Reviews and feature articleEarly-life environmental determinants of allergic diseases and the wider pandemic of inflammatory noncommunicable diseases
Section snippets
A global health challenge of pandemic proportions
Dramatic environmental and lifestyle changes of the modern age pose a significant threat to human health. An unparalleled increase in a diverse range of chronic noncommunicable diseases (NCDs) is one of the major global challenges of the 21st century. This growing burden of NCDs currently poses the greatest threat to health in both developed and developing regions and is a major barrier to human development. The dominant focus of the NCDs agenda is usually on “the big four”: cardiovascular
Inflammation as a common feature of many NCDs: A central role of the immune system
Chronic low-grade inflammation is a common feature of virtually all NCDs, highlighting the central multisystem interactions of the immune system.2 The specific vulnerability of the immune system to recent environmental changes is also reflected in the dramatic increase in virtually all inflammatory disorders and, in particular, immune diseases, such as allergy and autoimmunity. Furthermore, clinical expression of allergy within the first months of life and detectable immune dysregulation at
Early life: A critical time of risk and opportunity
Prevention is the ultimate approach to reducing the burden of NCDs, and the greatest potential for this lies in early life. There is already substantive evidence that initiatives to promote a healthy start to life can reduce the risk of both early and later NCDs, with wide social and economic benefits.6, 7 The early environment in both pregnancy and early childhood can determine physiologic, structural, immune, metabolic, and behavioral development and modify response patterns that influence
Common risk factors mean common solutions: The need for interdisciplinary collaboration
Although genetic factors can determine individual susceptibility and patterns of disease, only environmental change can account for the rapid increase in NCDs. This also suggests common risk factors and the need for common solutions. Moving forward, there is a clear imperative for coordinated interdisciplinary strategies, particularly those focused on early life. There are a number of good examples of immunomodulatory interventions explored for allergy prevention that might have additional
Epigenetics, genetics, and evolutionary perspectives
The TH2 responses that characterize allergic disease are not inherently pathological and only cause disease when excessive or misdirected. Provoking new thoughts and challenging long-held concepts that TH2 responses have primarily evolved to defend against helminthes, Palm et al73 have recently proposed that the very rapid, acute IgE-mediated responses are equally, if not more likely, to have evolved to protect against a broader diverse range of environmental irritants, toxins, venoms,
Thinking beyond health to find solutions
Our current global health crisis is a major threat to social and economic development worldwide, and it is increasingly important that we (working in health) collaborate with other sectors in finding solutions to the many global challenges facing humanity and our planet. Human health is inexorably linked with the health of our natural environment. Threats, including global warming, decreasing biodiversity, and modern pollutants, have repercussions for food, water, and energy security. Equally,
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Supported by a Practitioner Fellowship from the National Health and Medical Research Council (NHMRC) of Australia.
Disclosure of potential conflict of interest: S. L. Prescott has received grants from the National Health and Medical Research Council and is a board member for Nestlé, Danone, and ALK-Abelló.