Primary Prevention of Asthma and Other Allergic Disorders

Abstract

There are two major factors critical to the development of asthma that must be considered: the individual's genetic background and the environment. Because the gene(s) for asthma has not yet been identified, it is critical to consider environmental factors that may contribute to the process and that may be controlled. Exposure to specific allergens is important in the development of allergies and allergy-associated disease, including asthma. Ingestants may be the earliest initiating trigger for “turn on” of allergy. Subsequently, sensitization to indoor inhalants becomes important in asthma. Among pollutants, environmental tobacco smoke (ETS) is most important. Finally, infections, including viral, bacterial, and helminthic, may play a role in the development of asthma. Dietary intervention appears important for atopic dermatitis but less so for asthma. Nevertheless, breastfeeding is important to decrease respiratory illness in infants and should be encouraged. In terms of allergen avoidance, avoidance of indoor allergens, particularly house dust mite, cat, and cockroach, have the greatest potential for benefit. Exposure to ETS in early life must be avoided. Other approaches to primary prevention include potential novel techniques such as vaccines or immunization. Asthma is a multifactorial disease and complex interventions are likely to be required to decrease the prevalence of this increasingly common disease.

Key Words:

Asthma - environment - prenatal - infancy allergy - ETS - infections - lymphocytes