Clinical Review Science, medicine, and the future

Allergic disorders

BMJ 2000; 320 doi: http://dx.doi.org/10.1136/bmj.320.7229.231 (Published 22 January 2000) Cite this as: BMJ 2000;320:231
  1. Stephen T Holgate, MRC clinical professor of immunopharmacology (sth@soton.ac.uk)
  1. Medical Specialties, Southampton General Hospital, Southampton SO16 6YD

    When John Bostock first described hay fever in 1819 the condition was rare, but allergy has now reached epidemic proportions, with almost one in two people in the developed world exhibiting an allergic response to some common environmental factor. Most allergic diseases are linked to atopy, the predisposition to generate the allergic antibody IgE to common environmental agents. Because IgE is able to sensitise mast cells anywhere in the body, atopic individuals often express disease in more than one organ. Although current treatments are able to control symptoms, allergy still causes appreciable misery. There is an urgent need for new approaches to more effectively treat allergic responses and prevent their occurrence. This review focuses on some exciting new developments based on a clearer understanding of the underlying cellular and mediator mechanisms and how the human body interacts with the changing environment.

    Methods

    I identified those aspects of allergy research with the greatest potential for novel therapeutic approaches from my personal knowledge of the subject. The information sources for the article are peer reviewed reports of original observations and, where appropriate, reviews of the recent literature by established investigators.

    Background

    Population based studies have revealed large geographical differences in the prevalence of allergic disease, with countries such as Britain, Australia, and New Zealand having figures 10-15 times higher than central and eastern Europe and Asia. Although atopic disorders show strong heritability, differences in environments are likely to account for the geographical variations. The increasing prevalence of allergic disorders has been especially noticeable in the past two decades, predominantly in young people and linked to a Western lifestyle. On the basis of careful epidemiological studies, changes to maternal and infant diets, reduced exposure to antibiotics in infancy, and avoidance of indoor air pollutants (especially cigarette smoke) and aeroallergens have all been suggested as steps …

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