Gene-environmental interaction in the development of atopic asthma: new developments

Purpose of reviewOver recent years, major advances have occurred in understanding of the role of atopyin asthma. To accommodate these advances requires a revision in the paradigm thatasthma is an atopic disease. In turn, a revision in the focus of gene–environment studiesis now needed. The aim of this review, therefore, is to provide a new perspective to thetopic of the role of genes and environment in the development of symptoms in atopicasthma.Recent findingsRecent data from prospective birth-cohort studies has shown that atopic events appearto play a limited role in the development of asthma and even less of a role in significantacute wheeze in children. Overwhelmingly, acute respiratory viral infection, not acuteallergen exposure, is the major environmental cause of acute wheezing episodes inasthmatic children. This knowledge has led to the examination of the genetics of theimmune system, particularly genes controlling innate immune responses, with respect toviral defences – an important area of gene–environment interaction in asthma.SummaryAdvances in knowledge of the genetics of viral defence have contributed to improvedinsight into asthma in children and could lead to effective new antiviral asthma therapies.