Are allergic multimorbidities and IgE polysensitization associated with the persistence or re-occurrence of foetal type 2 signalling? The MeDALL hypothesis
Are allergic multimorbidities and IgE polysensitization associated with the persistence or re-occurrence of foetal type 2 signalling? The MeDALL hypothesis
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DOI：
10.1111/all.12637
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发表时间：
2015-09-01
期刊：
影响因子：
12.4
通讯作者：
von Hertzen, L.
中科院分区：
文献类型：
--
作者：
Bousquet, J.;Anto, J. M.;von Hertzen, L.
过敏性疾病[哮喘、鼻炎和特应性皮炎（AD）]是复杂的。它们与过敏原特异性IgE以及可能在同一患者中并存的非过敏性机制有关。此外，这些疾病往往聚集发生，患者会出现伴随或连续的疾病（多病共存）。IgE致敏应被视为一种数量性状。单一致敏和多致敏个体之间存在重要的临床和免疫学差异。过敏性疾病的多病共存具有共同的致病机制，这些机制仅部分由IgE介导。过敏性疾病随时间的持续存在与多病共存和/或IgE多致敏有关。过敏家族史的重要性可能随年龄增长而降低。本综述提出假设：过敏性多病共存和IgE多致敏是相关的，并且与胎儿2型信号传导的持续存在或再次出现有关。哮喘、鼻炎和AD是一种常见的全身性免疫失衡（中胚层起源）的表现，伴有特定的重塑模式（外胚层或内胚层起源）。本研究提出了一种IgE介导的过敏性疾病的新分类，该分类能够定义新的表型，以便（i）更好地理解遗传和表观遗传机制，（ii）更好地对学龄前过敏性儿童进行预后分层，以及（iii）提出新的治疗和预防策略。
Allergic diseases [asthma, rhinitis and atopic dermatitis (AD)] are complex. They are associated with allergen-specific IgE and nonallergic mechanisms that may coexist in the same patient. In addition, these diseases tend to cluster and patients present concomitant or consecutive diseases (multimorbidity). IgE sensitization should be considered as a quantitative trait. Important clinical and immunological differences exist between mono- and polysensitized subjects. Multimorbidities of allergic diseases share common causal mechanisms that are only partly IgE-mediated. Persistence of allergic diseases over time is associated with multimorbidity and/or IgE polysensitization. The importance of the family history of allergy may decrease with age. This review puts forward the hypothesis that allergic multimorbidities and IgE polysensitization are associated and related to the persistence or re-occurrence of foetal type 2 signalling. Asthma, rhinitis and AD are manifestations of a common systemic immune imbalance (mesodermal origin) with specific patterns of remodelling (ectodermal or endodermal origin). This study proposes a new classification of IgE-mediated allergic diseases that allows the definition of novel phenotypes to (i) better understand genetic and epigenetic mechanisms, (ii) better stratify allergic preschool children for prognosis and (iii) propose novel strategies of treatment and prevention.