The environmental influence on childhood asthma
The environmental influence on childhood asthma
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DOI：
10.1111/j.1398-9995.1999.tb04383.x
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发表时间：
1999-01-01
期刊：
影响因子：
12.4
通讯作者：
Björkstén, B
中科院分区：
文献类型：
--
作者：
Björkstén, B
过敏症的发病机制取决于过敏原暴露的时间和数量与遗传易感个体中非特异性“佐剂”因素的存在之间的相互作用。似乎在生命早期有一段时期，个体特别容易受到敏感化的影响，而且随着时间的推移，敏感度也会发生变化。过敏原几乎无处不在，但各个过敏原的相对重要性因地区而异。在许多温带地区，屋尘螨过去是没有的，但现在更常见了。这可能是由于现代的建房方法。特定过敏症患病率的差异不能解释一般过敏症患病率的差异。可能增强致敏性的各种环境因素包括烟草烟雾、NO2、SO2、臭氧和柴油颗粒。到目前为止，被动吸烟是最确定的危险因素，特别是在儿童早期。在过敏性疾病的发生发展中，室内环境可能比室外空气污染起到更大的作用。母亲不仅是遗传信息的来源，也是一个“环境因素”，因为母亲和她的后代之间有一种通过胎盘和母乳调节的密切免疫相互作用，这可能会影响患过敏性疾病的可能性。“生活方式”和“环境”的概念应该扩大到包括，例如，饮食变化、微生物环境和广泛的旅行，因为所有目前怀疑的危险因素加在一起，只能解释变态反应的地理差异和不断增加的发病率的一小部分。未来对重要环境因素的寻找应该是跨学科的，并针对尚未被探索的领域，从而给予“生活方式”更广泛的解释。
The pathogenesis of allergy depends on the interaction between the time and amount of allergen exposure and the presence of nonspecific "adjuvant" factors in genetically susceptible individuals. There seems to be a period in early life during which the individual is particularly susceptible to sensitization, and there are variations in susceptibility over time. Allergens are almost ubiquitous, but the relative importance of the individual allergens varies between regions. In many temperate regions, house-dust mites used to be absent but are now more common. This may be due to modern methods of building houses. Differences in the prevalence of a particular allergy cannot explain variations in the prevalence of allergy in general. Various environmental factors that may enhance sensitization include tobacco smoke, NO2, SO2, ozone, and diesel particles. Passive smoking is by far the best established risk factor, particularly in early childhood. The indoor environment probably plays a larger role than outdoor air pollution in the development of allergic disease. The mother is not only a source of genetic information, but also an "environmental factor", as there is a close immunologic interaction between the mother and her offspring, mediated through the placenta and the breast milk, which may affect the likelihood of allergic disease. The concepts of "lifestyle" and "environment" should be expanded to include, for example, dietary changes, the microbial environment, and extensive traveling, as all the currently suspected risk factors taken together can only explain a small proportion of the geographic differences in and increasing prevalence of allergy. The future search for significant environmental factors should be interdisciplinary and be directed toward areas that have not yet been explored, thus giving "lifestyle" a broader interpretation.