Chan-Yeung Moira, Becker Allan
Occupational and Environmental Lung Diseases Unit, Respiratory Division, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
Curr Opin Allergy Clin Immunol. 2006 Jun;6(3):146-51. doi: 10.1097/01.all.0000225150.91661.34.
The prevalence of asthma and allergic disorders in childhood is increasing in many parts of the world. This review focuses on recent findings with regard to environmental risk factors and their manipulation in the primary prevention of these diseases in childhood.
Recent studies have failed to resolve the controversy on the subject of exposure to indoor aeroallergens and the risk of sensitization and asthma in childhood. Bronchiolitis due to respiratory syncytial virus in infancy is associated with a significant increase in risk of asthma, but not atopy. In the prevention of these diseases, the effects of breastfeeding are controversial, with studies showing a protective effect in children without allergic predisposition, but other studies showing no effect or even the potential for an increased asthma risk. A significant reduction in the prevalence of doctor-diagnosed asthma at 7 years was found in a randomized controlled multifaceted (reduction of inhaled and ingested allergens) intervention study of high-risk infants. Other intervention measures, such as an education program on how to reduce exposure, the use of probiotics, and immunization against infections, all showed some protective effects.
More research is required, especially with regard to longer periods of follow-up for all current intervention studies aimed at reducing exposure, the onset and duration of intervention, and other novel intervention measures in the primary prevention of asthma and allergic diseases in childhood.
在世界许多地区，儿童哮喘和过敏性疾病的患病率正在上升。本综述重点关注关于环境危险因素及其在儿童期这些疾病一级预防中的干预措施的最新研究结果。
近期研究未能解决关于接触室内空气过敏原与儿童期致敏及哮喘风险这一主题的争议。婴儿期呼吸道合胞病毒引起的细支气管炎与哮喘风险显著增加相关，但与特应性无关。在这些疾病的预防方面，母乳喂养的效果存在争议，一些研究表明对无过敏倾向的儿童有保护作用，但其他研究显示无效果甚至可能增加哮喘风险。在一项针对高危婴儿的随机对照多方面（减少吸入和摄入过敏原）干预研究中，发现7岁时医生诊断的哮喘患病率显著降低。其他干预措施，如关于如何减少接触的教育项目、使用益生菌以及针对感染的免疫接种，均显示出一定的保护作用。
需要更多研究，特别是对于所有旨在减少接触、干预开始时间和持续时间的当前干预研究进行更长时间的随访，以及关于儿童期哮喘和过敏性疾病一级预防中的其他新型干预措施。
