Why are rates of asthma in developed countries higher now than in the past?

Cited by [68]

• 42 - The Epidemiology of Asthma

  2019, Kendig's Disorders of the Respiratory Tract in Children

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  Epidemiology is the study of populations to discover modifiable factors that contribute to disease occurrence and natural history with a view to reducing disease burden through prevention. Asthma is a complex, polygenic disease with heterogeneous manifestations making it difficult to define precisely in population studies. Despite this, global efforts to harmonize outcome definitions have led to detailed understanding of the temporal and spatial variations of asthma prevalence in children. Asthma prevalence notably increased in high-income countries during the final three decades of the 20th century, but the cause for this has never been fully established.

  Early life has been implicated as a critical period for the development of asthma. Many environmental influences have been considered as potential risk factors for asthma, but few have been associated with more than modest increases in risk. One barrier to identifying causal risk factors is the clustering of environmental factors with consequent confounding of relationships between environment and disease. Thus even strong and reproducible associations can seldom be regarded as causal without experimental evidence, which is generally lacking.

  Despite these difficulties, new approaches to asthma classification, meticulous observations in birth cohorts, technological advances that enable assignment or genetic risk and identification of biomarkers for disease pathways, and analytical advances have contributed to real advances in understanding asthma pathogenesis. The interaction of allergic sensitization with respiratory viral infections offers a promising target for the development of preventative interventions.

• Evidence in immunotherapy for paediatric respiratory allergy: Advances and recommendations

  2016, Allergologia et Immunopathologia

  Citation Excerpt :

  Allergic respiratory diseases are a major health problem in the paediatric population due to their high level of prevalence and chronicity, as well as to their relevance in both the cost of healthcare and the quality of life of the patients and their families. According to large population-based studies, the prevalence of asthma and allergic rhinitis [AR] in children has increased in recent decades, presenting wheezing in the past year in up to 12% of children aged 6–7 years and to 14% at 13–14 years; AR has a prevalence of 15%.1–3 The total costs of asthma are greater in children than in adults due to the greater severity of the disease in this population,4 decreasing their quality of life in terms of health.5

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  Allergic respiratory diseases are major health problems in paediatric population due their high level of prevalence and chronicity, and to their relevance in the costs and quality of life. One of the most important risk factors for the development of airway diseases in children and adolescents is atopy. The mainstays for the treatment of these diseases are avoiding allergens, controlling symptoms, and preventing them through sustained desensitization by allergen immunotherapy [AIT]. AIT is a treatment option that consists in the administration of increasing amounts of allergens to modify the biological response to them, inducing long-term tolerance even after treatment has ended. This treatment approach has shown to decrease symptoms and improve quality of life, becoming cost effective for a large number of patients. In addition, it is considered the only treatment that can influence the natural course of the disease by targeting the cause of the allergic inflammatory response. The aim of this publication is to reflect the advances of AIT in the diagnosis and treatment of allergic respiratory diseases in children and adolescents reviewing articles published since 2000, establishing evidence categories to support the strength of the recommendations based on evidence. The first part of the article covers the prerequisite issues to understand how AIT is effective, such as the correct etiologic and clinical diagnosis of allergic respiratory diseases. Following this, the article outlines the advancements in understanding the mechanisms by which AIT achieve immune tolerance to allergens. Administration routes, treatment regimens, dose and duration, efficacy, safety, and factors associated with adherence are also reviewed. Finally, the article reviews future advances in the research of AIT.

• Thermal and environmental conditions in Shanghai households: Risk factors for childhood health

  2016, Building and Environment

  Citation Excerpt :

  Many epidemiological studies have demonstrated an increase in allergic diseases in the past 40 years worldwide [1–3].

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  An overall investigation of children’s health status, residential thermal environment, and pollutants was conducted in the homes primary school children during winter and summer in Shanghai, China. The houses were divided into Group A [unhealthy child living] and Group B [healthy child living]. During a two-week monitoring period in winter, indoor temperatures in Group A were significantly lower than in Group B [1–2 °C; p