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Environmental Interventions for Preventing Atopic Diseases

  • Review
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Abstract

Purpose of Review

In this review, we detail the exposome (consisting of environmental factors such as diet, microbial colonization, allergens, pollutants, and stressors), mechanistic and clinical research supporting its influence on atopic disease, and potentiation from climate change. We highlight contemporary environmental interventions and available evidence substantiating their roles in atopic disease prevention, from observational cohorts to randomized controlled trials, when available.

Recent Findings

Early introduction to allergenic foods is an effective primary prevention strategy to reduce food allergy. Diverse dietary intake also appears to be a promising strategy for allergic disease prevention, but additional study is necessary. Air pollution and tobacco smoke are highly associated with allergic disease, among other medical comorbidities, paving the way for campaigns and legislation to reduce these exposures. There is no clear evidence that oral vitamin D supplementation, prebiotic or probiotic supplementation, daily emollient application, and antiviral prophylaxis are effective in preventing atopic disease, but these interventions require further study.

Summary

While some environmental interventions have a well-defined role in the prevention of atopic disease, additional study of many remaining interventions is necessary to enhance our understanding of their role in disease prevention. Alignment of research findings from randomized controlled trials with public policy is essential to develop meaningful public health outcomes and prevent allergic disease on the population level.

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Abbreviations

CO2 :

Carbon dioxide

CS:

Cesarian section

DNA:

Deoxyribonucleic acid

EASI:

Eczema area and severity index

EAT:

Enquiring about tolerance

ETS:

Environmental tobacco smoke

ICS:

Inhaled corticosteroid

IL:

Interleukin

ILC:

Innate lymphoid cell

ISAAC:

International Study of Asthma, and Allergies in Children

IU:

International unit

LEAP:

Learning Early About Peanut

MDI:

Maternal dietary index

NIAID:

National Institute of Allergy and Infectious Disease

NDVI:

Normalized difference vegetation index

NO2 :

Nitrogen dioxide

OFC:

Oral food challenge

OMIP:

Oral mucosal immunoprophylaxis

OR:

Odds ratio

PASTURE:

Protection against Allergy: Study in Rural Environments

PCR:

Polymerase chain reaction

PM:

Particulate matter

RCT:

Randomized, controlled trial

ROS:

Reactive oxidative species

RSV:

Respiratory syncytial virus

RV:

Rhinovirus

SCFA:

Short chain fatty acid

SCORAD:

Scoring atopic dermatitis

SUNBEAM:

Systems Biology of Early Atopy

sIgE:

Specific IgE

SPT:

Skin prick test

SO2 :

Sulfur dioxide

TEWL:

Transepidermal water loss

TGF-β:

Transforming growth factor β

Th2:

T helper 2

Th17:

T helper 17

Treg :

T regulatory

TRAP:

Traffic related air pollution

VKDA:

Vitamin D kids asthma

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Authors and Affiliations

  1. Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

    Scott Pfirrman

  2. Division of Allergy & Immunology, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

    Ashley Devonshire & Andrew Winslow

  3. Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA

    Ashley Devonshire & Andrew Winslow

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  1. Scott Pfirrman
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Contributions

S.P. performed literature search, wrote the abstract, prepared Tables 1 and 2, and reviewed the manuscript; A.D. revised the abstract and the manuscript; A.W. wrote and finalized the main manuscript text and prepared Tables 1 and 2.

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Correspondence to Andrew Winslow.

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Pfirrman, S., Devonshire, A. & Winslow, A. Environmental Interventions for Preventing Atopic Diseases. Curr Allergy Asthma Rep (2024). https://doi.org/10.1007/s11882-024-01141-1

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