Princess Margaret Hospital and School Paediatrics and Child Health Research, University of Western Australia, Perth, WA, Australia.
Pediatr Allergy Immunol. 2011 Mar;22(2):155-60. doi: 10.1111/j.1399-3038.2011.01145.x.
Food allergy is a substantial and evolving public health issue, recently emerging over the last 10-15 yr as a 'second wave' of the allergy epidemic. It remains unclear why this new phenomenon has lagged decades behind the 'first wave' of asthma, allergic rhinitis and inhalant sensitization. In regions like Australia, which lead the respiratory epidemic, challenge-proven IgE-mediated food allergy now affects up to 10% of infants. Although their parents were among the first generation to experience the large-scale rise in allergic diseases, disorders of oral tolerance were previously uncommon. Of further concern, this new generation appears less likely to outgrow food allergy than their predecessors with long-term implications for disease burden. Allergic disease has been linked to the modern lifestyle including changing dietary patterns, changing intestinal commensal bacteria and vehicular pollution. It is not yet known whether the rise in food allergy is a harbinger of earlier and more severe effects of these progressive environmental changes or whether additional or unrelated lifestyle factors are implicated. New studies suggest environmental factors can produce epigenetic changes in gene expression and disease risk that may be potentially heritable across generations. The rising rates of maternal allergy, a strong direct determinant of allergic risk, could also be amplifying the effect of environmental changes. Preliminary evidence that non-Caucasian populations may be even more susceptible to the adverse effects of 'westernisation' has substantial global implications with progressive urbanization of the more populous regions in the developing world. Unravelling the environmental drivers is critical to curtail a potential tsunami of allergic disease.
食物过敏是一个重大且不断演变的公共卫生问题，最近在过去 10-15 年中作为过敏流行的“第二波”出现。目前尚不清楚为什么这种新现象落后于哮喘、过敏性鼻炎和吸入性致敏的“第一波”几十年。在澳大利亚等引领呼吸道流行的地区，经过验证的 IgE 介导的食物过敏现在影响多达 10%的婴儿。尽管他们的父母是第一批经历过敏疾病大规模上升的人，但以前很少出现口服耐受紊乱。更令人担忧的是，这一代人比他们的前辈更不可能摆脱食物过敏，这对疾病负担有长期影响。过敏疾病与现代生活方式有关，包括饮食模式的改变、肠道共生菌的改变和车辆污染。目前尚不清楚食物过敏的增加是否是这些渐进性环境变化更早和更严重影响的先兆，或者是否涉及其他或不相关的生活方式因素。新的研究表明，环境因素可以在基因表达和疾病风险方面产生表观遗传变化，这些变化可能在代际之间具有潜在的遗传性。过敏母亲的比例上升，这是过敏风险的直接决定因素，也可能放大环境变化的影响。非白人群体可能更容易受到“西化”不良影响的初步证据，这对发展中世界人口较多的地区的城市化进程具有重大的全球影响。揭示环境驱动因素对于遏制过敏疾病的潜在海啸至关重要。
