Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Vic, Australia.
Murdoch Childrens Research Institute, Melbourne, Vic, Australia.
Allergy. 2018 Jan;73(1):17-28. doi: 10.1111/all.13228. Epub 2017 Jul 12.
A popular hypothesis known as the atopic march proposes a set of sequential allergy and respiratory disorders in early childhood contributes enormously to the burden of disease in developed countries. Although the concept of the atopic march has been refined and strengthened by many cross-sectional and longitudinal studies linking eczema as the initial manifestation with progression to hay fever and then asthma, there is yet no definitive proof that the atopic march is the primary causal factor in childhood allergic disease. This debate is mainly related to the controversy around potential confounding of these associations by genetic and environmental factors. Family studies are ideally suited to unravelling the role of these factors. While multiple reviews have synthesized evidence from studies investigating this question, no review to date has explored specific evidence generated by twin and sibling studies to understand the aetiology of atopic march diseases. Our aim was to conduct a systematic review of twin and sibling studies that examine the allergic phenotypes that form the atopic march, to determine whether such analyses of data from these studies attempt to control for the effect confounding by shared factors, and to report estimates of the magnitude of associations between multiple phenotypes. Our review suggests that (1) genetics play a bigger role predisposing eczema to hay fever and eczema to asthma than environmental factors, and (2) the link between eczema and asthma and hay fever is independent of shared early-life environmental factors.
一种流行的假说，即特应性进行曲，提出了一系列在儿童早期出现的过敏和呼吸道疾病，这对发达国家的疾病负担有巨大影响。尽管特应性进行曲的概念已经通过许多横断面和纵向研究得到了细化和加强，这些研究将湿疹作为最初表现与花粉热和哮喘的进展联系起来，但尚无确凿证据表明特应性进行曲是儿童过敏性疾病的主要致病因素。这场争论主要与这些关联是否受到遗传和环境因素的潜在混杂所困扰有关。家族研究最适合揭示这些因素的作用。虽然有多项综述综合了研究这个问题的研究证据，但迄今为止，还没有综述探讨双胞胎和兄弟姐妹研究中产生的特定证据，以了解特应性进行曲疾病的病因。我们的目的是对检查特应性进行曲形成的过敏表型的双胞胎和兄弟姐妹研究进行系统综述，以确定这些研究的数据的此类分析是否试图控制共同因素的影响，并报告多种表型之间关联程度的估计值。我们的综述表明：(1) 遗传因素在易患湿疹、湿疹发展为哮喘方面比环境因素发挥更大作用；(2) 湿疹与哮喘和花粉热之间的联系与早期共同的环境因素无关。
