Skin and Allergy Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.
Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
Allergy. 2021 Dec;76(12):3613-3626. doi: 10.1111/all.14895. Epub 2021 May 24.
Increase of allergic conditions has occurred at the same pace with the Great Acceleration, which stands for the rapid growth rate of human activities upon earth from 1950s. Changes of environment and lifestyle along with escalating urbanization are acknowledged as the main underlying causes. Secondary (tertiary) prevention for better disease control has advanced considerably with innovations for oral immunotherapy and effective treatment of inflammation with corticosteroids, calcineurin inhibitors, and biological medications. Patients are less disabled than before. However, primary prevention has remained a dilemma. Factors predicting allergy and asthma risk have proven complex: Risk factors increase the risk, while protective factors counteract them. Interaction of human body with environmental biodiversity with micro-organisms and biogenic compounds as well as the central role of epigenetic adaptation in immune homeostasis have given new insight. Allergic diseases are good indicators of the twisted relation to environment. In various non-communicable diseases, the protective mode of the immune system indicates low-grade inflammation without apparent cause. Giving microbes, pro- and prebiotics, has shown some promise in prevention and treatment. The real-world public health programme in Finland (2008-2018) emphasized nature relatedness and protective factors for immunological resilience, instead of avoidance. The nationwide action mitigated the allergy burden, but in the lack of controls, primary preventive effect remains to be proven. The first results of controlled biodiversity interventions are promising. In the fast urbanizing world, new approaches are called for allergy prevention, which also has a major cost saving potential.
过敏病症的发生与“大加速”（Great Acceleration）同步增长，“大加速”代表了自 20 世纪 50 年代以来地球人类活动的快速增长率。环境和生活方式的变化以及城市化的不断加剧被认为是主要的潜在原因。二级（三级）预防措施（即通过创新进行口服免疫治疗和使用皮质类固醇、钙调磷酸酶抑制剂和生物药物有效治疗炎症）已取得了相当大的进展，从而更好地控制疾病。与以前相比，患者的残疾程度有所降低。然而，初级预防仍然是一个难题。预测过敏和哮喘风险的因素被证明很复杂：危险因素会增加风险，而保护因素则会抵消这些风险。人体与环境生物多样性以及微生物和生物源化合物的相互作用，以及表观遗传适应在免疫稳态中的核心作用，提供了新的见解。过敏疾病是人类与环境扭曲关系的良好指标。在各种非传染性疾病中，免疫系统的保护模式表明存在无明显原因的低度炎症。给微生物、益生菌和益生元的方法在预防和治疗方面显示出了一定的前景。芬兰的真实世界公共卫生计划（2008-2018 年）强调了与自然的相关性和免疫反应的保护因素，而不是避免接触。该全国性行动减轻了过敏负担，但由于缺乏对照，初级预防效果仍有待证明。控制生物多样性干预的首批结果令人鼓舞。在快速城市化的世界中，需要采取新的方法来预防过敏，这也具有很大的节省成本的潜力。
