Atopic Diseases Mechanisms, Exposures, and Diagnostics

Abstract

Epidemiological data suggest that atopic diseases (asthma, atopic dermatitis, allergic
rhinitis, and food allergy) begin in early life and that most cases present clinically during
early childhood. The disease incidences increase as communities adopt western lifestyles
and the diseases are highly prevalent. Disentangling the pathophysiological mechanisms
leading to disease debut is necessary to identify beneficial/harmful exposures so that
successful prevention and treatment can be generated.
The objective of this thesis is to explore mechanisms of atopic diseases, to investigate the
importance of environmental factors in early life, prior to disease development, and finally
to explore new diagnostic tools to interpret allergic sensitization more accurately. The
thesis is built on nine studies originating from the COPSAC2000 and COPSAC2010 birth
cohorts investigating mechanisms of atopic disease and modifiable exposures in the
environment that can affect the development of atopic diseases, and finally, examining
how component resolved diagnostics can help provide a patient-tailored approach to
allergy diagnostics.
First, the distribution of sIgE levels in children is investigated, as this is one of the main
criteria for the definition of atopy. Thereafter, it is explored how studies of parental atopic
status, sensitization patterns, and early debut and severity of atopic dermatitis have
substantiated the theory of an early-life window-of-opportunity for intervention that
precedes the development of atopic diseases in childhood. Then, it is examined whether
early-life exposures such as breastfeeding, dogs, cats, and house dust mites in the home
perinatally constitute important influencers in this crucial time of life. Finally, it is explored
how component resolved diagnostics may allow patient-tailored recommendations
suggesting that some dog allergic patients tolerate female dogs. The utility of molecular
diagnostics is also discussed in relation to other allergen sources and future directions are
proposed. Last, it is discussed how these findings could be validated in randomized
controlled trials, which might prepare the ground for improved diagnostics and prevention
strategies to mitigate the current atopic pandemic.
Original languageEnglish
PublisherUniversity of Copenhagen
Number of pages88
Publication statusPublished - 11 Jan 2024

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