JO Warner, JA Warner, EA Miles, AC Jones

Abstract

The prevalence of asthma and related allergic disorders has increased considerably over the last 20-30 years. As genetic stock has not changed, environmental factors must have influenced the phenotype. Studies have shown that the key events leading to sensitization and the development of allergic disease are operative early in life. Indeed, our own studies would suggest that primary sensitization frequently occurs in utero. Postnatal allergen exposure then localises the cells to target organs where inflammation develops and disease manifests. The characteristics of the allergic immune response are now clearly elaborated with distinct subclasses of lymphocyte generating a particular set of peptide regulatory factors (cytokines) being pivotal in controlling both the production of immunoglobulin E and the activation of eosinophils and mast cells. Insights into the mechanisms leading to sensitization are beginning to identify therapeutic targets which may in the future reduce the prevalence of allergic disease in a highly cost effective manner. The interventions will include modification of the environment, immune modulation and targeted pharmacotherapy.