Johnson Christine C, Ownby Dennis R
a Department of Public Health Sciences , Henry Ford Hospital , Detroit , MI , USA.
b Department of Pediatrics , Georgia Regents University , Augusta , GA , USA.
Expert Rev Clin Immunol. 2016;12(4):379-88. doi: 10.1586/1744666X.2016.1139452. Epub 2016 Feb 7.
Our global hypothesis is that atopic conditions and asthma develop because an individual's immune system is not able to appropriately resolve inflammation resulting from allergen exposures. We propose that the failure to appropriately down-regulate inflammation and produce a toleragenic state results primarily from less robust immune homeostatic processes rather than from a tendency to over-respond to allergenic stimuli. An individual with lower immune homeostatic capacity is unable to rapidly and completely terminate, on average over time, immune responses to innocuous allergens, increasing risk of allergic disease. A lack of robust homeostasis also increases the risk of other inflammatory conditions, such as prolonged respiratory viral infections and obesity, leading to the common co-occurrence of these conditions. Further, we posit that the development of vigorous immune homeostatic mechanisms is an evolutionary adaptation strongly influenced by both 1) exposure to a diverse maternal microbiota through the prenatal period, labor and delivery, and, 2) an orderly assemblage process of the infant's gut microbiota ecosystem shaped by breastfeeding and early exposure to a wide variety of ingested foods and environmental microbes. This early succession of microbial communities together with early allergen exposures orchestrate the development of an immune system with a robust ability to optimally control inflammatory responses and a lowered risk for atopic disorders.
我们的总体假设是,特应性疾病和哮喘的发生是因为个体的免疫系统无法适当地消除由过敏原暴露引起的炎症。我们提出,无法适当地下调炎症并产生耐受状态主要是由于免疫稳态过程不够强大,而不是对过敏原刺激过度反应的倾向。免疫稳态能力较低的个体平均而言无法随着时间的推移迅速且完全地终止对无害过敏原的免疫反应,从而增加了患过敏性疾病的风险。缺乏强大的稳态也会增加其他炎症性疾病的风险,例如延长的呼吸道病毒感染和肥胖症,导致这些疾病的共同发生。此外,我们假定强大的免疫稳态机制的发展是一种进化适应,受到以下两方面的强烈影响:1)在孕期、分娩过程中接触多种母体微生物群,以及2)由母乳喂养和早期接触多种摄入食物及环境微生物塑造的婴儿肠道微生物群生态系统的有序组装过程。这种微生物群落的早期演替以及早期过敏原暴露共同促进了具有强大能力以最佳方式控制炎症反应且患特应性疾病风险较低的免疫系统的发育。
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