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.
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
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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