Asthma, atopy, antibiotics and the bowel.
Asthma, atopy, antibiotics and the bowel.
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DOI：
10.1080/09629350152700975
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发表时间：
2001-12
影响因子：
4.6
通讯作者：
Crane J
中科院分区：
文献类型：
--
作者：
Crane J
在过去的三十年里，世界各地的许多研究报告显示哮喘和过敏性疾病有所增加，最近被描述为流行病。[1]虽然已经提出了许多假说来解释这些变化，但卫生假说在过去十年中涵盖了特应性致敏和特应性疾病的流行病学和免疫学之间不断扩大的联系。最近，戴维·斯特拉坎（David Strachan）对这些关联和假说的效用进行了综述，他首先报道了出生顺序与花粉热之间的关联，并将卫生假说作为一种解释。[3] 10年前，Gerrard等人在比较萨斯喀彻温省北方的梅蒂斯人（土著印第安人）和白色人群体中的特应性疾病时，首次提出了特应性疾病和传染病之间的反向关系。4.这一假说的免疫学基础是，在生命早期，由于接触微生物而引起的免疫偏向于T辅助细胞（Th）1免疫应答，Th 1应答抑制Th 2应答和免疫球蛋白E（IgE）的产生。因此，该假说指的是IgE介导的疾病，如枯草热，但不太适用于哮喘，其中特应性起着重要的作用，但不是唯一的。最近，在参与欧洲共同体呼吸健康调查的五个西班牙中心，在20至44岁的成年人中研究了哮喘、支气管高反应性（BHR）和特应性之间的关系。校正后的BHR归因于特应性的比例为21%，哮喘症状和BHR归因于特应性的比例为42%。5与卫生假说相关的因素，如出生顺序或特定感染，其与哮喘的关联强度将因过敏性哮喘的比例而异。任何有用的假设的一个重要特征是，它应该统一不同的观察。卫生假说做到了这一点，提出了对国家内部和国家之间特应性疾病的社会经济差异的解释，以及对患病率长期上升趋势的合理解释。关于感染或微生物暴露与特应性疾病之间关系的研究也倾向于支持卫生假说，最近研究了抗生素对这些联系的影响。Farooqi等人发现，在全科出生队列中，出生后2年内接受抗生素治疗的医生诊断的特应性疾病的风险为2倍。[6]所有类别的抗生素都明显增加了风险，尽管头孢菌素类和大环内酯类的风险更大;它与所治疗的基础疾病无关，并且对于有和没有母体过敏史的患者相似。在这项研究中，抗生素暴露是特应性疾病最强的预测因子。另外两项研究调查了瑞典和新西兰儿童的抗生素使用情况，这些儿童的家庭与人择生活方式有一定的联系。信奉这种生活方式的家庭，其信条是由鲁道夫·施泰纳在世纪提出的，他们倾向于尽量减少对传统医疗的参与。
The past three decades have seen an increase in reported asthma and allergic diseases from many studies around the world, recently described as an epidemic. 1 While many hypotheses have been developed to explain these changes, the hygiene hypothesis has for the past decade encompassed an expanding link between the epidemiology and immunology of both atopic sensitisation and atopic diseases. These associations and the utility of the hypothesis have recently been reviewed by David Strachan, 2 who first reported the associations between birth order and hayfever, and articulated the hygiene hypothesis as an explanation. 3 Inverse relationships between atopic and infectious disease was first raised a decade earlier by Gerrard et al. in a comparison of atopic disease amongst the Metis (native Indian) and white communities of northern Saskatchewan. 4 The immunological basis for the hypothesis rests on the concept of immune deviation in early life towards T helper cell (Th) 1 immune responses induced by microbial exposure, with Th1 responses suppressing Th2 responses and immunoglobulin E (IgE) production. The hypothesis therefore refers to IgE-mediated diseases such as hayfever but is less applicable to asthma, where atopy plays an important but not exclusive role. The relationships between asthma, bronchial hyperresponsiveness (BHR) and atopy have recently been examined among 20-to 44-year-old adults, in five Spanish centres involved in the European Community Respiratory Health Survey. The adjusted proportion of BHR attributable to atopy was 21% and the proportion of asthma symptoms and BHR attributable to atopy was 42%. 5 Factors associated with the hygiene hypothesis such as birth order or specific infections will vary in their strength of association with asthma depending on the proportion of asthma attributable to atopy. An important feature of any useful hypothesis is that it should unify disparate observations. The hygiene hypothesis does this, suggesting explanations for socio-economic variations in atopic disease both within and between countries, and a plausible explanation of some of the long-term upward trends in prevalence. Studies of the relationship between infection or microbial exposures and atopic disease also tend to support the hygiene hypothesis.The influence of antibiotics on these associations has recently been studied. Farooqi et al. found a twofold risk of doctor-diagnosed atopic diseases with antibiotic treatment in the first 2 years of life, among a general practice birth cohort. 6 The increased risk was apparent for all classes of antibiotics, although greater for cephalosporins and macrolides; it was independent of the underlying condition being treated, and was similar for those with and without a history of maternal atopy. Antibiotic exposure was the strongest predictor of atopic disease in this study. The other two studies have examined antibiotic use among children in Sweden and New Zealand, whose families have some association with an anthroposophic lifestyle. Families embracing this lifestyle, whose tenets were set out by Rudolph Steiner in the nineteenth century, tend to minimise their involvement with conventional medical
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影响因子：
3.8
作者：
Sepp, E;Julge, K;Mikelsaar, M
通讯作者：
Mikelsaar, M
影响因子：
--
作者：
STRACHAN, DP
通讯作者：
STRACHAN, DP
影响因子：
10
作者：
Farooqi, IS;Hopkin, JM
通讯作者：
Hopkin, JM
影响因子：
6.1
作者：
Björkstén, B;Naaber, P;Mikelsaar, M
通讯作者：
Mikelsaar, M
影响因子：
168.9
作者：
Alm, JS;Swartz, J;Pershagen, G
通讯作者：
Pershagen, G