Custovic Adnan, Murray Clare S, Gore Robin B, Woodcock Ashley
North West Lung Centre, Wythenshawe Hospital, Manchester, United Kingdom.
Ann Allergy Asthma Immunol. 2002 May;88(5):432-41; quiz 442-3, 529. doi: 10.1016/S1081-1206(10)62378-2.
Reading of this article reinforces the reader's knowledge of the role of allergen exposure in relation to asthma and its severity, as well as the relevance of allergen avoidance in the treatment of asthma.
Initial literature search for existing evidence-based guidelines, reviews, and meta-analyses was carried out, and further literature searches were performed to review individual randomized controlled trials. Evidence level was graded according to the Scottish Intercollegiate Guidelines Network recommendations.
There is good evidence for the link between mite and cockroach allergen exposure and sensitization, and between sensitization and asthma. For pet allergens, some studies found that exposure to pets in early life was associated with specific immunoglobulin E sensitization and allergic disease later in childhood, whereas others reported a protective effect. The effectiveness of allergen reduction in the treatment of asthma is suggested by studies in which the patients improve substantially when moved into the low-allergen environment of hospitals or high-altitude sanatoria. Because of limitations in the design of the most clinical of studies, we do not yet have a conclusive answer on the effectiveness of domestic aeroallergen avoidance.
Minimizing the impact of identified environmental risk factors is an important first step to reduce the severity of asthma. Although environmental control is difficult, it should be an integral part of the overall management of sensitized patients. However, what is unclear is which patients would benefit and by how much, and whether the intervention is cost-effective. These questions will be answered satisfactorily only by large randomized trials.
阅读本文可增强读者对变应原暴露与哮喘及其严重程度之间关系的认识，以及避免接触变应原在哮喘治疗中的相关性。
对现有的循证指南、综述和荟萃分析进行了初步文献检索，并进行了进一步的文献检索以回顾个体随机对照试验。证据水平根据苏格兰校际指南网络的建议进行分级。
有充分证据表明接触螨和蟑螂变应原与致敏之间，以及致敏与哮喘之间存在联系。对于宠物变应原，一些研究发现早年接触宠物与儿童后期的特异性免疫球蛋白E致敏和过敏性疾病有关，而其他研究则报告有保护作用。在一些研究中，当患者转移到医院或高原疗养院的低变应原环境中时病情显著改善，这表明减少变应原在哮喘治疗中是有效的。由于大多数临床研究设计存在局限性，我们尚未就避免家庭空气变应原的有效性得出确凿答案。
尽量减少已确定的环境危险因素的影响是降低哮喘严重程度的重要第一步。尽管环境控制困难，但它应是致敏患者整体管理的一个组成部分。然而，尚不清楚哪些患者会从中受益以及受益程度如何，以及这种干预是否具有成本效益。只有通过大型随机试验才能令人满意地回答这些问题。
