de Blay Frédéric, Birba Emile
Department of Respiratory Medicine, Lyautey Hospital, University Hospitals of Strasbourg, Strasbourg, France.
Curr Opin Allergy Clin Immunol. 2003 Jun;3(3):165-8. doi: 10.1097/00130832-200306000-00003.
Epidemiological surveys indicate that there has been a notable increase in the prevalence of asthma and other allergic diseases in children and adults. The purpose of this review is to report and comment on recent studies about the role of allergen in primary prevention and to seek new insights on the effects of allergen control in allergic patients.
This paper deals with allergen reduction in primary prevention, the effect of early exposure to pets on atopic diseases and the development of new occupational activity improving allergen control in allergic patients.
The role of allergen dose involved in the onset of atopy is controversial. Studies hypothesizing that a reduction of allergen dose might reduce atopy failed to confirm the data from the Isle of Wight study and found no effect on the frequency of immunoglobulin E sensitization. This effect might nonetheless occur later in life. Other studies indicate that high doses of allergen early in life have a protective effect against cat and dog sensitization. Only one retrospective study found that cat exposure was protective against cat sensitization. A German prospective study suggested, however, that it is more probable that cat allergen exposure is harmfully related to sensitization, by increasing IgE synthesis. The effect of high doses must be clarified by further prospective studies. Accordingly, we must be very careful when giving advice on primary prevention, particularly about the protective effect of cat and dog allergens. Secondary prevention may be dramatically improved with the help of a new occupational activity: the medical indoor environment counsellor.
流行病学调查表明，儿童和成人哮喘及其他过敏性疾病的患病率显著上升。本综述的目的是报告和评论近期关于变应原在一级预防中的作用的研究，并寻求变应原控制对过敏性患者影响的新见解。
本文探讨了一级预防中变应原的减少、早期接触宠物对特应性疾病的影响以及改善过敏性患者变应原控制的新职业活动的发展。
变应原剂量在特应性发病中的作用存在争议。假设减少变应原剂量可能降低特应性的研究未能证实怀特岛研究的数据，且未发现对免疫球蛋白E致敏频率有影响。不过，这种影响可能在生命后期出现。其他研究表明，生命早期高剂量变应原对猫和狗致敏有保护作用。仅有一项回顾性研究发现接触猫对猫致敏有保护作用。然而，一项德国前瞻性研究表明，猫变应原暴露更有可能通过增加IgE合成而与致敏存在有害关联。高剂量的影响必须通过进一步的前瞻性研究加以阐明。因此，在给出一级预防建议时，尤其是关于猫和狗变应原的保护作用时，我们必须非常谨慎。借助一种新的职业活动——医学室内环境顾问，二级预防可能会得到显著改善。
