Harris J M, Cullinan P, Williams H C, Mills P, Moffat S, White C, Newman Taylor A J
Department of Occupational and Environmental Medicine, Imperial College of Science and Technology (National Heart and Lung Institute), 1b Manresa Road, London SW3 6LR, UK.
Br J Dermatol. 2001 Apr;144(4):795-802. doi: 10.1046/j.1365-2133.2001.04135.x.
Although atopic eczema (AE) is a common disease, little is known about its causes.
To investigate the role of dietary and environmental factors associated with the development of AE by the age of 2 years.
A cohort of children was recruited before birth from a consecutive series of newly pregnant mothers presenting for antenatal care at three general practices in Ashford, Kent, U.K. Data up to the age of 2 years were available for 624 (97%) of the original cohort. AE was defined using components of the U.K. diagnostic criteria for AE, maternal report of doctor-diagnosed eczema and maternally reported eczema. Exposures of interest were family history of allergic disease, dietary and breastfeeding patterns, family size and exposure to indoor domestic allergens.
The cumulative prevalence of AE using the U.K. diagnostic criteria was 14% (95% confidence interval, CI 11-17%). The prevalence of maternally reported doctor-diagnosed eczema was much higher (31%, 95% CI 27-35%) and almost half (45%) the mothers reported that their child had ever had eczema (95% CI 41-49%). The relationship between parental atopy, parental history of allergic disease and the child's eczema was consistently stronger for the mothers than the fathers. There was a marked increase in the prevalence of eczema with increasing maternal education and in less crowded homes, associations that remained significant after controlling for other factors.
The associations with environmental factors are consistent with the hypothesis that more crowded houses, increased family size and birth order, which may possibly increase early exposure to infections, may offer protection from subsequent development of eczema.
尽管特应性皮炎（AE）是一种常见疾病，但其病因却鲜为人知。
调查与2岁前AE发病相关的饮食和环境因素的作用。
从英国肯特郡阿什福德的三家全科诊所连续就诊的新怀孕母亲中招募一组儿童，这些儿童在出生前就被纳入研究。原始队列中有624名儿童（97%）获得了2岁前的数据。AE的定义采用了英国AE诊断标准的组成部分、医生诊断的湿疹的母亲报告以及母亲报告的湿疹情况。感兴趣的暴露因素包括过敏性疾病家族史、饮食和母乳喂养模式、家庭规模以及接触室内家庭过敏原情况。
采用英国诊断标准，AE的累积患病率为14%（95%置信区间，CI 11 - 17%）。母亲报告的医生诊断的湿疹患病率要高得多（31%，95% CI 27 - 35%），几乎一半（45%）的母亲报告她们的孩子曾患过湿疹（95% CI 41 - 49%）。母亲的父母特应性、父母过敏性疾病史与孩子湿疹之间的关系始终比父亲更强。随着母亲教育程度的提高以及家庭居住不太拥挤，湿疹患病率显著增加，在控制其他因素后这些关联仍然显著。
与环境因素的关联与以下假设一致，即房屋更拥挤、家庭规模增加和出生顺序可能会增加早期感染暴露，这可能为预防随后的湿疹发生提供保护。
