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东德和西德的重新统一能让我们了解到过敏症流行的原因是什么?

What can reunification of East and West Germany tell us about the cause of the allergy epidemic?

作者信息

Krämer U, Schmitz R, Ring J, Behrendt H

机构信息

IUF - Leibniz Research Institute for Environmental Medicine, Düsseldorf, Germany.

出版信息

Clin Exp Allergy. 2015 Jan;45(1):94-107. doi: 10.1111/cea.12458.

Abstract

The increase of allergies in East Germany--reaching West German prevalence shortly after the reunification--is considered a model for the allergy epidemic in the western world. Whether such a pattern was observed in all comparison studies and for all allergic manifestations is not known because a complete overview is missing. Hints about possible causal factors for the allergy epidemic could be gained by identifying known risk factors, which explain the observed pattern of allergy development in Germany. Again, an overview about these efforts is missing. We identified 14 cross-sectional studies conducted after 1989 and calculated prevalence ratios (West/East) for asthma, hayfever, eczema and allergic sensitization. Additionally, a tabular overview about the explanatory power of risk factors hypothesized in the nineties and covering outdoor exposure, indoor factors, early childhood influences, nutrition as well as awareness is given. At the time of the German reunification, the prevalence ratio West/East was largest for hayfever and sensitization to birch pollen, less pronounced for the other phenotypes and even less than one for atopic eczema. Hayfever and sensitization to birch pollen also showed the steepest increase in East Germany afterwards. Single-room heating with fossil fuels and living as only child in a family were identified as explaining up to 23.5% of the excess trend in East compared to the trend in West. Hayfever as most typical atopic disease showed the difference in allergy pattern between East and West Germany clearest. Risk factors identified for these phenotypes are completely different (single child) or even act in the opposite direction (single-room heating) from classical risk factors for airway diseases. This might be the most important lesson from the West/East German experience. It already stimulated many other studies focussing on protective factors such as microbial stimulation.

摘要

东德过敏症发病率的上升——统一后不久便达到了西德的流行程度——被视为西方世界过敏症流行的一个范例。由于缺乏完整的综述,尚不清楚在所有比较研究中以及对于所有过敏表现是否都观察到了这种模式。通过识别已知的风险因素,可以获得有关过敏症流行可能的因果因素的线索,这些因素可以解释德国观察到的过敏发展模式。同样,关于这些研究工作的综述也缺失。我们确定了1989年以后进行的14项横断面研究,并计算了哮喘、花粉热、湿疹和过敏致敏的患病率比(西德/东德)。此外,还给出了一个表格综述,内容涉及20世纪90年代假设的风险因素的解释力,涵盖户外暴露、室内因素、幼儿期影响、营养以及认知等方面。在德国统一之时,西德/东德的患病率比在花粉热和桦树花粉致敏方面最大,在其他表型方面则不那么明显,而特应性湿疹的患病率比甚至小于1。此后,东德的花粉热和桦树花粉致敏也呈现出最急剧的上升。使用化石燃料的单室供暖以及独生子女家庭被确定为可以解释东德与西德相比高达23.5%的超额趋势。花粉热作为最典型的特应性疾病,最清楚地显示了东西德在过敏模式上的差异。为这些表型确定的风险因素与气道疾病的经典风险因素完全不同(独生子女),甚至作用方向相反(单室供暖)。这可能是东西德经验中最重要的教训。它已经激发了许多其他关注诸如微生物刺激等保护因素的研究。

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