Acceptance of the existence of patterns of immune-based disease has inherent ramifications. Among these is the concomitant recognition that, even within an individual, underlying immune dysfunction contributes to elevated risk for not one but several chronic diseases across a lifetime. For this reason, it is advantageous to be able to minimize the extent to which a specific pattern of disease can progress. A diagnosis of childhood asthma has certain implications for present medical care and health management. However, the management of pediatric asthma might be distinctly different if elevated risk of sleep disorders, lung cancer, obesity, recurrent respiratory infections, otitis media, behavioral disorders, and olfactory dysfunction are added to the pediatrician’s concerns for a child’s health. For some of the comorbidities, risk reduction may occur with present management of entryway diseases. But for other comorbidities, special interventions may be needed to break the entryway disease pattern. This is more likely to occur if physicians are aware of the existence of disease patterns and the entryway disease or condition is treated with the health care goal of breaking the overall disease pattern rather than the potentially more restrictive goal of managing the symptoms of the initial presenting disease.
Problems arise when and if current management of childhood asthma, type 1 diabetes, pediatric celiac disease, or recurrent otitis media deals only with the clinical symptoms but fails to address the underlying immune dysfunction that led to the entryway disease. The former treatment course would be more likely to leave intact the elevated risk of one or more additional diseases than would a pattern-based pediatric therapeutic approach (Dietert and Zelikoff 2009
). This last point can be highlighted by the potential considerations for managing type 1 diabetes in children. Treatments often focus on lifelong insulin administration, regulation of blood glucose levels, careful dietary controls, and effective exercise (Haller et al. 2005
; Hood et al. 2009
). But given that this population of children carries an elevated risk for additional autoimmune (autoimmune thyroiditis, celiac disease, multiple sclerosis) and inflammatory conditions (atherosclerosis, depression, sleep disorders) (Dietert and Zelikoff 2009
), insulin and glucose management alone is unlikely to correct underlying immune dysfunction. In contrast, therapies that include comprehensive immunomodulatory procedures (Zhao et al. 2009
) have the potential to correct the persistent immune defect(s) and reduce the serious additional health risks.
As shown for patterns connected to metabolic syndrome () and childhood asthma (), intervention can be used to disrupt a pattern of disease. In theory, this intervention could occur anytime after underlying immune dysfunction is identified. But in practice, this would occur after the diagnosis of the entryway disease (and detection of underlying immune dysfunction). A sliding scale is depicted in the intervention window after the onset and diagnosis of each entryway disease or condition. This is used to indicate that, across a lifetime, the most effective and comprehensive intervention opportunity to break a disease pattern and reduce the risk for all associated diseases is likely to be nearest to the time of entryway disease diagnosis (i.e., early in life). The longer underlying immune dysfunction persists as the individual ages, the more difficult it may be to reduce the risk for the entire spectrum of associated diseases.
For example, childhood asthma is often associated with other allergic conditions, and many of these can arise just before or after the appearance of asthma (Leynaert et al. 2000
). Therefore, the window of intervention to effectively block the development of other comorbid allergic diseases in asthmatic children may be quite narrow. Likewise, childhood asthma and obesity are often comorbid in young children (Tai et al. 2009
). In contrast, lung cancer is most often diagnosed in older adults (Horner et al. 2009
). The window of opportunity to intervene effectively and reduce the risk of lung cancer among asthmatic children is likely to be greater than for reducing the risk of other allergic conditions or childhood obesity. However, even for adult-onset diseases such as lung cancer, as each decade of life passes with continuing immune dysfunction and mounting immune-inflicted insult to the airways, effective intervention is likely to be more difficult.
In general, a global medical approach that includes attention to any underlying immune dysfunction early in life, such as immediately after a pediatric entryway disease is diagnosed, should be useful. It is more likely to break an immune-based pattern of disease than sequential, condition-restricted medical treatment of each condition (resulting in polypharmacy) within a pattern.