Exposure to dust mite allergen and endotoxin in early life and asthma and atopy in childhood
Exposure to dust mite allergen and endotoxin in early life and asthma and atopy in childhood
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DOI：
10.1016/j.jaci.2007.03.037
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发表时间：
2007-07-01
影响因子：
14.2
通讯作者：
Gold, Diane R.
中科院分区：
文献类型：
--
作者：
Celedon, Juan C.;Milton, Donald K.;Gold, Diane R.
背景：尚无关于生命早期同时暴露于尘螨过敏原和内毒素与学龄期哮喘和特应性之间关系的纵向研究。目的：探讨2至3个月龄接触尘螨过敏原和内毒素与高危儿童哮喘、喘息和特应性的关系。方法：对440名父母有特应性病史的儿童进行出生队列研究。 波士顿大都市区。结果：在多变量分析中，早期接触高水平尘螨过敏原 (>= 10 mu g/g) 与 7 岁时患哮喘的风险增加相关（比值比 [OR]，3.0；95% CI，1.1-7.9）和迟发型喘息（OR，5.0；95% CI，1.5-16.4）。 2 至 3 个月时接触高于最低四分位数的内毒素水平与学龄期特应性发病率降低相关（OR，0.5；95% CI，0.2-0.9）。与特应性呈负相关相反，生命早期接触内毒素与 1 岁至 7 岁之间任何喘息的风险增加相关，但这种风险随时间的推移没有显着变化（内毒素水平每四分位增量的风险比为 1.23；95% CI，1.07-1.43）。结论：在有特应性风险的儿童中，早期接触高水平的尘螨过敏原与患特应性过敏的风险增加相关。 哮喘和迟发性喘息。在这些儿童中，内毒素暴露与特应性风险降低相关，但喘息风险增加。临床意义：早期内毒素暴露可能是预防特应性的保护因素，但对于高危儿童来说是喘息的危险因素。
Background: There has been no longitudinal study of the relation between concurrent exposure to dust mite allergen and endotoxin in early life and asthma and atopy at school age.Objectives: To examine the relation between exposure to dust mite allergen and endotoxin at age 2 to 3 months and asthma, wheeze, and atopy in high-risk children.Methods: Birth cohort study of 440 children with parental history of atopy in the Boston metropolitan area.Results: In multivariate analyses, early exposure to high levels of dust mite allergen (>= 10 mu g/g) was associated with increased risks of asthma at age 7 years (odds ratio [OR], 3.0; 95% CI, 1.1-7.9) and late-onset wheeze (OR, 5.0; 95% Cl, 1.5-16.4). Exposure to endotoxin levels above the lowest quartile at age 2 to 3 months was associated with reduced odds of atopy at school age (OR, 0.5; 95% CI, 0.2-0.9). In contrast with its inverse association with atopy, endotoxin exposure in early life was associated with an increased risk of any wheeze between ages I and 7 years that did not change significantly with time (hazard ratio for each quartile increment in endotoxin levels, 1.23; 95% CI, 1.07-1.43).Conclusion: Among children at risk of atopy, early exposure to high levels of dust mite allergen is associated with increased risks of asthma and late-onset wheeze. In these children, endotoxin exposure is associated with a reduced risk of atopy but an increased risk of wheeze.Clinical implications: Early endotoxin exposure may be a protective factor against atopy but a risk factor for wheeze in high-risk children.