哮喘与过敏的发展：酵母及其他真菌暴露的不同影响
Asthma and allergy development: contrasting influences of yeasts and other fungal exposures.
作者信息
Behbod B, Sordillo J E, Hoffman E B, Datta S, Webb T E, Kwan D L, Kamel J A, Muilenberg M L, Scott J A, Chew G L, Platts-Mills T A E, Schwartz J, Coull B, Burge H, Gold D R
机构信息
Harvard School of Public Health, Boston, MA, USA.
出版信息
Clin Exp Allergy. 2015 Jan;45(1):154-63. doi: 10.1111/cea.12401.
BACKGROUND
Infancy is a developmental stage with heightened susceptibility to environmental influences on the risk of chronic childhood disease. Few birth cohort studies have detailed measures of fungal diversity data in infants' bedrooms, limiting the potential to measure long-term associations of these complex exposures with development of asthma or allergy.
OBJECTIVE
We evaluated the relation of home fungal levels in infancy to repeated measures of wheeze and development of asthma and rhinitis by age 13, and sensitization by age 12 years.
METHODS
In the Epidemiology of Home Allergens and Asthma prospective birth cohort study, we recruited 408 children with family history of allergic disease or asthma. When children were aged 2-3 months, we measured culturable fungi in bedroom air and dust, and in outdoor air. Main outcomes included ascertainment of symptoms/disease onset by questionnaire from birth through age 13. We estimated hazard ratios and, for wheeze and sensitization, odds ratios for an interquartile increase in log-transformed fungal concentrations, adjusting for other outcome predictors and potential confounders.
RESULTS
Elevated levels of yeasts in bedroom floor dust were associated with reduced: i) wheeze at any age; ii) fungal sensitization; and iii) asthma development by age 13 (hazard ratio (HR) = 0.86; 95% confidence interval (CI), [0.75 to 0.98]). Outdoor airborne Cladosporium and dustborne Aspergillus predicted increased rhinitis. Risk of fungal sensitization by age 12, in response to environmental Alternaria and Aspergillus, was elevated in children with a maternal history of fungal sensitization.
CONCLUSIONS AND CLINICAL RELEVANCE
Despite the irritant and allergenic properties of fungi, early-life elevated dust yeast exposures or their components may be protective against allergy and asthma in children at risk for these outcomes. Ascertainment of fungal components associated with immunoprotective effects may have therapeutic relevance for asthma.
背景
婴儿期是一个发育阶段，在此期间，环境因素对儿童慢性疾病风险的影响更为敏感。很少有出生队列研究详细测量婴儿卧室中的真菌多样性数据，这限制了衡量这些复杂暴露与哮喘或过敏发展之间长期关联的可能性。
目的
我们评估了婴儿期家庭真菌水平与13岁时反复喘息测量以及哮喘和鼻炎发展之间的关系，以及12岁时的致敏情况。
方法
在家庭过敏原与哮喘流行病学前瞻性出生队列研究中，我们招募了408名有过敏性疾病或哮喘家族史的儿童。当儿童2 - 3个月大时，我们测量了卧室空气和灰尘以及室外空气中可培养的真菌。主要结局包括通过问卷确定从出生到13岁的症状/疾病发作情况。我们估计了风险比，对于喘息和致敏情况，还估计了对数转换真菌浓度四分位数间距增加时的比值比，并对其他结局预测因素和潜在混杂因素进行了调整。
结果
卧室地板灰尘中酵母菌水平升高与以下情况减少相关：i）任何年龄的喘息；ii）真菌致敏；以及iii）13岁时哮喘的发展（风险比（HR）= 0.86；95%置信区间（CI），[0.75至0.98]）。室外空气中的枝孢菌和灰尘中的曲霉菌预示着鼻炎增加。有母亲真菌致敏史的儿童，在12岁时因环境链格孢菌和曲霉菌致敏的风险升高。
结论及临床意义
尽管真菌具有刺激性和致敏性，但生命早期灰尘中酵母菌暴露增加或其成分可能对有这些结局风险的儿童预防过敏和哮喘具有保护作用。确定与免疫保护作用相关的真菌成分可能对哮喘治疗具有重要意义。
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