The Impact of Ambient Environmental Exposures to Microbial Products on Asthma Outcomes from Birth to Childhood

  • Evin Howard
  • Vwaire Orhurhu
  • Lisa Huang
  • Barbara Guthrie
  • Wanda PhipatanakulEmail author
Allergies and the Environment (M Hernandez, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Allergies and the Environment


Purpose of Review

Asthma is a chronic respiratory condition with increasing domestic and worldwide prevalence that burdens individuals and the healthcare system with high costs associated with long-term treatments and acute emergency room (ER) visits. It can be triggered by ambient microbes, including bacteria, viruses, and fungi. In this review, we examine the outcomes of asthma patients in relation to environmental exposures to ambient microbe products, focusing on whether exposure leads to asthma development from birth to childhood and if particular microbes are associated with worsened asthma exacerbations.

Recent Findings

Bacterial endotoxin is more prominent in homes with pets and may cause cytokine cascades that lead to asthma exacerbation. However, some studies have demonstrated a protective effect with early exposure. Patients with positive Aspergillus skin testing are more prone to moderate-severe or severe-uncontrolled asthma. Fungal sensitization is also associated with earlier onset of asthma and demonstrates a dose-dependent relationship of symptom severity and duration. Among viruses, rhinovirus has the greatest association with decreased lung function, severe asthma, and asthma-related hospital admissions. Distribution of microbial products and associated asthma symptoms depends on the geographical climate. Genetic variations among individuals also mitigate the effects of microbial products on asthma development and symptom severity.


Microbial products of bacteria, fungi, and viruses are associated with the development of asthma, more severe asthma symptoms, and worse outcomes. However, some early exposure studies have also demonstrated a protective effect. Bacterial and fungal products are related to decreased lung function and earlier onset of asthma. Viral products are related to asthma-associated hospital admissions; and the climate and patient genetics can also temper or intensify the relationships between microbial products, asthma development, and asthma symptom severity. Further research should focus on the effects of early microbe exposure and its interaction with human immune systems and asthma-related outcomes.


Early microbial exposure Asthma outcomes Allergen sensitivity Bacteria Fungi Virus 



Research reported in this publication is supported by the National Institute of Allergy and Infectious Diseases of the National Institutes of Health (Grant No: K24AI106822)

Compliance with Ethical Standards

All reported studies/experiments with human subjects performed by the authors have been previously published and compiled with all applicable ethical standards (including the Helsinki declaration and its amendments, institutional/national research committee standards, and international/national/institutional guidelines).

Conflict of Interest

The authors declare no conflicts of interest relevant to this manuscript.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Evin Howard
    • 1
  • Vwaire Orhurhu
    • 2
  • Lisa Huang
    • 3
  • Barbara Guthrie
    • 1
  • Wanda Phipatanakul
    • 4
    Email author
  1. 1.Bouvé College of Health Sciences, Graduate School of NursingNortheastern UniversityBostonUSA
  2. 2.Department of Anesthesia, Critical Care, & Pain Medicine, Harvard Medical SchoolMassachusetts General HospitalBostonUSA
  3. 3.Department of Anesthesia, Critical Care, & Pain Medicine, Harvard Medical SchoolBeth Israel Deaconess Medical CenterBostonUSA
  4. 4.Division of Asthma, Allergy, & Immunology, Harvard Medical SchoolChildren’s Hospital BostonBostonUSA

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