Environmental factors influencing the development and progression of pediatric asthma.

Recent data underscore the importance of environmental factors in the sensitization of children to certain allergens and the development of asthma. Maternal smoking and family (especially maternal) history of atopy appear to be risk factors for persistent sensitization and development of asthma. Indeed, exposure to tobacco smoke in utero significantly increases asthma risk and influences the timing of sensitization. It must be stated that any smoking at home has consequences for the development of asthma and other respiratory conditions. In addition, reports of possible protective effects of specific environmental conditions suggest that exposure to certain stimuli may reduce or block the development and progression of asthma. Attendance at a day care center early in life appears to offer protective effects against wheezing, as do early episodes of rhinitis, herpes, and measles. Children raised on a farm also have a decreased prevalence of atopic diseases. The protective effect of contact with livestock and poultry is consistent among several studies. Although the pathophysiologic mechanisms involved remain undefined, studies suggest that exposure to endotoxin and other components of bacteria may play an important role in protecting against childhood atopic diseases. Whether in utero exposure is beneficial remains to be determined.