不良童年经历与过敏性疾病：范围综述

文献信息

中文摘要

背景： 每七人中就有一人至少经历四种不良童年经历（ACE）。这些经历与不良健康结局相关。目的：目的是梳理ACE与哮喘、食物过敏、过敏性鼻炎、特应性皮炎、荨麻疹及肥大细胞活化综合征之间的关联。方法：选取并摘录评估ACE与哮喘、食物过敏、过敏性鼻炎、特应性皮炎、荨麻疹或肥大细胞活化综合征之间关联的原始研究。排除综述文章及未经同行评议的文献。证据来源包括多个医学文献数据库，检索时间自建库至2026年4月3日。每篇文章均在标题和摘要、全文及数据提取阶段进行双人重复审查，分歧通过共识或独立审查解决。采用改良评估工具进行质量评价。结果：去除重复后（181篇），评估了357篇全文文章，排除267项研究。对90篇文章的全文进行合格性评估，排除31项研究（1篇预印本、11项结局错误、1项暴露错误、17项研究设计错误、1项人群错误）。这些研究存在回忆偏倚及结局诊断准确性方面的局限性。在纳入综述的59项研究中，57项主要关注哮喘/肺部疾病，6项以不同方式报告了描述不充分的过敏结局，2项报告了特应性皮炎。未发现探讨ACE与食物过敏、荨麻疹或肥大细胞活化综合征之间关联的研究。现有证据表明ACE与哮喘风险存在关联，并注意到可能的剂量-反应效应，提示ACE暴露越多风险可能越大。结论：提示ACE与哮喘之间存在关联。需要更多研究来了解ACE对过敏科/免疫科医师所评估的其他疾病的影响。

英文摘要

Background: One in seven individuals experience at least four adverse childhood experiences (ACE). These experiences have been associated with poor health outcomes. Objectives: The objective was to map the association between ACEs and asthma, food allergy, allergic rhinitis, atopic dermatitis, urticaria, and mast cell activation syndrome. Methods: Original research that evaluated the association between ACEs and asthma, food allergy, allergic rhinitis, atopic dermatitis, urticaria, or mast cell activation syndrome was selected and abstracted. Review articles and non-peer-reviewed literature were excluded. Sources of evidence included several medical literature databases from inception to April 3, 2026. Each article was reviewed in duplicate at title and abstract, full text, and data extraction, with conflicts resolved by consensus or independent review. Quality assessment was conducted by using a modified assessment tool. Results: After duplicate removal (181 articles), 357 full-text articles were evaluated, with 267 studies excluded. The full text of 90 articles was assessed for eligibility, with 31 studies excluded (1 preprint, 11 wrong outcome, 1 wrong exposure, 17 wrong study design, 1 wrong population). The studies were subject to recall bias and limitations in terms of diagnostic accuracy of the outcome. Of 59 studies selected for inclusion in the review, 57 focused primarily on asthma/lung disease, 6 variably reported on poorly described allergy outcomes, and 2 reported on atopic dermatitis. No studies were identified that explored the association between ACEs and food allergy, urticaria, or mast cell activation syndrome. There is available evidence of an association of ACEs and asthma risk with a potential dose-response effect noted, indicating the possibility of a greater risk with greater ACE exposure. Conclusion: An association between ACEs and asthma is suggested. More research is needed to understand the impact of ACEs on other conditions evaluated by allergist/immunologists.