Ronsmans Steven, Le Moual Nicole, Dumas Orianne
KU Leuven, Centre for Environment and Health, Department of Public Health and Primary Care, Leuven, Belgium.
Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Équipe d'Épidémiologie respiratoire intégrative, CESP, 94807, Villejuif, France.
Curr Opin Allergy Clin Immunol. 2023 Apr 1;23(2):63-69. doi: 10.1097/ACI.0000000000000884. Epub 2022 Dec 2.
In this narrative review, we aim to highlight novel research findings on both acute/subacute irritant-induced asthma (IIA) and chronic exposure IIA (also called 'low dose' IIA).
Novel case series showed that acute and subacute IIA cases had similar causal agents (e.g., acid or base aerosols/fumes, dusts, mixtures) but had occurred in different circumstances (accidents vs. regular work). Acute and subacute IIA cases had similar clinical characteristics but poorer short-term outcomes than sensitizer-induced occupational asthma patients. Novel large epidemiological studies reported associations between chronic occupational exposure to irritants and current adult-onset asthma and poor asthma control, and with a specific asthma endotype characterized by neutrophilic inflammation and oxidative stress. Recent studies reconfirmed the association of the use of disinfectants and cleaning products (especially sprays) with IIA. A role for genetic susceptibility has been suggested.
Recent literature provided further understanding of both acute/subacute and chronic exposure IIA, in terms of causes, possible mechanisms, and consequences such as poor asthma control. Research is needed to clarify several aspects of IIA, including its frequency (still likely underestimated), modulating factors, and mechanisms. Research aiming at improving irritant exposure assessment, including intensity/duration, and determining relevant exposure windows would be welcome.
在本叙述性综述中，我们旨在强调关于急性/亚急性刺激性诱导哮喘（IIA）和慢性暴露性IIA（也称为“低剂量”IIA）的新研究发现。
新的病例系列表明，急性和亚急性IIA病例有相似的致病因素（如酸或碱气溶胶/烟雾、粉尘、混合物），但发生在不同的情况下（事故与日常工作）。急性和亚急性IIA病例有相似的临床特征，但与致敏剂诱导的职业性哮喘患者相比，短期预后较差。新的大型流行病学研究报告了慢性职业性接触刺激物与当前成人新发哮喘及哮喘控制不佳之间的关联，以及与以中性粒细胞炎症和氧化应激为特征的特定哮喘亚型之间的关联。最近的研究再次证实了使用消毒剂和清洁产品（尤其是喷雾剂）与IIA之间的关联。有人提出了遗传易感性的作用。
最近的文献在病因、可能的机制以及诸如哮喘控制不佳等后果方面，对急性/亚急性和慢性暴露性IIA有了进一步的认识。需要开展研究以阐明IIA的几个方面，包括其发生率（可能仍被低估）、调节因素和机制。欢迎开展旨在改善刺激物暴露评估（包括强度/持续时间）以及确定相关暴露窗口期的研究。
