Origins of reactive airways disease in early life: do viral infections play a role?
There is mounting evidence suggesting that infection with respiratory syncytial virus (RSV) in early life increases the risk of developing reactive airway disease (RAD) later in childhood. A recent prospective study demonstrated that children hospitalized with RSV bronchiolitis in infancy face a significantly increased risk of recurrent wheezing and allergy at least until the age of 7 y that is independent of hereditary factors. Proposed mechanisms for this link include immune dysregulation, in which RSV-specific IgE or an imbalance between T-lymphocyte-dependent immune pathways may be involved, and abnormal neural control, in which the non-adrenergic, non-cholinergic pathways are altered by RSV infection. More recent studies suggest that immune and neural mechanisms may be linked and that post-RSV airway inflammation may be explained, at least in part, on the basis of these neuroimmune interactions.


CONCLUSIONS
Passive immunoprophylaxis may protect against persistent viral-induced inflammation of the respiratory tract, long-term changes in pulmonary function and increased frequency of RAD episodes.
Piedimonte
G
G
Batchelor Children's Research Institute, Pediatric Pulmonology and Cystic Fibrosis Center, University of Miami School of Medicine, 1580 NW 10th Ave. (D-820), Miami, FL 33136, USA. gpiedimo@med.miami.edu
D000818:Animals; D001249:Asthma / Q000209:etiology* / Q000503:physiopathology*; D001707:Biopsy, Needle; D016535:Bronchial Hyperreactivity / Q000209:etiology* / Q000503:physiopathology; D001988:Bronchiolitis / Q000209:etiology* / Q000473:pathology; D004195:Disease Models, Animal; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D051379:Mice; D018345:Mice, Knockout; D008967:Molecular Biology; D009434:Neural Pathways; D011379:Prognosis; D011446:Prospective Studies; D051381:Rats; D011916:Rats, Inbred F344; D018357:Respiratory Syncytial Virus Infections / Q000150:complications* / Q000276:immunology; D018570:Risk Assessment; D012680:Sensitivity and Specificity