Skip to main content

Advertisement

Log in

The environment and risk factors for atopy

  • Published:
Current Allergy and Asthma Reports Aims and scope Submit manuscript

Abstract

Atopy is the genetic potential to manifest the trinity of classic allergic diseases—atopic dermatitis, allergic rhinitis, and asthma. All have been observed to have increased over the past several decades. The interplay of the genetics of atopy with various environmental exposures may manifest itself in the form of allergic phenotypes or paradoxically may actually suppress the allergic response. The hygiene hypothesis offers an explanation of why certain environmental exposures early in life may suppress or activate clinical disease. Primary prevention is directed at preventing the clinical manifestations of atopy by suppressing or delaying the onset of allergic sensitivity. Studies of primary prevention have brought mixed results. Secondary prevention is directed at reducing or removing triggers in the environment of the sensitized individual. Secondary prevention measures directed at one allergen have not proven successful. Comprehensive intervention programs dealing with both allergens and other potential triggers appear beneficial.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References and Recommended Reading

  1. Silverstein AM: Clemens Freiherr von Pirquet: explaining immune complex disease in 1906. Nature Immunol 2000, 1:453–455.

    Article  CAS  Google Scholar 

  2. Cohen S, Dworetzky M, Frick OL: Coca and Cooke on the classification of hypersensitiveness. J Allergy Clin Immunol 2003, 111:609.

    Article  Google Scholar 

  3. Bardana EJ Jr: Immunoglobulin E-(IgE) and non-IgE-mediated reactions in the pathogenesis of atopic eczema/dermatitis syndrome (AEDS). Allergy 2004, 59(Suppl 78):25–29.

    Article  PubMed  CAS  Google Scholar 

  4. Sly RM: Changing prevalence of allergic rhinitis and asthma. Ann Allergy Asthma Immunol 1999, 82:233–248.

    Article  PubMed  CAS  Google Scholar 

  5. Wright AL, Holberg CJ, Martinez FD, et al.: Epidemiology of physician-diagnosed allergic rhinitis in childhood. Pediatrics 1994, 94:895–901.

    PubMed  CAS  Google Scholar 

  6. Verlato G, Corsico A, Villani S, et al.: Is the prevalence of adult asthma and allergic rhinitis still increasing? Results of an Italian study. J Allergy Clin Immunol 2003, 111:1232–1238.

    Article  PubMed  Google Scholar 

  7. von Hertzen L, Haahtela T: Signs of reversing trends in prevalence of asthma. Allergy 2005, 60:283–292.

    Article  Google Scholar 

  8. Latvala J, von Hertzen L, Lindholm H, et al.: Trends in prevalence of asthma and allergy in Finnish young men: nationwide study, 1966–2003. BMJ 2005, 330:1186–1187.

    Article  PubMed  Google Scholar 

  9. Zollner IK, Weiland SK, Piechotowski I, et al.: No increase in the prevalence of asthma, allergies, and atopic sensitisation among children in Germany: 1992–2001. Thorax 2005, 60:545–548.

    Article  PubMed  CAS  Google Scholar 

  10. Braun-Fahrlander C, Gassner M, Grize L, et al.: No further increase in asthma, hay fever and atopic sensitisation in adolescents living in Switzerland. Eur Respir J 2004, 23:407–413.

    Article  PubMed  CAS  Google Scholar 

  11. Anderson HR, Ruggles R, Strachan DP, et al.: Trends in prevalence of symptoms of asthma, hay fever, and eczema in 12–14 year olds in the British Isles, 1995–2002: questionnaire survey. BMJ 2004, 328:1052–1053.

    Article  PubMed  Google Scholar 

  12. Dey AN, Bloom B: Summary health statistics for U.S. children: National Health Interview Survey, 2003. Vital Health Stat 10 2005, 223:1–78.

    PubMed  Google Scholar 

  13. Mannino DM, Homa DM, Pertowski CA, et al.: Surveillance for asthma—United States, 1960–1995. MMWR CDC Surveil Summ 1998, 47:1–28.

    CAS  Google Scholar 

  14. Lethbridge-Cejku M, Schiller JS, Bernadel L: Summary health statistics for U.S. adults: National Health Interview Survey, 2002. Vital Health Stat 10 2004, 222:1–151.

    PubMed  Google Scholar 

  15. Cooke RA, Vander Veer A Jr: Human sensitization. J Immunogenet 1916, 1:201–305.

    CAS  Google Scholar 

  16. Bias WB, Marsh DG, Ishizaka K: Genetic control of the immune response in man (abstract). Am J Hum Genet 1973, 25:16A.

    Google Scholar 

  17. Blumenthal MN, Namboodiri K, Mendell N, et al.: Genetic transmission of serum IgE levels. Am J Med Genet 1981, 10:219–228.

    Article  PubMed  CAS  Google Scholar 

  18. Cookson WO, Hopkin JM: Dominant inheritance of atopic immunoglobulin-E responsiveness. Lancet 1988, 1:86–88.

    Article  PubMed  CAS  Google Scholar 

  19. Vercelli D: Genetic regulation of IgE responses: Achilles and the tortoise. J Allergy Clin Immunol 2005, 116:60–64. Excellent review of the genetics of allergy.

    Article  PubMed  CAS  Google Scholar 

  20. Vercelli D: Genetics, epigenetics, and the environment: switching, buffering, releasing. J Allergy Clin Immunol 2004, 113:381–386.

    Article  PubMed  CAS  Google Scholar 

  21. Strachan DP: Hay fever, hygiene, and household size. BMJ 1989, 299:1259–1260.

    PubMed  CAS  Google Scholar 

  22. Martinez FD: The coming-of-age of the hygiene hypothesis. Respir Res 2001, 2:129–132. Reviews both the genetics and clinical manifestations of the hygiene hypothesis.

    Article  PubMed  CAS  Google Scholar 

  23. Braun-Fahrlander C, Riedler J, Herz U, et al.: Environmental exposure to endotoxin and its relation to asthma in schoolage children. N Eng J Med 2002, 347:869–877.

    Article  Google Scholar 

  24. Ownby DR, Johnson CC, Peterson EL: Exposure to dogs and cats in the first year of life and risk of allergic sensitization at 6 to 7 years of age. JAMA 2002, 288:963–972.

    Article  PubMed  Google Scholar 

  25. Strachan DP: Family size, infection and atopy: the first decade of the “hygiene hypothesis.” Thorax 2000, 55(Suppl 1):S2-S10.

    Article  PubMed  Google Scholar 

  26. Platts-Mills TAE: Paradoxical effect of domestic animals on asthma and allergic sensitization. JAMA 2002, 288:1012–1014.

    Article  PubMed  Google Scholar 

  27. Romagnani S: Immunologic influences on allergy and the TH1/TH2 balance. J Allergy Clin Immunol 2004, 113:395–400.

    Article  PubMed  CAS  Google Scholar 

  28. Platts-Mills TA, Erwin E, Heymann P, et al.: Is the hygiene hypothesis still a viable explanation for the increased prevalence of asthma? Allergy 2005, 60(Suppl 79):25–31.

    Article  PubMed  Google Scholar 

  29. Maziak W: The asthma epidemic and our artificial habitats. BMC Pulm Med 2005, 31:5:5.

    Article  Google Scholar 

  30. Bresciani M, Parisi C, Manghi G, et al.: The hygiene hypothesis: Does it function worldwide? Curr Opin Allergy Clin Immunol 2005, 5:147–151.

    Article  PubMed  Google Scholar 

  31. Eldeirawi K, McConnell R, Freels S, et al.: Associations of place of birth with asthma and wheezing in Mexican American children. J Allergy Clin Immunol 2005, 116:42–48.

    Article  PubMed  Google Scholar 

  32. Leung RC, Carlin JB, Burdon JG, Czarny D: Asthma, allergy and atopy in Asian immigrants in Melbourne. Med J Aust 1994, 161:418–425.

    PubMed  CAS  Google Scholar 

  33. Kalyoncu AF: Symptoms of asthma, bronchial responsiveness and atopy in immigrants and emigrants in Europe. Eur Respir J 2002, 19:980–981.

    Article  PubMed  CAS  Google Scholar 

  34. Jaakkola JJ, Gissler M: Maternal smoking in pregnancy, fetal development, and childhood asthma. Am J Public Health 2004, 94:136–140.

    Article  PubMed  Google Scholar 

  35. DiFranza JR, Aligne CA, Weitzman M: Prenatal and postnatal environmental tobacco smoke exposure and children’s health. Pediatrics 2004, 113(4 Suppl):1007–1015.

    PubMed  Google Scholar 

  36. Martinez F, Cline M, Burrows B: Increased incidence of asthma in children of smoking mothers. Pediatrics 1992, 89:21–26.

    PubMed  CAS  Google Scholar 

  37. Arshad SH: Primary prevention of asthma and allergy. J Allergy Clin Immunol 2005, 116:3–14. Detailed review and discussion of primary prevention research.

    Article  PubMed  Google Scholar 

  38. Halmerbauer G, Gartner C, Schier M, et al.: Study on the prevention of allergy in Children in Europe (SPACE): allergic sensitization in children at 1 year of age in a controlled trial of allergen avoidance from birth. Pediatr Allergy Immunol 2002, 13:47–54.

    Article  PubMed  Google Scholar 

  39. Custovic A, Simpson BM, Simpson A, et al.: Manchester Asthma and Allergy Study: low-allergen environment can be achieved and maintained during pregnancy and in early life. J Allergy Clin Immunol 2000, 105:252–258.

    Article  PubMed  CAS  Google Scholar 

  40. Custovic A, Simpson BM, Simpson A, et al.: Effect of environmental manipulation in pregnancy and early life on respiratory symptoms and atopy during first year of life: a randomised trial. Lancet 2001, 358:188–193.

    Article  PubMed  CAS  Google Scholar 

  41. Brunekreef B, Smit J, de Jongste J, et al.: The prevention and incidence of asthma and mite allergy (PIAMA) birth cohort study: design and first results. Pediatr Allergy Immunol 2002, 13:55–60.

    Article  PubMed  Google Scholar 

  42. Koopman LP, van Strien RT, Kerkhof M, et al.: Placebocontrolled trial of house dust mite-impermeable mattress covers: effect on symptoms in early childhood. Am J Respir Crit Care Med 2002, 166:307–313.

    Article  PubMed  Google Scholar 

  43. Arshad SH, Bateman B, Matthews SM: Primary prevention of asthma and atopy during childhood by allergen avoidance in infancy: a randomised controlled study. Thorax 2003, 58:489–493.

    Article  PubMed  CAS  Google Scholar 

  44. Chan-Yeung M, Manfreda J, Dimich-Ward H, et al.: A randomized controlled study on the effectiveness of a multifaceted intervention program in the primary prevention of asthma in high-risk infants. Arch Pediatr Adolesc Med 2000, 154:657–663.

    PubMed  CAS  Google Scholar 

  45. Becker A, Watson W, Ferguson A, et al.: The Canadian Asthma Primary Prevention Study: outcomes at 2 years of age. J Allergy Clin Immunol 2004, 113:650–656. Comprehensive primary prevention with positive outcomes.

    Article  PubMed  Google Scholar 

  46. Arshad SH, Tariq SM, Matthews S, Hakim E: Sensitization to common allergens and its association with allergic disorders at age 4 years: a whole population birth cohort study. Pediatrics 2001, 108:E33.

    Article  PubMed  CAS  Google Scholar 

  47. Gruchalla RS, Pongracic J, Plaut M, et al.: Inner City Asthma Study: relationships among sensitivity, allergen exposure, and asthma morbidity. J Allergy Clin Immunol 2005, 115:478–485.

    Article  PubMed  Google Scholar 

  48. Matsui EC, Wood RA, Rand C, et al.: Mouse allergen exposure and mouse skin test sensitivity in suburban, middle-class children with asthma. J Allergy Clin Immunol 2004, 113:910–915.

    Article  PubMed  Google Scholar 

  49. Matsui EC, Simons E, Rand C, et al.: Airborne mouse allergen in the homes of inner-city children with asthma. J Allergy Clin Immunol 2005, 115:358–363.

    Article  PubMed  CAS  Google Scholar 

  50. Garcia DP, Corbett ML, Sublett JL, et al.: Cockroach allergy in Kentucky: a comparison of inner city, suburban, and rural small town populations. Ann Allergy 1994, 72:203–208.

    PubMed  CAS  Google Scholar 

  51. Rosenstreich DL, Eggleston P, Kattan M, et al.: The role of cockroach allergy and exposure to cockroach allergen in causing morbidity among inner-city children with asthma. N Engl J Med 1997, 336:1356–1363.

    Article  PubMed  CAS  Google Scholar 

  52. Morgan WJ, Crain EF, Gruchalla RS, et al.: Results of a homebased environmental intervention among urban children with asthma. Inner-City Asthma Study Group. N Engl J Med 2004, 351:1068–1080. Secondary prevention study with positive outcomes.

    Article  PubMed  CAS  Google Scholar 

  53. Eggleston PA: Environmental control for fungal allergen exposure. Curr Allergy Asthma Rep 2003, 3:424–429.

    PubMed  Google Scholar 

  54. Eggleston PA: Improving indoor environments: reducing allergen exposures. J Allergy Clin Immunol 2005, 116:122–126.

    Article  PubMed  Google Scholar 

  55. Schwartz J: Air pollution and children’s health. Pediatrics 2004, 113(4 Suppl):1037–1043.

    PubMed  Google Scholar 

  56. Riedl M, Diaz-Sanchez D: Biology of diesel exhaust effects on respiratory function. J Allergy Clin Immunol 2005, 115:221–228.

    Article  PubMed  CAS  Google Scholar 

  57. New Concerns About Ionizing Air Cleaners. Consumer Reports 2005, May:24–25.

  58. US Environmental Protection Agency: Ozone Generators That Are Sold As Air Cleaners. www.epa.gov/iaq/pubs/ozonegen. html. July 26, 2004.

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Sublett, J.L. The environment and risk factors for atopy. Curr Allergy Asthma Rep 5, 445–450 (2005). https://doi.org/10.1007/s11882-005-0024-x

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11882-005-0024-x

Keywords

Navigation