The Role of Environmental Exposures in Atopic Dermatitis
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ALLERGIES AND THE ENVIRONMENT (T MORAN, SECTION EDITOR)
The Role of Environmental Exposures in Atopic Dermatitis Shanthi Narla 1 & Jonathan I. Silverberg 2 Accepted: 15 September 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review Although genetic factors clearly play a role in the development of atopic dermatitis (AD), the recent dramatic increase in the prevalence of AD in low- and middle-income countries is not consistent with only a role of genetic factors. These findings strongly suggest that environmental factors may play an important role in the pathogenesis of AD. Recent Findings We reviewed the role of gene-environment studies; in utero exposures including tobacco smoke, alcohol, maternal stress, various digestive supplements, and gestational diabetes; early-life exposures including diet, gut microbiota, antibiotics, and breastfeeding; climate including temperature, ultraviolet radiation exposure, and air pollution; and household products, indoor allergens, water hardness, pH, and skin microbiota and their effects on AD. Summary Environmental factors definitely play a role in the pathogenesis of AD. However, identifying definitive factors continues to be difficult in the setting of conflicting evidence and the complex interactions between genotypes and the environment resulting in a multitude of AD phenotypes. All of the different environmental interactions discussed highlight the importance of intervening on multiple levels in a patient’s environment to improve or even prevent AD symptoms. Further, the importance of modifying environmental factors early on in a person’s life is demonstrated. When possible, all of these environmental factors should be considered in treating a patient with AD and the appropriate modifications should be made at population and individual levels. Keywords Atopic dermatitis . Environment . Prenatal . Tobacco smoke . Alcohol . Maternal stress . Gene-environment interactions . Fatty acids . Prebiotics . Probiotics . Postbiotics . Gestational diabetes . Antibiotics . Breastfeeding . Climate . Temperature . Ultraviolet radiation . Air pollution . Household products . Indoor allergens . Water hardness . pH . Skin microbiota . Gut microbiota . Cesarean section . Hygiene hypothesis
Abbreviations AD Atopic dermatitis GEI Gene-environment interactions UVR Ultraviolet radiation FLG Filaggrin GDM Gestational diabetes mellitus SCFA Short-chain fatty acids AD-E Atopic dermatitis or eczema This article is part of the Topical Collection on Allergies and the Environment * Jonathan I. Silverberg [email protected] 1
Department of Dermatology, St. Luke’s University Health Network, Easton, PA 18045, USA
2
Department of Dermatology, The George Washington University School of Medicine and Health Sciences, Suite 2B-430, 2150 Pennsylvania Avenue, Washington, DC 20037, USA
ISAAC TRAP SNP MMP TNF IL HPs NMF SR PRR AMP RCT EPA DHA PUFA scGOS lcFOS BMI
International Study of Asthma and Allergies in Childhood Traffic-related air pollution
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