背景:过敏性疾病由于其在全球范围内的患病率不断增加,因此仍然受到关注。内在和环境危险因素与变应性疾病的发病机理有关。在可能的风险因素中,迁移与过敏性疾病的表现有关。我们旨在巩固现有证据,回顾环境因素与过敏性疾病之间关系的假设,为今后的工作提供方向。
方法:本系统评价和荟萃分析符合系统评价和荟萃分析(PRISMA)指南的首选报告项目。2023年9月搜索了WebofScience数据库,以检索调查过敏性鼻炎(AR)之间关系的出版物,特应性皮炎(AD),或哮喘和以下因素:(I)移民身份(即,移民vs.本地人)或(ii)移民移民以来的持续时间。使用JBI关键评估工具评估偏倚风险。还总结了纳入研究的细节和发现,并在适当的情况下进行了荟萃分析。
结果:综述了50项研究,估计有3,755,248人。文章调查了哮喘(n=46),AR(n=16),和AD(n=14)。还研究了各种与迁移相关的因素:个体跨区域的运动(n=40),移民后的持续时间(n=12),移民年龄(n=9),和文化适应(n=2)。迁移状态与AD无显著相关(合并比值比[pOR]=0.68,95%置信区间(CI)=0.31,1.49)。尽管移民的AR患病率低于本地人(pOR=0.58,95%CI=0.45,0.74),在目的地国家居住至少10年的移民患AR的风险高于居住时间少于10年的移民(pOR=8.36,95%CI=4.15,16.81)。移民也与哮喘风险降低相关(pOR=0.56,95%CI=0.44,0.72)。在移民中,在东道国居住至少10年与哮喘表现增加相关(pOR=1.85,95%CI=1.25,2.73).与5岁以上移民的移民相比,5岁及以下移民的移民患哮喘的可能性没有显着提高(pOR=1.01,95%CI=0.68,1.50)。
结论:本综述受到纳入研究的主要横断面性质的限制。过敏性疾病的客观诊断,例如使用支气管扩张剂可逆性测试的肺活量测定哮喘而不是问卷回答,可以增加结果的可靠性。此外,移民群体大多是非特异性的,他们的原籍国几乎没有区别。总的来说,迁移似乎是过敏性疾病的保护因素,但是随着时间的推移,保护逐渐消退,移民群体中过敏性疾病的患病率接近宿主人群。
BACKGROUND: Allergic diseases remain of concern due to their increasing prevalence worldwide. Intrinsic and environmental risk factors have been implicated in the pathogenesis of allergic disease. Among the possible risk factors, migration has been associated with the manifestation of allergic diseases. We aimed to consolidate the existing evidence,
review the hypotheses for the relationship between environmental factors and allergic disease, and provide a direction for future work.
METHODS: This systematic
review and meta-analysis complied with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The Web of Science database was searched in September 2023 to retrieve publications investigating the relationship between allergic rhinitis (AR), atopic dermatitis (AD), or asthma and the following factors: (i) migrant status (i.e., migrants vs. natives) or (ii) duration since migration among migrants. Risk of bias was assessed using the JBI critical appraisal tool. Details and findings from the included studies were also summarized and meta-analyses were conducted where appropriate.
RESULTS: Fifty studies encompassing an estimated 3,755,248 individuals were reviewed. Articles investigated asthma (n = 46), AR (n = 16), and AD (n = 14). A variety of migration-related factors were also studied: movement of individuals across regions (n = 40), duration since immigration (n = 12), age at immigration (n = 9), and acculturation (n = 2). Migration status was not significantly associated with AD (pooled odds ratio [pOR] = 0.68, 95% confidence interval (CI) = 0.31, 1.49). Although AR prevalence was lower among immigrants than natives (pOR = 0.58, 95% CI = 0.45, 0.74), immigrants who had resided at least 10 years in the destination country had a higher risk of AR than immigrants with a duration of residence of less than 10 years (pOR = 8.36, 95% CI = 4.15, 16.81). Being an immigrant was also associated with a decreased risk of asthma (pOR = 0.56, 95% CI = 0.44, 0.72). Among immigrants, residing in the host country for at least 10 years was associated with increased asthma manifestation (pOR = 1.85, 95% CI = 1.25, 2.73). Immigrants who migrated aged 5 and below did not exhibit a significantly higher likelihood of asthma than migrants who immigrated older than 5 years (pOR = 1.01, 95% CI = 0.68, 1.50).
CONCLUSIONS: This
review was limited by the primarily cross-sectional nature of the included studies. Objective diagnoses of allergic disease, such as using the spirometry of bronchodilator reversibility test for asthma rather than questionnaire responses, could add to the reliability of the outcomes. Furthermore, immigrant groups were mostly nonspecific, with little distinction between their country of origin. Overall, migration appears to be a protective factor for allergic diseases, but the protection subsides over time and the prevalence of allergic diseases among the immigrant group approaches that of the host population.