D'Amato G, Liccardi G, Cazzola M
Dept of Chest Diseases, Hospital A. Cardarelli, Naples, Italy.
Monaldi Arch Chest Dis. 1994 Dec;49(5):406-11.
Respiratory allergic diseases appear to be increasing in most countries. In particular, asthma morbidity and mortality have been reported to be increasing despite the availability of effective asthma medications. It has been also observed that subjects living in urban and industrialized areas are more likely to have respiratory allergic symptoms than those living in rural areas. This increase has been linked to air pollution, rather than to a modification of the genome of the patient. The interplay of genetic and environmental factors in the development of allergic disorders remains a subject of investigation. In the outdoor environment, the most important air pollutants are sulphur dioxide, ozone and particulate matter, in particular diesel exhaust emissions. These pollutants, besides acting as irritants, increasing airways hyper-reactivity, are thought to be causal factors which act to modulate the immune response, with an adjuvant activity on immunoglobulin E (IgE) synthesis. In other words, atopic state can be upregulated by environmental influences, and some subjects develop atopic diseases in response to these environmental factors. Since airborne allergens and air pollutants are often both increased in the same areas, potentiation, either in the degree of acquired sensitization or in the degree of the response to allergens, should be considered as an important factor which might help to explain the increasing frequency of allergic respiratory disease. In the light of our present knowledge, it is evident that further investigation in human subjects, aimed at evaluating specific agents, and their concentration in the atmosphere, which can influence pulmonary function, is needed. These studies may help to explain the increasing problem of asthma morbidity and mortality.
在大多数国家，呼吸道过敏性疾病似乎都在增加。特别是，尽管有有效的哮喘药物，但据报道哮喘的发病率和死亡率仍在上升。还观察到，生活在城市和工业化地区的人比生活在农村地区的人更容易出现呼吸道过敏症状。这种增加与空气污染有关，而不是与患者基因组的改变有关。遗传和环境因素在过敏性疾病发展中的相互作用仍是一个研究课题。在室外环境中，最重要的空气污染物是二氧化硫、臭氧和颗粒物，特别是柴油废气排放。这些污染物除了作为刺激物增加气道高反应性外，还被认为是调节免疫反应的致病因素，对免疫球蛋白E（IgE）合成具有佐剂活性。换句话说，特应性状态可因环境影响而上调，一些人会因这些环境因素而患上特应性疾病。由于空气传播的过敏原和空气污染物在同一地区往往都有所增加，因此在获得性致敏程度或对过敏原的反应程度方面的增强应被视为一个重要因素，这可能有助于解释过敏性呼吸道疾病发病率上升的原因。根据我们目前的知识，显然需要对人类受试者进行进一步研究，以评估可能影响肺功能的特定物质及其在大气中的浓度。这些研究可能有助于解释哮喘发病率和死亡率不断上升的问题。
