COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark.
Department of Pediatrics, Slagelse Hospital, Slagelse, Denmark.
Pediatr Allergy Immunol. 2024 Jul;35(7):e14198. doi: 10.1111/pai.14198.
Epidemiological data suggest that atopic diseases begin in early life and that most cases present clinically during early childhood. The diseases are highly prevalent and increase as communities adopt western lifestyles. Disentangling the pathophysiological mechanisms leading to disease debut is necessary to identify beneficial/harmful exposures so that successful prevention and treatment can be generated. The objective of this review is to explore the definition of atopy and mechanisms of atopic diseases, and to investigate the importance of environmental factors in early life, prior to disease development. First, the distribution of sIgE levels in children is investigated, as this is one of the main criteria for the definition of atopy. Thereafter, it is explored how studies of parental atopic status, sensitization patterns, and early debut and severity of atopic dermatitis have substantiated the theory of an early-life window of opportunity for intervention that precedes the development of atopic diseases in childhood. Then, it is examined whether early-life exposures such as breastfeeding, dogs, cats, and house dust mites in the home perinatally constitute important influencers in this crucial time of life. Finally, it is discussed how these findings could be validated in randomized controlled trials, which might prepare the ground for improved diagnostics and prevention strategies to mitigate the current atopic pandemic.
流行病学数据表明，特应性疾病始于生命早期，且大多数病例在儿童早期出现临床症状。这些疾病的患病率很高，并随着社区采用西方生活方式而增加。为了确定有益/有害的暴露因素，从而实现成功的预防和治疗，有必要阐明导致疾病发生的病理生理机制。本综述的目的是探讨特应性的定义和特应性疾病的机制，并研究环境因素在疾病发生前对生命早期的重要性。首先，研究儿童血清 IgE 水平的分布情况，因为这是特应性定义的主要标准之一。此后，探讨了父母特应性状况、致敏模式以及特应性皮炎的早期发病和严重程度的研究如何证实了这样一种理论，即在儿童特应性疾病发生之前，生命早期存在一个干预的机会之窗。然后，研究了围产期在家庭中接触母乳喂养、狗、猫和屋尘螨等早期生活暴露是否构成生命这一关键时期的重要影响因素。最后，讨论了如何在随机对照试验中验证这些发现，这可能为改善诊断和预防策略奠定基础，以减轻当前的特应性流行。
