External exposome and allergic respiratory and skin diseases
External exposome and allergic respiratory and skin diseases
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外部麻烦和过敏性呼吸道和皮肤疾病
DOI：
10.1016/j.jaci.2018.01.016
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发表时间：
2018-03-01
影响因子：
14.2
通讯作者：
Annesi-Maesano, Isabella
中科院分区：
文献类型：
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作者：
Cecchi, Lorenzo;D'Amato, Gennaro;Annesi-Maesano, Isabella
过敏症是多种遗传和环境因素相互作用的复杂疾病。然而，在过去几十年里观察到的过敏症的增加完全可以解释为同期发生的环境变化。目前，暴露体，即受试者从孕前开始暴露的特异性和非特异性外部环境暴露（外部暴露体）及其在器官和细胞水平上的后果（内部暴露体），被认为可以解释过敏性疾病的发生、发展和恶化。在特定外部暴露体的环境因素中，室内外空气过敏原和空气污染物在过敏原炎症反应的发病机制和变应性疾病的临床表现中起着关键作用。气候变化、城市化和生物多样性的丧失影响着主要空气过敏原和空气污染物的来源、排放和浓度，是当今和未来几十年越来越多的过敏患者面临的健康和生活质量的最关键挑战之一。雷暴相关哮喘是综合环境因素影响的一个戏剧性例子，也是了解呼吸道过敏工作机制的体内模型。环境或生活方式驱动的肠道和皮肤微生物组组成异常是过敏性疾病的关键介质。更好地了解外部暴露对过敏发展的影响对于敦促患者、卫生专业人员和政策制定者采取行动减轻环境变化的影响并适应它们至关重要。
Allergies are complex diseases that result from interactions between multiple genetic and environmental factors. However, the increase in allergies observed in the past decades is explained exclusively by environmental changes occurring in the same period. Presently, the exposome, the totality of specific and nonspecific external environmental exposures (external exposome) to which a subject is exposed from preconception onward and their consequences at the organ and cell levels (internal exposome), is being considered to explain the inception, development, and exacerbations of allergic diseases. Among the best-studied environmental factors of the specific external exposome, indoor and outdoor aeroallergens and air pollutants play a key role in the etiopathogenesis of the inflammatory response to allergens and in clinical manifestations of allergic disease. Climate change, urbanization, and loss of biodiversity affect sources, emissions, and concentrations of main aeroallergens and air pollutants and are among the most critical challenges facing the health and quality of life of the still increasing number of allergic patients today and in the coming decades. Thunderstorm-related asthma is a dramatic example of the effects of combined environmental factors and an in vivo model for understanding the mechanisms at work in respiratory allergy. Environment-or lifestyle-driven aberrancies in the gut and skin microbiome composition represent key mediators of allergic diseases. A better knowledge of the effect of the external exposome on allergy development is crucial for urging patients, health professionals, and policymakers to take actions to mitigate the effect of environmental changes and to adapt to them.