Prevalence of asthma
BMJ 2005; 330 doi: https://doi.org/10.1136/bmj.330.7499.1037 (Published 05 May 2005) Cite this as: BMJ 2005;330:1037All rapid responses
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Editor,
I am in complete agreement with Richard E D Hamm regarding the rise
in the incidence of Asthma. When some body develops a temporary pulmonary
condition causing wheeze they are labelled as being asthmatic. Once a
person gets a label it is impossible to lose it.
Competing interests:
None declared
Competing interests: No competing interests
When I was a young GP in the late 1960's, Asthma was generally
regarded as a disease characterised by sudden episodes of serious wheeze.
In the late 1980's or early 90's my excellent Practice Nurse went on an
ashma course along with many of her colleagues and I found on her return
that now anyone who wheezed once was considered to be an asthmatic. Much
of the asthma management at the time was lead by practice nurses and I
rapidly found a huge increase in the numbers of 'asthmatics' in the
practice.I saw, however, no change in the incidence of what I had been
taught to call asthma, but this coincided with reports in newspapers and
learned journals of a huge and worrying rise in asthma. In other words, it
seems to me that the rise was an apparent rise due to reclassification of
the disease and it is not therefore surprising that the numbers have at
least levelled out as all the backlog has been accounted for.
Competing interests:
None declared
Competing interests: No competing interests
Early childhood vaccines are not mentioned.
In his editorial Professor Ross Anderson did not mention early
childhood vaccinations as a possible cause for asthma and atopic diseases.
In response to his request to develop theories of causation I believe that
this need better exploration.
I suggest that postponing vaccination would ultimately create a
healthier population according to the theory that part of the immune
system can be divided in the humeral system (Th2) and the cellular (Th1)
system and that the response to stimuli during life can be set in infancy.
The humeral system produces antibodies and the cellular system takes
care of killing infected cells and inhibits viral replication in body
cells. Ideally the Th1/Th2 part of our immune system works in a balanced
way.
However, the infants immune system can be primed in the first 6 to 12
months, in other words, set for the rest of that persons life to react in
a predominant Th2 response (atopic) due to repeated stimulation in those
first month of life (fig 2). This can possibly deducted from the
difference in immune response to a natural infection and a vaccination.
In a natural infection the immune response is balanced, the humeral
immune system attacks viruses outside body cells and the cellular immune
system attacks infected body cells in order to clear the body from this
virus.
In a natural measles or rubella infection a rash will appear, which
is the result of the cellular part of the immune system (TH1- response).
However, the body does not produce such a prominent rash as in
natural infections after vaccination. This shows that this response of the
cellular immune system is not as such stimulated with vaccinations,
possibly resulting in an emphasis on producing antibodies.
Giving more vaccines at the same time causes an even stronger humeral
(Th2-) response and can prime the immune system of that person’s immune
system to react in a predominant antibody fashion to stimulants later in
life. These antibody responses are seen in atopic diseases.
This theory would explain that early childhood vaccinations cause the
increase over the past decades in allergic disorders. Postponing
vaccination to a time where the immune system is less vulnerable to be set
in an atopic response mode could theoretically have major health
advantages. (2)
1 http://bmj.bmjjournals.com/cgi/content/full/330/7499/1037
2 http://bmj.bmjjournals.com/cgi/eletters/328/7450/1223#60429
Competing interests:
None declared
Competing interests: No competing interests