol Persistent Asthma Atopic Disease 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2009

Authors and Affiliations

  • Patrick G. Holt
    • 1
  1. 1.Telethon Institute for Child Health Research, Centre for Child Health ResearchThe University of Western AustraliaPerthWestern Australia

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