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Sensitization to Allergen
• Requires sufficient exposure (concentration and time)
• Requires genetic predisposition
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Natural History of Childhood Asthma
• Thus, the likely scenario is that allergen exposure over the first few years of life induces sensitization.
• Continuing exposure can induce and maintain inflammation in the nose and lungs.
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Natural History of Childhood Asthma
• It remains unclear at what time the critical exposure occurs and what role allergen exposure has played to induce development and influence severity of asthma
• Objective evidence of an immune response to allergens is generally not present until after two years of age.
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Major Indoor Allergens
• Cockroach• Dust mite• Animal Dander• Fungi
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German Cockroach
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Dust Mite
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Cockroach and Asthma Morbidity
• Group1=No Allergy/Low Exposure
• Group2=No Allergy/High Exposure
• Group3=Allergy/Low Exposure
• Group4=Allergy/High Exposure
0
0.2
0.4
1 2 3 4
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Development of Asthma
Exposure to cockroach allergen early in life may contribute to the development of asthma in susceptible children.
J Allergy Clin Immunol 2001;107:41-7
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Conclusions/Observations
• Asthma deaths/morbidity have increased and disproportionately high in African Americans
• Genetics and environment contribute to development and probably asthma severity
• Good management necessitates- Access to high quality care- Control of exposure to allergens/irritants- Pharmacotherapy for pathophysiology