Lee Eun, Yang Song-I, Suh Dong In, Kim Hyo-Bin, Lee So-Yeon, Kwon Sung Ok, Hong Soo-Jong
Department of Pediatrics, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Republic of Korea.
Department of Pediatrics, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea.
Pediatr Allergy Immunol. 2025 Jun;36(6):e70130. doi: 10.1111/pai.70130.
Atopic dermatitis (AD) is a prevalent chronic inflammatory skin disease arising from a multifaceted interplay between genetic susceptibility and environmental exposures. Longitudinal cohort studies have been instrumental in elucidating the contribution of environmental factors to both the onset and persistence of AD. This review synthesizes evidence from such studies to delineate key environmental determinants across various domains. Early-life exposures, including delivery mode and antibiotic exposure, modulate microbial composition and function, thereby influencing immune development and predisposing individuals to AD. Both outdoor and indoor air pollutants, such as particulate matter and volatile organic compounds, have been shown to impair skin barrier integrity and dysregulate immune responses, facilitating the initiation and progression of AD. Nutritional factors, encompassing maternal and infant dietary patterns, shape gut microbiota and metabolite profiles and systemic immune activity, further modulating AD risk. Moreover, psychological stress during the prenatal and postnatal periods has been associated with alterations in immune function and epigenetic programming, which may heighten susceptibility to AD. Environmental influences also appear to vary by AD phenotype and trajectory, underscoring the need for individualized prevention strategies. Advances in exposome research, encompassing both external and internal environmental components, have enhanced mechanistic understanding and facilitated the identification of candidate biomarkers. Collectively, current evidence supports the notion that early-life environmental exposures act not as isolated determinants but in concert with genetic, microbial, and immunologic factors to shape AD pathogenesis. A comprehensive framework integrating exposomics and multiomics may ultimately inform the development of targeted preventive and therapeutic strategies for children with AD.
特应性皮炎（AD）是一种常见的慢性炎症性皮肤病，由遗传易感性和环境暴露之间的多方面相互作用引起。纵向队列研究有助于阐明环境因素对AD发病和持续存在的影响。本综述综合了这些研究的证据，以勾勒出各个领域的关键环境决定因素。早期生活暴露，包括分娩方式和抗生素暴露，会调节微生物组成和功能，从而影响免疫发育并使个体易患AD。室外和室内空气污染物，如颗粒物和挥发性有机化合物，已被证明会损害皮肤屏障完整性并使免疫反应失调，促进AD的发生和发展。营养因素，包括母婴饮食模式，塑造肠道微生物群和代谢物谱以及全身免疫活动，进一步调节AD风险。此外，产前和产后的心理压力与免疫功能和表观遗传编程的改变有关，这可能会增加对AD的易感性。环境影响似乎也因AD表型和病程而异，这突出了个性化预防策略的必要性。暴露组研究的进展，包括外部和内部环境成分，增强了对发病机制的理解，并有助于识别候选生物标志物。总体而言，目前的证据支持这样一种观点，即早期生活环境暴露并非孤立的决定因素，而是与遗传、微生物和免疫因素共同作用，塑造AD的发病机制。一个整合暴露组学和多组学的综合框架最终可能为AD儿童的靶向预防和治疗策略的制定提供信息。
