Burbank Allison J, Sood Amika K, Kesic Matthew J, Peden David B, Hernandez Michelle L
Center for Environmental Medicine, Asthma and Lung Biology, University of North Carolina at Chapel Hill, Chapel Hill, NC.
Center for Environmental Medicine, Asthma and Lung Biology, University of North Carolina at Chapel Hill, Chapel Hill, NC.
J Allergy Clin Immunol. 2017 Jul;140(1):1-12. doi: 10.1016/j.jaci.2017.05.010.
Allergic disease prevalence has increased significantly in recent decades. Primary prevention efforts are being guided by study of the exposome (or collective environmental exposures beginning during the prenatal period) to identify modifiable factors that affect allergic disease risk. In this review we explore the evidence supporting a relationship between key components of the external exposome in the prenatal and early-life periods and their effect on atopy development focused on microbial, allergen, and air pollution exposures. The abundance and diversity of microbial exposures during the first months and years of life have been linked with risk of allergic sensitization and disease. Indoor environmental allergen exposure during early life can also affect disease development, depending on the allergen type, dose, and timing of exposure. Recent evidence supports the role of ambient air pollution in allergic disease inception. The lack of clarity in the literature surrounding the relationship between environment and atopy reflects the complex interplay between cumulative environmental factors and genetic susceptibility, such that no one factor dictates disease development in all subjects. Understanding the effect of the summation of environmental exposures throughout a child's development is needed to identify cost-effective interventions that reduce atopy risk in children.
近几十年来，过敏性疾病的患病率显著上升。初级预防工作以暴露组（或从孕期开始的累积环境暴露）研究为指导，以确定影响过敏性疾病风险的可改变因素。在本综述中，我们探讨了支持产前和生命早期外部暴露组的关键组成部分之间的关系及其对特应性发展影响的证据，重点关注微生物、过敏原和空气污染暴露。生命最初几个月和几年中微生物暴露的丰度和多样性与过敏性致敏和疾病风险有关。生命早期室内环境过敏原暴露也会影响疾病发展，这取决于过敏原类型、剂量和暴露时间。最近的证据支持环境空气污染在过敏性疾病发病中的作用。围绕环境与特应性之间关系的文献缺乏明确性，这反映了累积环境因素与遗传易感性之间的复杂相互作用，因此没有一个因素能决定所有受试者的疾病发展。需要了解儿童发育过程中环境暴露总和的影响，以确定降低儿童特应性风险的具有成本效益的干预措施。
