PEDIATRIC ASTHMA AND DEVELOPMENT OF ATOPY: Edited by Leonard B. Bacharier and Stanley J. SzeflerMicrobes, allergic sensitization, and the natural history of asthmaAnderson, Halie M.; Jackson, Daniel J. Author Information Division of Allergy, Immunology and Rheumatology, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA Correspondence to Dr Daniel J. Jackson, MD, 600 Highland Avenue, CSC K4/936, Madison, WI 53792-9988, USA. Tel: +1 608 263 7686; e-mail: [email protected] Current Opinion in Allergy and Clinical Immunology: April 2017 - Volume 17 - Issue 2 - p 116-122 doi: 10.1097/ACI.0000000000000338 Buy Metrics Abstract Purpose of review Understanding factors that lead to asthma development in early life is essential to developing strategies aimed at primary or secondary prevention. Recent findings This article will review current evidence addressing the development of early life allergic sensitization in relation to microbes and the gut and airway microbiome. Wheezing illnesses, particularly viral, remain a significant risk factor for asthma inception; however, bacterial pathogens have recently emerged as an additional important contributor to asthma risk, either alone or as cofactors with viral infections. The combined influence and interaction of early life viral wheezing and aeroallergen sensitization is important, with allergic sensitization preceding the onset of viral wheeze. Lastly, we review recent data from longitudinal studies regarding the development of irreversible airway obstruction and its impact on the natural history of asthma. Summary The development of asthma remains complex and incompletely understood. There is interplay between genetic predisposition and environmental exposures, including allergens and microbes. Interventions aimed at these risk factors during the preschool years may prevent the longitudinal course of asthma progression to irreversible airway obstruction. Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.