How tricks from nature inspire asthma research

Erika von Mutius would love to make herself superfluous. That would mean her big dream has come true: that children no longer get asthma. Von Mutius, pediatrician and epidemiologist, has been one of the key players in the international collaboration united in this mission since 2017. As the research team puts the finishing touches on five years of analysis, we reflect with her on her impressive career and look ahead.

'Asthma is the most common chronic condition in children. I think of all those children and their families whom I've seen over the years. All those hospitalizations, all the medications you have to take. Not being able to go to your best friend's house because they have a cat and you might have an asthma attack. Wanting to be as active as any other child, but being limited in sports because of asthma. And if you're one of the unlucky ones, it lasts a lifetime. You just have to think about the nights as a parent when you helplessly watch your child struggle to breathe. It's terrifying.'

Two careers

Professor Dr. Erika von Mutius (1957) is not only a pediatrician but also an epidemiologist. 'That was pure coincidence. Well, not entirely. I started my training at the academic children's hospital in Munich. It was expected of me to also do some research. And since I wanted to continue my training there, I agreed. When you want to stay, you don't say no, right?' 

The focus on asthma and allergies occurred early in her career. 'The first research I was involved in was about air pollution and croup (a viral infection of the upper airways). But honestly, I didn't consider croup as such a significant problem. Children usually recover quickly after an attack. In terms of disease burden, I found asthma much more serious. And allergy goes hand in hand with asthma. Even during that research on air pollution and croup, I started working at an outpatient clinic for children with asthma. So, I've treated many children with asthma.'

Von Mutius was responsible for a famous study showing that children in East Germany had fewer allergies than those living in West Germany. 'When the study on air pollution and croup was completed, my supervisor urged me to do new research. I devised a plan to compare urban and rural air pollution in Bavaria. My theory was that air pollution was the cause of asthma and allergies. But we doubted if there would be enough air pollution in Munich to prove that theory.

Just as the research began – we're talking about 1989 - the Wall fell. That gave us the unique opportunity to go to East Germany where there was really a lot of air pollution. It was the chance to prove my theory. But what did we find? In East Germany, many fewer children suffered from allergies and asthma than in West Germany. Meanwhile, we know that the type of air pollution determines the risk of developing asthma and allergies. Pollution from traffic, as in Munich, turned out to be the real risk for asthma and allergies.'


In 2013, Von Mutius received Germany's highest science award. She received it for her study on the effect of farm exposure on the development of childhood allergy and asthma. 'I never expected to receive the Leibniz Prize, because my research was about pediatrics and epidemiology. Often, the German scientific council awards this famous prize to basic science (also called 'pure' science because it has not yet resulted into translation in clinical practice).'

Von Mutius has worked in research teams her entire life. 'I love teamwork. I have learned a lot from my colleagues and would never have been able to do it alone. Participating in conferences provides you with new ideas. The best conversations with colleagues happen at the end of the day. That's when you tell each other what you really think. That's what makes it interesting.'

Since 2017, von Mutius has been involved in the international collaboration to prevent asthma. In von Mutius’s and her colleague Markus Ege's project, the effect of minimally processed cow’s milk was tested on young children. 'The study is based on strong evidence from farm studies that drinking raw cow's milk can protect children against asthma and allergies. However, raw cow's milk can also be dangerous and lead to serious infections that can damage the kidneys. Therefore, we cannot recommend drinking raw cow's milk to prevent allergies. But cow's milk that has only been lightly pasteurized, without being heated to high temperatures or mixed, may have the same effect.

The various studies we do within the collaboration complement each other. We reinforce each other with our knowledge. Some colleagues do research in the laboratory, while we tested the effect of minimally processed cow’s milk on children. Ultimately, the outcomes together will help in developing new avenues to prevent asthma. I am convinced of that.'


Shortly after starting the farm milk research, the COVID-19 pandemic emerged. That caused difficulties. 'Our research started in the fall of 2019. In hindsight, it turned out to be the most unfortunate time to start a study involving families with young, healthy children. Many fewer families participated than we had hoped. Additionally, the company that supplied our milk had financial difficulties. We had to quickly find a new supplier. We switched from powdered milk, which we could send every 2 months, to liquid milk which must be sent freshly within one day or two. Because we had to have it delivered, the costs became much higher. Also, due to the pandemic, we couldn't perform the clinical visits as planned. It made it extra difficult.'

The results of the research on minimally processed milk are promising: more microorganisms were found in the intestines of children who drank the milk. Also, the children had fewer infections. But to really demonstrate that these two things are related, larger numbers of children need to participate in the research. That wasn't possible now because of the COVID-19 pandemic. Yet, von Mutius believes the research was worth it.

'Absolutely. It is important to start these kinds of studies anyway. It is important to take a gamble on something. Would I do it again? Absolutely. Because the opportunity to prevent a disease like asthma using relatively simple means is so tempting.'

Von Mutius dreams of preventing asthma in children. 'I would love to make myself superfluous. Preventing diseases in children is what pediatrics is often about. You want children to be healthy. We have been very successful in preventing certain diseases. Think of vaccinations, screenings for diabetes, and research into severe metabolic diseases. We can now detect and treat children with problems at an early stage.

Although we can treat asthma, we cannot cure it or prevent it yet. We will probably never be able to prevent it 100% because people can also be genetically predisposed to the disease. But if we can prevent thirty, forty, fifty percent, that is a fantastic achievement.'

Nature knows

Von Mutius is curious about where the research into preventing asthma in children will lead. 'In my long career, I have done a lot of research on health and diseases. It is very clear from that research that asthma simply does not occur in certain environments. Nature offers strong protection. We need to learn from that and try to pull off the same tricks as nature.

Everything in childhood is about development. A child grows and learns to talk, but the organs also develop. The lung matures in the first three years of life, as does the immune system and the system of microorganisms in the intestines. If a child is around animals, plants, and soil a lot, as it occurs on traditional farms, it comes into contact with many bacteria, fungi, and viruses. The immune system develops faster as a result than when the child grows up in a city. I think we have lost the art of educating our immune system in our Western world. If we know how to restore that, then we're well on our way.'

Text: Marlijn Klerk

Photo credits: Helmholtz Munich / © Matthias Tunger