Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Pediatrics, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan; Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
J Microbiol Immunol Infect. 2013 Oct;46(5):320-9. doi: 10.1016/j.jmii.2013.04.005. Epub 2013 Jun 7.
The prevalence of allergic diseases has been growing rapidly in industrial countries during recent decades. It is postulated that growing up with less microbial exposure may render the immune system susceptible to a T helper type 2 (Th2)-predominant allergic response-also known as the hygiene hypothesis. This review delineates recent epidemiological and experimental evidence for the hygiene hypothesis, and integrates this hypothesis into the association between early life exposure to antibiotics and the development of allergic diseases and asthma. Several retrospective or prospective epidemiological studies reveal that early exposure to antibiotics may be positively associated with the development of allergic diseases and asthma. However, the conclusion is inconsistent. Experimental studies show that antibiotics may induce the Th2-skewed response by suppressing the T helper type 1 (Th1) response through inhibition of Th1 cytokines and disruption of the natural course of infection, or by disturbing the microflora of the gastrointestinal (GI) tract and therefore jeopardizing the establishment of oral tolerance and regulatory T cell immune responses. The hygiene hypothesis may not be the only explanation for the rapid increase in the prevalence of allergic diseases and asthma. Further epidemiological and experimental studies addressing the issue of the impact of environmental factors on the development of allergic diseases and the underlying mechanisms may unveil novel strategies for the prevention and treatment of allergic diseases in the future.
在过去几十年中，工业化国家的过敏性疾病患病率迅速上升。有人推测，在成长过程中接触的微生物较少，可能使免疫系统容易产生 T 辅助细胞 2（Th2）占主导的过敏反应——也称为卫生假说。本文阐述了卫生假说的最新流行病学和实验证据，并将该假说整合到早期生活中接触抗生素与过敏性疾病和哮喘发展之间的关联中。几项回顾性或前瞻性的流行病学研究表明，早期接触抗生素可能与过敏性疾病和哮喘的发展呈正相关。然而，结论并不一致。实验研究表明，抗生素可能通过抑制 Th1 细胞因子和破坏感染的自然过程，或通过扰乱胃肠道（GI）的微生物群，从而破坏调节性 T 细胞免疫反应和破坏口服耐受的建立，来诱导 Th2 偏向性反应。卫生假说可能不是过敏性疾病和哮喘患病率迅速上升的唯一解释。进一步的流行病学和实验研究解决环境因素对过敏性疾病发展的影响及其潜在机制的问题，可能会为未来预防和治疗过敏性疾病揭示新的策略。
