Abstract

Bronchial asthma is one of the most chronic pulmonary diseases and major public health problems. In general, asthma prevails in developed countries than developing countries, and its prevalence is increasing in the latter. For instance, the hygiene hypothesis demonstrated that this phenomenon resulted from higher household hygienic standards that decreased the chances of infections, which would subsequently increase the occurrence of allergy. In this review, we attempted to integrate our knowledge with the hygiene hypothesis into beneficial preventive approaches for allergic asthma. Therefore, we highlighted the studies that investigated the correlation between allergic asthma and the two different types of infections that induce the two major antagonizing arms of T cells. This elucidation reflects the association between various types of natural infections and the immune system, which is predicted to support the main objective of the current research on investigating of the benefits of natural infections, regardless their immune pathways for the prevention of allergic asthma. We demonstrated that natural infection with Mycobacterium tuberculosis (Mtb) prevents the development of allergic asthma, thus Bacille Calmette-Guérin (BCG) vaccine is suggested at early age to mediate the same prevention particularly with increasing its efficiency through genetic engineering-based modifications. Likewise, natural helminth infections might inhabit the allergic asthma development. Therefore, helminth-derived proteins at early age are good candidates for designing vaccines for allergic asthma and it requires further investigation. Finally, we recommend imitation of natural infections as a general strategy for preventing allergic asthma that increased dramatically over the past decades.

Highlights

  • Bronchial asthma is regarded as the most chronic pulmonary disease and a major public health problem, affecting more than 350 million people worldwide with a high mortality rate in severe cases

  • We demonstrated that natural infection with Mycobacterium tuberculosis (Mtb) prevents the development of allergic asthma, Bacille Calmette-Guérin (BCG) vaccine is suggested at early age to mediate the same prevention with increasing its efficiency through genetic engineering-based modifications

  • We revealed the beneficial features of the hygiene hypothesis for preventing allergic asthma via simulating the natural infections that either induce Th1 or T helper 2 (Th2) cells primarily as nature will find its way regardless of the immune pathway, and this can be applied to other allergic diseases

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Summary

BACKGROUND

Bronchial asthma is regarded as the most chronic pulmonary disease and a major public health problem, affecting more than 350 million people worldwide with a high mortality rate in severe cases. For human allergic asthma (Table 2), several epidemiological studies with various study designs concluded that early BCG vaccination significantly decreases the subsequent development of asthma in different countries, such as England, France, Turkey, Germany and Spain in Europe, and Japan, Thailand and India in Asia [25, 52,53,54,55,56,57]. This conclusion was supported by the inverse correlation between BCG scar dimeter and atopic asthma in Brazil and Korea [65, 66]. OVA, Ovalbumin; DCs, dendritic cells; i.d., intradermal; i.n., intranasal; i.p., Intraperitoneal; S.C., Subcutaneous

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