Epithelial barrier hypothesis: Effect of the external exposome on the microbiome and epithelial barriers in allergic disease.
Zeynep Celebi SozenerBetül Özdel ÖztürkPamir ÇerçiMurat TurkBegum Gorgulu AkinMübeccel AkdişSeda AltinerÜmüş Özbey Yücelİsmail ÖğülürYasutaka Mitamuraİnsu YılmazKari Christine NadeauCevdet OzdemirDilşad MunganMübeccel AkdisPublished in: Allergy (2022)
Environmental exposure plays a major role in the development of allergic diseases. The exposome can be classified into internal (e.g., aging, hormones, and metabolic processes), specific external (e.g., chemical pollutants or lifestyle factors), and general external (e.g., broader socioeconomic and psychological contexts) domains, all of which are interrelated. All the factors we are exposed to, from the moment of conception to death, are part of the external exposome. Several hundreds of thousands of new chemicals have been introduced in modern life without our having a full understanding of their toxic health effects and ways to mitigate these effects. Climate change, air pollution, microplastics, tobacco smoke, changes and loss of biodiversity, alterations in dietary habits, and the microbiome due to modernization, urbanization, and globalization constitute our surrounding environment and external exposome. Some of these factors disrupt the epithelial barriers of the skin and mucosal surfaces, and these disruptions have been linked in the last few decades to the increasing prevalence and severity of allergic and inflammatory diseases such as atopic dermatitis, food allergy, allergic rhinitis, chronic rhinosinusitis, eosinophilic esophagitis, and asthma. The epithelial barrier hypothesis provides a mechanistic explanation of how these factors can explain the rapid increase in allergic and autoimmune diseases. In this review, we discuss factors affecting the planet's health in the context of the 'epithelial barrier hypothesis,' including climate change, pollution, changes and loss of biodiversity, and emphasize the changes in the external exposome in the last few decades and their effects on allergic diseases. In addition, the roles of increased dietary fatty acid consumption and environmental substances (detergents, airborne pollen, ozone, microplastics, nanoparticles, and tobacco) affecting epithelial barriers are discussed. Considering the emerging data from recent studies, we suggest stringent governmental regulations, global policy adjustments, patient education, and the establishment of individualized control measures to mitigate environmental threats and decrease allergic disease.
Keyphrases
- allergic rhinitis
- climate change
- human health
- atopic dermatitis
- healthcare
- particulate matter
- risk assessment
- air pollution
- public health
- chronic rhinosinusitis
- fatty acid
- heavy metals
- metabolic syndrome
- mental health
- risk factors
- chronic obstructive pulmonary disease
- weight loss
- quality improvement
- type diabetes
- depressive symptoms
- drinking water
- health information
- soft tissue
- data analysis
- staphylococcus aureus