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J Allergy Clin Immunol. 2020 Jan 8. pii: S0091-6749(20)30002-6. doi: 10.1016/j.jaci.2019.12.904. [Epub ahead of print]

Evolving Concepts in how Viruses Impact Asthma.

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Department of Medicine, University of Washington, Seattle, Washington.
Division of Pediatric Allergy, Immunology & Pulmonary Medicine, Washington University School of Medicine, St. Louis MO , The Kipper Institute of Allergy and Immunology, Schneider Children's Medical Center of Israel, Petach Tikvah, Israel.
Allergy/Immunology and Pediatric Pulmonology and Sleep Medicine, University of Chicago School of Medicine, Chicago, IL.
Division of Pediatric Allergy, Immunology and Rheumatology, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI.
Department of Pediatrics, University of Virginia Medical Center, Charlottesville, VA.
Division of Allergy/Immunology, University of Arkansas for Medical Sciences, Little Rock, AR.
Division of Pediatric Pulmonology, Allergy and Sleep Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN.
Allergy Partners of the Triangle, Raleigh, N.C.
Department of Medicine, University of Virginia Medical Center, Charlottesville, VA.
Departments of Pediatrics and Immunology/Pathology, Baylor College of Medicine, Houston, TX.
Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN. Electronic address:


Over the last decade, there have been substantial advances in our understanding about how viral infections regulate asthma (Table 1). Important lessons have been learned from birth cohort studies examining viral infections and subsequent asthma, understanding the relationships between host genetics and viral infections, the contributions of respiratory viral infections to patterns of immune development, the impact of environmental exposure on severity of viral infections, and how the viral genome influences host immune responses to viral infections. Further, there has been major progress in our knowledge about how bacteria regulate host immune responses in asthma pathogenesis. In this article, we also examine the dynamics of respiratory tract bacterial colonization during viral upper respiratory tract infection, in addition to the relationship of the gut and respiratory microbiomes with respiratory viral infections. Finally, we focus on potential interventions that could decrease virus-induced wheezing and asthma. There are emerging therapeutic options to decrease severity of wheezing exacerbations caused by respiratory viral infections. Primary prevention is a major goal and a strategy toward this end is considered.


asthma; genetics; immune; microbiome; virus


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