• Georg J Loss, Martin Depner, Alexander J Hose, Jon Genuneit, Anne M Karvonen, Anne Hyvärinen, Caroline Roduit, Michael Kabesch, Roger Lauener, Petra Ina Pfefferle, Juha Pekkanen, Jean-Charles Dalphin, Josef Riedler, Charlotte Braun-Fahrländer, Erika von Mutius, Markus J Ege, and PASTURE (Protection against Allergy Study in Rural Environments) Study Group.
• 1 Dr. von Hauner Children's Hospital, Ludwig Maximilians University Munich, Munich, Germany.
• Am. J. Respir. Crit. Care Med. 2016 Apr 15; 193 (8): 889-97.

RationaleGrowing up on a farm protects from childhood asthma and early wheeze. Virus-triggered wheeze in infancy predicts asthma in individuals with a genetic asthma risk associated with chromosome 17q21.ObjectivesTo test environmental determinants of infections and wheeze in the first year of life, potential modifications of these associations by 17q21, and the implications for different trajectories of wheeze.MethodsWe followed 983 children in rural areas of Europe from birth until age 6 years. Symptoms of wheeze, rhinitis, fever, and environmental exposures were documented with weekly diaries during year 1. Asthma at age 6 was defined as ever having a reported doctor's diagnosis. Single-nucleotide polymorphisms related to ORMDL3 (rs8076131) and GSDMB (rs7216389, rs2290400) at 17q21 were genotyped.Measurements And Main ResultsEarly wheeze was positively associated with presence of older siblings among carriers of known asthma risk alleles at 17q21 (e.g., rs8076131) (adjusted odds ratio [aOR], 1.53; 95% confidence interval [CI], 1.16-2.01). Exposure to farm animal sheds was inversely related to wheeze (aOR, 0.44; 95% CI, 0.33-0.60). Both effects were similarly observed in children with transient wheeze up to age 3 years without subsequent development of asthma (aOR, 1.71 [95% CI, 1.09-2.67]; and aOR, 0.48 [95% CI, 0.30-0.76], respectively).ConclusionsThese findings suggest that the chromosome 17q21 locus relates to episodes of acute airway obstruction common to both transient wheeze and asthma. The previously identified asthma risk alleles are the ones susceptible to environmental influences. Thus, this gene-environment interaction reveals two faces of 17q21: The same genotype constitutes genetic risk and allows for environmental protection, thereby providing options for prospective prevention strategies.

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