The "envirome" and what the practitioner needs to know about it.

OBJECTIVE

This review on the "envirome" focuses on pollution, microbial, and social stressor elements of the environment that may impact development or expression of allergic diseases.

DATA SOURCES: Peer-reviewed publications on the impact of environmental factors indexed in PubMed were the primary data source for this review.

STUDY SELECTIONS: The primary search strategy for this review employed cross-referencing asthma, atopic dermatitis, and immunoglobulin E (IgE) against pollution (ozone, particulate matter, nitrogen oxides, tobacco smoke), microbial exposures (farm exposure, microbiome, infection, antibiotic use) and psychosocial stressors, with emphasis on results in the past 5 years, with inclusion of key seminal articles or comprehensive reviews.

RESULTS

Air pollution is a clear cause of allergic disease exacerbation, with increasing recognition that pollutant exposure increases risk of allergic disease. Microbial exposures and maternal and child stress also modulate development and expression of allergic disease. Early life exposures are especially critical periods during which all of these factors have notable impacts on allergic disease.

CONCLUSION

Nonallergenic environmental factors are important modulators and adjuvants for development of allergic disease, with early life exposures being especially important. Development and validation of interventions directed toward these factors during early life is a significant opportunity for primary prevention of allergic disease.