Clinic of Children's Diseases, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
Medicina (Kaunas). 2009;45(11):839-47.
The prevalence of allergic diseases is increasing in Lithuania as in the world. The prevalence of allergic sensitization is often higher than 50% of the population. The "hygiene hypothesis" proposed that reduced immune-stimulation by infections may have resulted in the more widespread clinical expression of atopic disease. However, it alone does not provide an adequate explanation for the observed increase of allergic diseases. Human rhinovirus infections are the major infections with a worldwide distribution. Viral infections of the respiratory tract are the most common triggers of acute asthma exacerbations. These exacerbations are poorly responsive to current asthma therapies and new approaches to therapy are needed. The aim of this review is to present the current knowledge and clinical implications of human rhinovirus infection in allergy and asthma development and needs for further research. Recent evidence has shown that the immune responses to human rhinoviruses differ between asthmatic and nonasthmatic subjects. Novel insights into the mechanisms of virus-induced asthma exacerbations support the possibility that viral infections may be involved in the epithelial cells damage, inflammation, and airway hyperresponsiveness as well as in profibrotic response and induction of airway remodeling. The data of original investigations support the concept that the immune stimulation by rhinovirus infections contributes to the development of asthma, when an atopic host is infected with human rhinoviruses. Early rhinoviral wheezing is the predictor of subsequent asthma development in high-risk children. Synergistic effect of allergic sensitization, allergen exposure, and viral infection was suggested in the increased risk of hospitalization for asthma in both children and adults. Timing of allergen exposure may be important in a synergistic outcome. The increased susceptibility to rhinovirus infections was identified in atopic asthma. This review also presents the current options on the treatment and prevention of virus-induced asthma. Further studies are needed in order to differentiate between the response to viruses of healthy and atopic or nonatopic asthmatic children and adults. New research data may lead to novel strategies in treatment and prevention of asthma exacerbations as well as prevention of asthma induction.
立陶宛与世界其他地区一样，过敏性疾病的患病率正在增加。过敏致敏的患病率通常高于人口的 50%。“卫生假说”提出，感染引起的免疫刺激减少可能导致特应性疾病的更广泛临床表达。然而，它本身并不能充分解释观察到的过敏性疾病的增加。人类鼻病毒感染是分布广泛的主要感染。呼吸道病毒感染是急性哮喘加重的最常见诱因。这些加重对当前的哮喘治疗反应不佳，需要新的治疗方法。本综述的目的是介绍人类鼻病毒感染在过敏和哮喘发展中的当前知识和临床意义，以及进一步研究的需要。最近的证据表明，哮喘和非哮喘患者对人类鼻病毒的免疫反应不同。病毒诱导的哮喘加重机制的新见解支持这样一种可能性，即病毒感染可能与上皮细胞损伤、炎症和气道高反应性以及纤维化反应和气道重塑的诱导有关。原始研究的数据支持这样一种概念，即当特应宿主感染人类鼻病毒时，鼻病毒感染的免疫刺激有助于哮喘的发展。早期鼻病毒喘息是高危儿童随后发生哮喘发展的预测指标。过敏致敏、过敏原暴露和病毒感染的协同作用表明，在儿童和成人中，因哮喘住院的风险增加。过敏原暴露的时间可能在协同结果中很重要。特应性哮喘患者对鼻病毒感染的易感性增加。本综述还介绍了目前治疗和预防病毒诱导的哮喘的选择。需要进一步的研究，以便区分健康和特应性或非特应性哮喘儿童和成人对病毒的反应。新的研究数据可能会导致治疗和预防哮喘加重以及预防哮喘发作的新策略。
