Introduction

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The so-called Lunteren Conferences in The Netherlands represent a tradition in addressing major scientific developments in the pathogenesis and treatment of asthma or chronic obstructive pulmonary disease (COPD), by bringing together the world's leading authorities in specific areas of interest. The conferences are generously sponsored by the Netherlands Asthma Foundation, and present state-of-the-art knowledge without commercial interest.

During the 4th Lunteren Conference in January 1999, the discussions were focused on a rapidly developing scientific area, namely the early phases of allergic sensitization. There is indisputably some relation between allergic sensitization and the pathogenesis and maintenance of asthma for a substantial group of patients. There is, however, little knowledge about the effect of prevention of allergic sensitization on the incidence and severity of asthma. Moreover, any discussion about such a preventive program requires an understanding of the processes involved during the early phases of sensitization.

The workshop was organized to discuss basic questions regarding the process of sensitization, such as:

• Why does not everyone become sensitized to every immunogenic protein in the environment?
• Is the increase in sensitization real and, if so, is it due to an enhanced expression of the gene(s) involved in sensitization or to sensitization of genetically low-risk individuals?
• Why is it that only a relatively small fraction of sensitized children develop asthma and (why) is this fraction increasing?
• Is prevention possible and, if so, how, when, and at what cost?
• How much would prevention of allergic sensitization contribute to decreasing asthma morbidity and mortality?

The main goals of the workshop were as follows:

1. To establish relevant and feasible scientific targets for research in the next few years

2. To discuss scenarios for prevention and treatment of

a. allergic sensitization itself, but also

b. the secondary effects of allergic sensitization

The participants were asked to consider the following issues:

• How important is prenatal sensitization for the development of inhalant allergy? Is there room for postnatal prevention?
• Is there any relationship between viral/bacterial infection and atopic sensitization? Does infection trigger allergic sensitization, or alternatively, does it prevent sensitization? Is this dependent on additional genetic or environmental factors?
• The "atopy gene" in relation to immunological tolerance induction: How important is lack of tolerance induction in relation to allergic sensitization in humans?
• Relation between atopy gene(s) and allergy: Is all (IgE- mediated) allergy dependent on atopic constitution, or do sporadic cases exist?
• The atopy genes in relation to the cytokine network: Are the disturbances in the cytokine network primary or secondary phenomena in relation to atopic sensitization?
• Relation between atopy and airway hyperresponsiveness: To what extent is hyperresponsiveness secondary to mucosal allergic inflammation? Or does preexisting hyperresponsiveness predispose to allergic sensitization?
• Relation between total IgE level and asthma: Is such a relation secondary to the association with specific IgE/allergy, or is total IgE a marker for cytokine gene expression independent of specific IgE?
• Relation between atopic asthma and atopic dermatitis: What does the skin tell us about the consequences of allergic inflammation? Is specific IgE in atopic dermatitis a primary factor or a secondary phenomenon?
• Role of the upper airways: Does sensitization to airbone allergens occur primarily via the bronchial or via the nasal epithelial surface, or are both equally important?

During the conference not all these issues received the attention that they required, but this was for a very good reason: The discussions on some of the other questions as mentioned were so intense that even a two-day meeting, with what we thought was a restricted agenda, proved to be too short. This was demonstrated by the long and exciting discussions following each of the presentations by the experts in the field. These discussions have been recorded, edited, and added following the articles in this supplement.

As the Organizing Committee of this meeting we acknowledge the resources of the Netherlands Asthma Foundation, both human and financial, that were indispensable and highly appreciated. In addition, we are grateful for supplementary financial support by the sponsors: Glaxo Wellcome BV, The Netherlands, and Pharmacia & Upjohn BV, The Netherlands.

ROB C. AALBERSE, Ph.D.

aalberse{at}clb.nl

PETER J. STERK, M.D., Ph.D

psterk{at}lumc.nl

Organizing Committee:

R. C. AALBERSE, Ph.D. (Chair)

H. M. JANSEN, M.D., Ph.D.

J. C. de JONGSTE, M.D., Ph.D

D. S. POSTMA, M. D., Ph.D

Ph. H. QUANJER, M.D., Ph.D

H. F. J. SAVELKOUL, M.D., Ph.D

P. J. STERK, M.D., Ph.D