To describe important precipitants of asthma and allergic disease, to highlight the links between these triggers and modifications within the immune system, and to examine innovative research regarding asthma prevention with focus on attenuating the atopic march.
Allergen avoidance, allergen immunotherapy, IgE antagonists, prevention and treatment of respiratory infections, as well as management of gastrointestinal and respiratory dysbiosis have been considered as strategies in asthma prevention. Antenatal vitamin D supplementation in expectant mothers and aggressive control of atopic dermatitis to prevent the development of other allergic conditions were carefully studied as well.
Asthma is a major cause of morbidity and lost productivity. Despite the tremendous burden of this disease, the scientific community is still struggling to find an effective means of prevention. The contribution of genetics to the development of atopy cannot be altered, but environmental changes as well as pharmacotherapy have been studied as modifiable risk factors. Many trials to date have been effective only for subjects with certain characteristics. This is likely because asthma is a heterogenous condition, with a variety of triggers and clinical phenotypes. Thus far, a universally effective prevention strategy has eluded us. However, if an intervention can be found to prevent asthma and the allergic march, it will greatly improve quality of life for millions of sufferers and decrease healthcare expenditures.
Division of Immunology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
Correspondence to Wanda Phipatanakul, MD, MS, Division of Immunology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA. Tel: +1 617 355 6117; e-mail: Wanda.Phipatanakul@childrens.harvard.edu