早期暴露其它孩童与动物可抵抗遗传性过敏皮肤炎


  May 6, 2004 - 一项四月30日于英国在线医学杂志发表的研究,对于遗传性过敏皮肤炎的卫生性假设提供了额外的证据。丹麦哥本哈根Statens Serum Institut流行病学中心的Christine Stabell Benn指出,一直以来,流行病学研究显示,在兄弟姊妹数目与过敏性疾病之间有著相反地关系,然而,在传染性疾病与过敏性疾病之间的关系并非始终如一的!
  
  在丹麦人民所做的全国性出生研究中,研究人员于四个独立的研究中,针对24341个孕妇,在怀孕期间进行两次、孩童6与18月龄时各进行一次面谈,然后收集遗传性过敏皮肤炎与在六个月前感染的相关信息,同时也收集了与暴露于微生物环境相关地因素。
  
  在六个月前,13070(54%)的儿童有过临床性的感染,18个月时,2638(10.8%) 的儿童曾患过遗传性过敏皮肤炎;相对于一般民众相信在生命中早期感染传染病,会对往后发展过敏性疾病具有较强的抵抗力,这项研究显示,六个月前,罹患遗传性过敏皮肤炎的机率会随著年龄而增高(rate ratio [RR], 1.08, 95% confidence interval [CI], 1.04 - 1.13)。
  
  相对地,罹患遗传性过敏皮肤炎的机率,则会随著兄弟姊妹数目、日常生活的照顾型态、畜主身分、农场位置而(RR, 0.86; 95% CI, 0.81 - 0.93)降低。研究人员表示,在考虑并对传染病数目做修正后,这保护性的影响始终维持一致,这项结果显示,罹患遗传性过敏皮肤炎的机率为独立的,且会在生命早期发生。
  
  研究人员总结指出,虽然这些发现支持了暴露于微生物环境中的情况对于预防遗传性过敏皮肤炎的重要性,但是他们也同时对婴儿时期罹患传染性疾病,可抵抗日后遗传性过敏皮肤炎发展的假说提出了异议。
  
  英国伦敦科学期刊BMJ编辑Geoff Watts在之后的评论中解释这些发现如何能为许多不同卫生假说的解释给予支持,其中一项影响因素,是因为调控T细胞的减少,而造成过敏症的出现。
  
  他表示,这些卫生方面的假说是否能推测疫苗使用,可基于刺激身体产生调控T细胞以达到对抗过敏的发生?答案是肯定的,初步的实验已经在进行中,免疫方面相关的试验也已逐渐获得结果。

Early Exposure to Other Childr

By Laurie Barclay, MD
Medscape Medical News

May 6, 2004 — A cohort study published in the April 30 online issue of the British Medical Journal offers additional evidence for the hygiene hypothesis of atopic dermatitis.

"Epidemiological studies have consistently shown an inverse relation between number of siblings and allergic diseases," write Christine Stabell Benn, from the Danish Epidemiology Science Centre of Statens Serum Institut in Copenhagen, Denmark, and colleagues. "The association between infectious diseases and allergic diseases has not been consistent."

Using the Danish national birth cohort, the investigators conducted four separate interviews of 24,341 pregnant women, twice during pregnancy and again when the child was six and 18 months of age, to collect information on atopic dermatitis and infections before six months of age, as well as on factors associated with exposure to microbes.

Before six months of age, 13,070 children (54%) had at least one clinical infection, and by age 18 months, 2,638 children (10.8%) had atopic dermatitis.

Contrary to the common belief that infectious diseases early in life may protect against the development of allergic diseases, the risk of atopic dermatitis in this cohort increased with each infectious disease before age six months (rate ratio [RR], 1.08, 95% confidence interval [CI], 1.04 - 1.13).

In contrast, the risk of atopic dermatitis decreased with each additional exposure to three or more siblings, day care, pet ownership, and farm residence (RR, 0.86; 95% CI, 0.81 - 0.93). This protective effect persisted after adjusting for number of infectious diseases, suggesting that it is established independently and very early in life, according to the authors.

Although these findings support the importance of microbial exposure for preventing atopic dermatitis, they challenge the hypothesis that infectious diseases in infancy protect against its development, the authors conclude.

In an accompanying commentary, Geoff Watts, science editor of the BMJ, in London, U.K., explains how these findings support various interpretations of the hygiene hypothesis. One effect of hygiene may be to decrease regulatory T cells and to allow the emergence of allergies.

"Does this version of the hygiene hypothesis suggest a method of vaccination against allergy based on stimulating the body's production of regulatory T cells?" he writes. "It does, and preliminary experiments are already under way. Immunology's love affair with dirt is blossoming and may yet bear fruit."

Neither the authors nor the commentator report any competing interests.

BMJ. Posted online April 30, 2004.

Reviewed by Gary D. Vogin, MD

    
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