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EDITORIALS: H Ross Anderson Prevalence of asthma BMJ 2005; 330: 1037-1038 [Full text]

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What is Asthma?

Richard E D Hamm   (6 May 2005)

Re: What is Asthma?

Narendra Babu Koyyalamudi   (9 May 2005)

Early childhood vaccines are not mentioned.

Wouter Havinga   (9 May 2005)

What is Asthma? 6 May 2005
Richard E D Hamm, retired GP Isle of Man IM9 1BJ Send response to journal: Re: What is Asthma?	When I was a young GP in the late 1960's, Asthma was generally regarded as a disease characterised by sudden episodes of serious wheeze. In the late 1980's or early 90's my excellent Practice Nurse went on an ashma course along with many of her colleagues and I found on her return that now anyone who wheezed once was considered to be an asthmatic. Much of the asthma management at the time was lead by practice nurses and I rapidly found a huge increase in the numbers of 'asthmatics' in the practice.I saw, however, no change in the incidence of what I had been taught to call asthma, but this coincided with reports in newspapers and learned journals of a huge and worrying rise in asthma. In other words, it seems to me that the rise was an apparent rise due to reclassification of the disease and it is not therefore surprising that the numbers have at least levelled out as all the backlog has been accounted for. Competing interests: None declared
Re: What is Asthma? 9 May 2005
Narendra Babu Koyyalamudi, Locum ENT Consultant Tyrone County Hospital,Omagh,Co.Tyrone BT790AP Send response to journal: Re: Re: What is Asthma?	Editor, I am in complete agreement with Richard E D Hamm regarding the rise in the incidence of Asthma. When some body develops a temporary pulmonary condition causing wheeze they are labelled as being asthmatic. Once a person gets a label it is impossible to lose it. Competing interests: None declared
Early childhood vaccines are not mentioned. 9 May 2005
Wouter Havinga, sessional GP GL6 6JL Send response to journal: Re: Early childhood vaccines are not mentioned.	In his editorial Professor Ross Anderson did not mention early childhood vaccinations as a possible cause for asthma and atopic diseases. In response to his request to develop theories of causation I believe that this need better exploration. I suggest that postponing vaccination would ultimately create a healthier population according to the theory that part of the immune system can be divided in the humeral system (Th2) and the cellular (Th1) system and that the response to stimuli during life can be set in infancy. The humeral system produces antibodies and the cellular system takes care of killing infected cells and inhibits viral replication in body cells. Ideally the Th1/Th2 part of our immune system works in a balanced way. However, the infants immune system can be primed in the first 6 to 12 months, in other words, set for the rest of that persons life to react in a predominant Th2 response (atopic) due to repeated stimulation in those first month of life (fig 2). This can possibly deducted from the difference in immune response to a natural infection and a vaccination. In a natural infection the immune response is balanced, the humeral immune system attacks viruses outside body cells and the cellular immune system attacks infected body cells in order to clear the body from this virus. In a natural measles or rubella infection a rash will appear, which is the result of the cellular part of the immune system (TH1- response). However, the body does not produce such a prominent rash as in natural infections after vaccination. This shows that this response of the cellular immune system is not as such stimulated with vaccinations, possibly resulting in an emphasis on producing antibodies. Giving more vaccines at the same time causes an even stronger humeral (Th2-) response and can prime the immune system of that person’s immune system to react in a predominant antibody fashion to stimulants later in life. These antibody responses are seen in atopic diseases. This theory would explain that early childhood vaccinations cause the increase over the past decades in allergic disorders. Postponing vaccination to a time where the immune system is less vulnerable to be set in an atopic response mode could theoretically have major health advantages. (2) 1 http://bmj.bmjjournals.com/cgi/content/full/330/7499/1037 2 http://bmj.bmjjournals.com/cgi/eletters/328/7450/1223#60429 Competing interests: None declared