Environmental factors influencing the development and
progression of pediatric asthma.
Von Mutius E.
Ludwig Maximilian University Children's Hospital, Munich, Germany.
Recent data underscore the importance of environmental factors in the
sensitization of children to certain allergens and the development of asthma.
Maternal smoking and family (especially maternal) history of atopy appear to be
risk factors for persistent sensitization and development of asthma. Indeed,
exposure to tobacco smoke in utero significantly increases asthma risk and
influences the timing of sensitization. It must be stated that any smoking at
home has consequences for the development of asthma and other respiratory
conditions. In addition, reports of possible protective effects of specific
environmental conditions suggest that exposure to certain stimuli may reduce or
block the development and progression of asthma. Attendance at a day care center
early in life appears to offer protective effects against wheezing, as do early
episodes of rhinitis, herpes, and measles. Children raised on a farm also have a
decreased prevalence of atopic diseases. The protective effect of contact with
livestock and poultry is consistent among several studies. Although the
pathophysiologic mechanisms involved remain undefined, studies suggest that
exposure to endotoxin and other components of bacteria may play an important
role in protecting against childhood atopic diseases. Whether in utero exposure
is beneficial remains to be determined.
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