Taniuchi Shoichiro, Soejima Kazuhiko, Hatano Yasuko, Takahashi Masaya, Minami Hirotaka
Department of Pediatrics, Takatsuki General Hospital.
Department of Pediatrics, Kansai Medical University.
J Nippon Med Sch. 2018;85(1):2-10. doi: 10.1272/jnms.2018_85-1.
The incidence of atopic diseases, including atopic dermatitis (AD), food allergies, allergic rhinitis, and asthma, has increased in recent decades, and currently affects approximately 20% of the population. Atopic march is the development of AD in infancy and subsequent food allergies, allergic rhinitis, and asthma in later childhood. Patients with infantile eczema may develop typical symptoms of AD, allergic rhinitis, and asthma at certain ages. Some patients' symptoms persist for several years, whereas others may have resolution with aging. Development of these diseases is strongly influenced by the following two factors: skin dysfunction caused by filaggrin mutations and development of colonization of microflora in early infancy. Filaggrin mutations predisposing to asthma, allergic rhinitis, and allergic sensitization, only in the presence of AD, strongly support the role of filaggrin in the pathogenesis of AD and in subsequent progression of the atopic march. Several studies have shown that development of colonization of microflora in early infancy might affect development of allergic disease or food desensitization. Therefore, massive allergen exposure to genetic skin dysfunction in early infancy and an imbalance of microflora might be necessary for development of atopic march.
包括特应性皮炎（AD）、食物过敏、过敏性鼻炎和哮喘在内的特应性疾病的发病率在近几十年来有所上升，目前影响着约20%的人口。特应性进程是指婴儿期发生AD，随后在儿童后期出现食物过敏、过敏性鼻炎和哮喘。婴儿湿疹患者在特定年龄可能会出现AD、过敏性鼻炎和哮喘的典型症状。一些患者的症状会持续数年，而另一些患者可能会随着年龄增长而缓解。这些疾病的发生受到以下两个因素的强烈影响：丝聚合蛋白突变引起的皮肤功能障碍以及婴儿早期微生物群落定植的发展。仅在存在AD的情况下，丝聚合蛋白突变易导致哮喘、过敏性鼻炎和过敏致敏，这有力地支持了丝聚合蛋白在AD发病机制及随后特应性进程发展中的作用。多项研究表明，婴儿早期微生物群落定植的发展可能会影响过敏性疾病的发生或食物脱敏。因此，婴儿早期大量接触变应原、遗传皮肤功能障碍以及微生物群落失衡可能是特应性进程发生所必需的。
