免疫恢复力和生物多样性与过敏性疾病和哮喘的预防
2021/05/26
摘要
过敏性疾病的增加与大加速，即自1950年代以来地球上人类活动的快速增长，同步发生。随着城市化进程加快产生的环境和生活方式的变化被认为是主要的潜在原因。二级（三级）预防随着口服免疫疗法的创新以及皮质类固醇、钙调神经磷酸酶抑制剂和生物药物对炎症的有效治疗，疾病控制的水平有了很大提高。病人致残比以前减少了。然而，一级预防仍然是一个两难的问题。预测过敏和哮喘风险的因素已经被证明是复杂的：危险性因素增加了风险，而保护性因素抵消了风险。人体与环境生物多样性、微生物和生物源化合物的相互作用以及表观遗传适应在免疫稳态中的中心作用，给了我们新的认识。过敏性疾病是与环境扭曲关系的良好指标。在各种非传染性疾病中，免疫系统的保护模式表现为无明显原因的低度炎症。给予微生物（益生菌和益生元）干预在预防和治疗方具有一定前景。芬兰的真实世界公共卫生计划（2008-2018年）强调了免疫恢复力的自然相关性和保护性，而非避免。全国性的行动减轻了过敏症负担，但在缺乏控制的情况下，一级预防效果仍有待证实。受控的生物多样性干预措施的初步结果显示是有前景的。在快速城市化的世界里，需要新的方法来预防过敏，这也有很大的成本节约潜力。
Immunological resilience and biodiversity for prevention of allergic diseases and asthma
Tari Haahtela, Harri Alenius, Jenni Lehtimäki, Aki Sinkkonen, Nanna Fyhrquist, Heikki Hyöty, Lasse Ruokolainen, Mika Mäkelä.
Abstract
Increase of allergic conditions has occurred at the same pace with the Great Accleration, which stands for the rapid growth rate of human activities upon Earth from 1950s. Changes of environment and lifestyle along with escalating urbanization, are acknowledged as the main underlying causes. Secondary (tertiary) prevention for better disease control has advanced considerably with innovations for oral immunotherapy and effective treatment of inflammation with corticosteroids, calcineurin inhibitors and biologic medications. Patients are less disabled than before. However, primary prevention has remained a dilemma. Factors predicting allergy and asthma risk have proven complex: risk factors increase the risk while protective factors counteract them. Interaction of human body with environmental biodiversity with micro-organisms and biogenic compounds as well as the central role of epigenetic adaptation in immune homeostasis have given new insight. Allergic diseases are good indicators of the twisted relation to environment. In various non-communicable diseases, the protective mode of the immune system indicates low-grade inflammation without apparent cause. Giving microbes, pro- and prebiotics, has shown some promise in prevention and treatment. The real-world public health programme in Finland (2008-2018) emphasized nature relatedness and protective factors for immunological resilience, instead of avoidance. The nationwide action mitigated the allergy burden, but in the lack of controls, primary preventive effect remains to be proven. The first results of controlled biodiversity interventions are promising. In the fastly urbanizing world, new approaches are called for allergy prevention, which also has a major cost saving potential.
过敏性疾病的增加与大加速，即自1950年代以来地球上人类活动的快速增长，同步发生。随着城市化进程加快产生的环境和生活方式的变化被认为是主要的潜在原因。二级（三级）预防随着口服免疫疗法的创新以及皮质类固醇、钙调神经磷酸酶抑制剂和生物药物对炎症的有效治疗，疾病控制的水平有了很大提高。病人致残比以前减少了。然而，一级预防仍然是一个两难的问题。预测过敏和哮喘风险的因素已经被证明是复杂的：危险性因素增加了风险，而保护性因素抵消了风险。人体与环境生物多样性、微生物和生物源化合物的相互作用以及表观遗传适应在免疫稳态中的中心作用，给了我们新的认识。过敏性疾病是与环境扭曲关系的良好指标。在各种非传染性疾病中，免疫系统的保护模式表现为无明显原因的低度炎症。给予微生物（益生菌和益生元）干预在预防和治疗方具有一定前景。芬兰的真实世界公共卫生计划（2008-2018年）强调了免疫恢复力的自然相关性和保护性，而非避免。全国性的行动减轻了过敏症负担，但在缺乏控制的情况下，一级预防效果仍有待证实。受控的生物多样性干预措施的初步结果显示是有前景的。在快速城市化的世界里，需要新的方法来预防过敏，这也有很大的成本节约潜力。
(中日友好医院呼吸与危重症医学科 顾宪民 摘译 林江涛 审校)
(Allergy. 2021 May 6. doi: 10.1111/all.14895.)
(Allergy. 2021 May 6. doi: 10.1111/all.14895.)
Immunological resilience and biodiversity for prevention of allergic diseases and asthma
Tari Haahtela, Harri Alenius, Jenni Lehtimäki, Aki Sinkkonen, Nanna Fyhrquist, Heikki Hyöty, Lasse Ruokolainen, Mika Mäkelä.
Abstract
Increase of allergic conditions has occurred at the same pace with the Great Accleration, which stands for the rapid growth rate of human activities upon Earth from 1950s. Changes of environment and lifestyle along with escalating urbanization, are acknowledged as the main underlying causes. Secondary (tertiary) prevention for better disease control has advanced considerably with innovations for oral immunotherapy and effective treatment of inflammation with corticosteroids, calcineurin inhibitors and biologic medications. Patients are less disabled than before. However, primary prevention has remained a dilemma. Factors predicting allergy and asthma risk have proven complex: risk factors increase the risk while protective factors counteract them. Interaction of human body with environmental biodiversity with micro-organisms and biogenic compounds as well as the central role of epigenetic adaptation in immune homeostasis have given new insight. Allergic diseases are good indicators of the twisted relation to environment. In various non-communicable diseases, the protective mode of the immune system indicates low-grade inflammation without apparent cause. Giving microbes, pro- and prebiotics, has shown some promise in prevention and treatment. The real-world public health programme in Finland (2008-2018) emphasized nature relatedness and protective factors for immunological resilience, instead of avoidance. The nationwide action mitigated the allergy burden, but in the lack of controls, primary preventive effect remains to be proven. The first results of controlled biodiversity interventions are promising. In the fastly urbanizing world, new approaches are called for allergy prevention, which also has a major cost saving potential.
上一篇：
儿童早期环境空气污染暴露与儿童哮喘风险增加相关：来自瑞典斯德哥尔摩的一项队列研究
下一篇：
一项通过饮食实现食物过敏一级预防的共识：来自美国过敏、哮喘和免疫学学会；美国过敏、哮喘和免疫学学会；以及加拿大过敏和临床
