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A general pattern of factors influencing development of asthma seems to be emerging, including family allergy history/ asthma genetics, smoking, diet, obesity, and inactivity, all of which seem to influence the development of asthma and disease outcomes (Table bellow).

Many clinical or area studies have reported substantially higher rates of asthma prevalence, hospitalization, and mortality among racial and ethnic minorities. However, asthma is also most common among low socioeconomic groups, regardless of race. While black children have higher rates of asthma than white children, most studies have found that black race is not a significant correlate of asthma after controlling for location of residence and socioeconomic status (SES). The basis for the effects of poverty and urban residence on asthma prevalence is not known. One potential asthma factor is allergen exposure and allergen sensitization are common in urban environments. Black children in inner city Atlanta are exposed to high levels of dust mites and cockroach allergen, and a high proportion of the children with asthma were sensitized to these allergens. Litonjua and colleagues also concluded that a large proportion of racial/ethnic differences in asthma prevalence can be explained by factors related to income, area of residence, and level of education.

Asthma Factors that Influence Disease Development and Severity

Income is a determinant of access to health care, and frequently, the quantity and quality of health care available. Persons who have low income, regardless of race or ethnicity, are more likely to be uninsured, to encounter delays or be denied care, to rely on hospital clinics in emergency departments for health services, and to receive substandard care. The usual socioeconomic indicators, education and personal or household income, serve only as surrogates for more complicated correlates of individuals within populations and multiple asthma factors that can impact both on prevalence of asthma and adverse outcomes from the disease.

Studies from Germany comparing the populations of East and West Germany have shown the prevalence of hay fever and asthma as significantly higher in West German children, suggesting that asthma environmental factors explain the difference in prevalence in these ethnically similar populations. Early exposure to infections (as with being in a day-care environment early in life) or exposure to endotoxin (as with growing up on a farm with close exposure to the farm animals) are associated with a decreased prevalence of asthma. In contrast, growing up in an urban environment or generally with an increased standard of living are associated with an increased prevalence of asthma. Such correlates are also present for atopic disorders other than asthma. In fact, Strachan, who noted that prevalence of hay fever was inversely related to family size, was the first to recognize the importance of early exposures on atopic disease. In the USA, asthma is more prevalent in African-Americans and Puerto Ricans. These findings are not explained by the observations on the role of social class in European studies. Given the ethnic differences between African-Americans and whites, these studies may represent gene-by-environment interaction producing varied phenotypic outcomes.

This study examined the genetic basis of sensitization to house dust mite allergy allergens. A genome scan was conducted using 603 microsatellite markers in 82 nuclear families (366 individuals) of German, British and Portuguese origin with at least two affected siblings. Sensitization to Dermatophagoides pteronyssinus was assessed by determining specific IgE antibody levels detected by immunochemiluminometric assay and immunosorbent assay and categorized as positive or negative relative to a predetermined cut-off point. (more…)

Allergic rhinitis is a very common problem associated with poor quality of life, reductions in social and work activities and poor interpersonal relationships. The main goal of the management of allergic rhinitis is to improve the quality of life. Immunotherapy is a specific therapy for allergic rhinitis and several reports have documented the safety and efficacy of this treatment . Safety has been a key issue in immunotherapy and various modalities are being investigated to make allergy immunotherapy more tolerable and safe to administer. (more…)

Two factors thought to influence the risk factor asthma are the promoting effect of sensitization to house dust mites and the preventive effect of increased omega-3 fatty acids. Although the avoidance of house dust mites allergen has been used as a preventive strategy in several trials, the effect of omega-3 fatty acid supplementation in the primary prevention of asthma and allergic disease is not known. (more…)

Asthma and allergic diseases are common in both children and adults. Their development depends on an interaction between asthma genetic and asthma environmental risk factors. Genetic manipulation in multi factorial diseases such as asthma is not feasible in the foreseeable future. However, theoretically, environmental exposures can be controlled in an attempt to stem the rising prevalence of these diseases (primary prevention). Environmental exposures may also influence the frequency of symptoms and the requirement for medication in those with established disease. (more…)

Natural history studies with the following design features provide a firm epidemiologic foundation for risk factor assessments and etiologic hypotheses:
(1) long-term cohort studies of a prospective design minimize biases resulting from poor parental recall;
(2) multiple evaluations over time provide important checkpoints during the dynamic period of childhood growth and development; and
(3) the inclusion of objective disease measurements strengthens these studies by validating subjective disease assessments (i.e. questionnaire data). (more…)

Atopic dermatitis is a chronic inflammatory condition of the skin which usually starts in infancy. It is sometimes called ‘atopic eczema’ or even simply ‘eczema’. Recently, the term ‘atopic eczema dermatitis syndrome’ or eczema symptoms or infantile eczema has also been proposed to indicate the varied nature of this disease. The diagnosis is based on clinical features of a chronic itchy dermatitis with typical morphology and distribution and a relapsing and remitting course. (more…)

The most crucial element in the assessment process of a possible allergic problem is patient’s allergy history. An allergy history is made up of a chief problem, resolve of seasonality or diurnal variation of symptoms, detection of triggers, occupational asthma exposure, and reaction to medicines, family history, and some other relevant medical history. An allergy history looks for to define the patient’s chief complaint(s) and concentrates on the details with regards to those complaints. There is a lexicon typical to patients with allergy complaints. Sinus dizziness strain and headaches are often cited as symptoms. The history taker should be attuned to the patient’s viewpoint as a possible allergy sufferer. Exactly where and when does the symptom happen? Or is it happened during sleep? (more…)

The symptoms of asthma occur together with variations in the diameter of medium- size airways such that it is increasingly difficult to exhale. Narrowing of the airways can occur because of smooth muscle contraction, edema or swelling of the wall, or increased mucus in the airways. However, it is increasingly clear that the pathologic event underlying most cases of asthma is acute inflammation of the airway walls. (more…)

To prevent the development of allergy, allergen avoidance has to be instituted before sensitization has occurred. The specific type of aero allergens may vary depending on the climatic and economic situation. For example, House Dust Mite is the most important allergen in humid climates and pet allergens assume importance in cold countries, while cockroach allergen is the major sensitizing agent in crowded, inner city areas. Several large prospective studies have instituted House Dust Mites avoidance measures during pregnancy, at birth and later in childhood, and assessed children for asthma and allergic manifestations. (more…)