The two sides of the "endotoxin coin".
نویسنده
چکیده
Correspondence to: Dr K Radon, Unit for Occupational and Environmental Epidemiology & Net Teaching, Institute and Outpatient Clinic for Occupational and Environmental Medicine, Ziemssenstr. 1, 80336 Munich, Germany; katja. [email protected] _________________________ E ndotoxins, part of the outer membrane of Gram negative bacteria, are a potent inducer of neutrophilic airway inflammation. A large number of studies in occupational epidemiology has shown that exposure to endotoxins increases the likelihood of organic dust toxic syndrome, chronic bronchitis, and asthma-like syndrome. In contrast, it has been shown that exposure to endotoxins in the occupational and environmental setting protects from respiratory allergies and sensitisation to allergens. With respect to asthma, the evidence is conflicting at first glance. While some studies indicated an increased risk of asthma after endotoxin exposure, others have shown that endotoxin exposure protects from asthma. However, these differences can be explained when different asthma phenotypes are taken into account. The risk of atopic asthma, mainly dominated by eosinophilic response, is decreased in those exposed to endotoxins. In contrast, the risk of nonatopic asthma, characterised by neutrophilic response, is enhanced in subjects with higher endotoxin exposure. These data are in accordance with the so-called hygiene hypothesis and have been supported by animal studies and at the cellular level. At the workplace, measures should therefore be taken in order to reduce endotoxin exposure. The effectiveness of such measures with respect to the incidence of diseases associated with a chronic neutrophilic inflammation in the airways should be assessed in intervention studies. At the same time we need to learn whether the evidence from epidemiological studies in farming environments might help us to obtain effective intervention strategies against allergies.
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ورودعنوان ژورنال:
- Occupational and environmental medicine
دوره 63 1 شماره
صفحات -
تاریخ انتشار 2006