Centre of Bioclimatology, University of Florence, Florence, Italy; SOS Allergy and Clinical Immunology, USL Toscana Centro, Prato, Italy.
Division of Respiratory and Allergic Diseases high specialty hospital A. Cardarelli, Naples, Italy; School of Specialization in Respiratory Diseases Federico II University, Naples, Italy.
J Allergy Clin Immunol. 2018 Mar;141(3):846-857. doi: 10.1016/j.jaci.2018.01.016.
Allergies are complex diseases that result from interactions between multiple genetic and environmental factors. However, the increase in allergies observed in the past decades is explained exclusively by environmental changes occurring in the same period. Presently, the exposome, the totality of specific and nonspecific external environmental exposures (external exposome) to which a subject is exposed from preconception onward and their consequences at the organ and cell levels (internal exposome), is being considered to explain the inception, development, and exacerbations of allergic diseases. Among the best-studied environmental factors of the specific external exposome, indoor and outdoor aeroallergens and air pollutants play a key role in the etiopathogenesis of the inflammatory response to allergens and in clinical manifestations of allergic disease. Climate change, urbanization, and loss of biodiversity affect sources, emissions, and concentrations of main aeroallergens and air pollutants and are among the most critical challenges facing the health and quality of life of the still increasing number of allergic patients today and in the coming decades. Thunderstorm-related asthma is a dramatic example of the effects of combined environmental factors and an in vivo model for understanding the mechanisms at work in respiratory allergy. Environment- or lifestyle-driven aberrancies in the gut and skin microbiome composition represent key mediators of allergic diseases. A better knowledge of the effect of the external exposome on allergy development is crucial for urging patients, health professionals, and policymakers to take actions to mitigate the effect of environmental changes and to adapt to them.
过敏是一种复杂的疾病，由多种遗传和环境因素相互作用所致。然而，过去几十年观察到的过敏发病率增加仅能用同一时期发生的环境变化来解释。目前，人们认为外暴露组（个体从受孕前到出生后接触的特定和非特定环境暴露的总和，以及其在器官和细胞水平的后果）可以用来解释过敏疾病的发生、发展和恶化。在特定外暴露组中，研究最充分的环境因素包括室内和室外空气过敏原和空气污染物，它们在过敏原引起的炎症反应的发病机制和过敏疾病的临床表现中起着关键作用。气候变化、城市化和生物多样性丧失影响主要空气过敏原和空气污染物的来源、排放和浓度，是当今和未来几十年内过敏患者数量不断增加所面临的最关键挑战之一。与雷暴有关的哮喘是环境因素综合作用的一个戏剧性例子，也是了解呼吸道过敏作用机制的体内模型。肠道和皮肤微生物组组成的环境或生活方式驱动的异常是过敏疾病的关键介质。更好地了解外暴露组对过敏发展的影响对于促使患者、卫生专业人员和政策制定者采取行动减轻环境变化的影响并适应这些变化至关重要。
