上海市学龄儿童过敏性疾病流行现状及相关因素分析

李荣; 陈仪婷; 吕佳骏; 黄利利; 龙姿冲; 夏缘青; 殷勇; 童世庐; 赵安达; 李生慧

doi:10.16835/j.cnki.1000-9817.2021.08.030

上海市学龄儿童过敏性疾病流行现状及相关因素分析

doi: 10.16835/j.cnki.1000-9817.2021.08.030

1.
.上海交通大学医学院公共卫生学院，200025
2.
上海交通大学医学院附属儿童医学中心呼吸科
3.
上海交通大学医学院附属儿童医学中心临床流行病学与生物统计研究室
4.
上海交通大学医学院附属第九人民医院临床营养科

基金项目:

国家自然科学基金项目 81874266

国家自然科学基金项目 81673183

上海市科学技术委员会科技创新行动计划研究专项 18411951600

详细信息

作者简介:
李荣(1997-)，男，甘肃兰州人，在读硕士，主要研究方向为儿童青少年睡眠与过敏性疾病

通讯作者:
李生慧，E-mail：lsh9907@163.com

中图分类号: R179 R725.9
计量
- 文章访问数: 861
- HTML全文浏览量: 333
- PDF下载量: 62
- 被引次数: 0
出版历程
- 收稿日期: 2021-02-01
- 修回日期: 2021-04-02
- 网络出版日期: 2021-08-20
- 刊出日期: 2021-08-25

Prevalence of allergic diseases and associated factors among school-aged children in Shanghai

1.
School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai (200025), China

摘要

摘要: 目的了解上海市学龄儿童过敏性疾病患病现状及相关影响因素，为预防儿童过敏性疾病提供参考。方法 2019年4—6月期间，在上海市开展多阶段整群抽样，共有17所小学的10 686名7~12岁学龄儿童被纳入调查。采用国际儿童哮喘和过敏研究(ISAAC)量表评估儿童过敏性疾病，采用多因素Logistic回归模型分析儿童过敏性疾病的影响因素。结果上海市学龄儿童中过敏性疾病的总体患病率为47.0%，男童(50.4%)患病率高于女童(43.3%)(χ²=54.44，P < 0.01)。常见过敏性疾病患病率为哮喘(13.9%)、过敏性鼻炎(18.2%)、特应性皮炎(34.3%)。部分儿童同时患有多种过敏性疾病。多因素Logistic回归分析结果显示，与哮喘、过敏性鼻炎、特应性皮炎3类过敏性疾病均呈正相关的因素为男童(OR值分别为1.52，1.44，1.22)、母亲学历本科及以上(OR值分别为1.26，1.77，1.84)、有过敏性疾病家族史(OR值分别为2.87，4.24，2.57)、是独生子女(OR值分别为1.16，1.28，1.22)、窗帘清洗频率 < 1次/月(OR值分别为1.41，1.79，1.77)、没有每天打扫房间(OR值分别为1.14，1.18，1.20)、粉尘暴露频率≥1次/月(OR值分别为1.45，1.56，1.42)(P值均 < 0.05)。3类过敏性疾病另存在特有的社会-环境-行为危险因素。结论上海市学龄儿童过敏性疾病患病率较高，相关影响因素涉及社会、环境和行为暴露的多个变量，值得后续深入探索。
- 过敏反应 /
- 患病率 /
- 回归分析 /
- 儿童
Abstract: Objective To examine the prevalence of allergic diseases in school-aged children from Shanghai and to explore related factors so as to produce epidemiological data regarding allergic diseases in children. Methods Multi-stage cluster sampling was used to carry out the study in Shanghai from April to June 2019. A total of 10 686 children aged 7-12 years from 17 primary schools participated in the survey. The International Study of Asthma and Allergies in Childhood (ISAAC)Scale was used to evaluate allergic diseases. Multivariate Logistic regression analysis was performed to analyze the related factors. Results The overall prevalence of allergic diseases among school-aged children in Shanghai was 47.0%. A higher prevalence was observed among boys (50.4% vs 43.3% in girls, χ²=54.44, P < 0.01). Common allergic diseases included asthma (13.9%), allergic rhinitis (18.2%), and atopic dermatitis (34.3%). The Logistic regression analysis showed that the common risk factors of asthma, allergic rhinitis and atopic dermatitis included the following: male gender (OR=1.52, 1.44, 1.22); mother has a bachelor's degree or above (OR=1.26, 1.77, 1.84); family history of allergic diseases (OR=2.87, 4.24, 2.57); only child (OR=1.16, 1.28, 1.22); curtain cleaning frequency < 1 time/month (OR=1.41, 1.79, 1.77); room not cleaned daily (OR=1.14, 1.18, 1.20); and dust exposure frequency ≥1 time/month (OR=1.45, 1.56, 1.42), all P < 0.05. These three types of allergic diseases were also associated with unique risk factors that dependent on social-environmental-behavioral factors. Conclusion Compared with previous data, the prevalence of allergic diseases among school-aged children in Shanghai increased significantly in 2019. The related influencing factors involve multiple variables including demographics, environmental exposure and behavior, which warrant further exploration.
- Anaphylaxis /
- Prevalence /
- Regression analysis /
- Child

HTML全文

表 1 不同组别上海市学龄儿童过敏性疾病患病率比较

Table 1. Comparison of the prevalence of allergic diseases in different groups of school-age children in Shanghai

性别与年龄		人数	统计值	过敏性疾病	哮喘	过敏性鼻炎	特应性皮炎	哮喘伴鼻炎	哮喘伴皮炎	鼻炎伴皮炎	同时患3类过敏性疾病
性别	男	5 581		2 813(50.4)	910(16.3)	1 202(21.5)	2 008(36.0)	419(7.5)	475(8.5)	669(12.0)	256(4.6)
	女	5 105		2 209(43.3)	576(11.3)	743(14.6)	1 657(32.5)	196(3.8)	306(6.0)	384(7.5)	119(2.3)
			χ²值	54.44	56.17	87.32	14.67	66.14	24.93	59.84	40.07
			P值	< 0.01	< 0.01	< 0.01	< 0.01	< 0.01	< 0.01	< 0.01	< 0.01
年龄/岁	7	1 761		897(50.9)	223(12.7)	304(17.3)	701(39.8)	83(4.7)	122(6.9)	181(10.3)	55(3.1)
	8	2 049		1 047(51.1)	309(15.1)	399(19.5)	766(37.4)	123(6.0)	160(7.8)	224(10.9)	80(3.9)
	9	2 070		988(47.7)	318(15.4)	388(18.7)	688(33.2)	138(6.7)	154(7.4)	188(9.1)	74(3.6)
	10	1 998		870(43.5)	269(13.5)	326(16.3)	632(31.6)	104(5.2)	144(7.2)	179(9.0)	70(3.5)
	11	1 990		865(43.5)	250(12.6)	378(19.0)	618(31.1)	122(6.1)	135(6.8)	191(9.6)	67(3.4)
	12	604		255(42.2)	84(13.9)	113(18.7)	182(30.1)	32(5.3)	46(7.6)	67(11.1)	21(3.5)
			χ²值	50.31	11.64	9.38	55.68	8.80	2.09	7.43	1.87
			P值	< 0.01	0.04	0.10	< 0.01	0.12	0.84	0.19	0.87
合计		10 686		5 022(47.0)	1 486(13.9)	1 945(18.2)	3 665(34.3)	615(5.8)	781(7.3)	1 053(9.9)	375(3.5)
注：()内数字为患病率/%。部分项目存在缺失值。

下载: 导出CSV

表 2 上海市学龄儿童过敏性疾病社会人口学特征单因素Logistic回归分析

Table 2. Univariate Logistic regression analysis of sociodemographic characteristics of allergic diseases in school-age children in Shanghai

因素	选项	人数	哮喘				过敏性鼻炎				特应性皮炎
因素	选项	人数	患病人数	患病率/%	OR值 (OR值95%CI)	P值	患病人数	患病率/%	OR值 (OR值95%CI)	P值	患病人数	患病率/%	OR值 (OR值95%CI)	P值
性别	女	5 105	576	11.3	1.00		743	14.6	1.00		1 657	32.5	1.00
	男	5 581	911	16.3	1.53(1.37~1.71)	< 0.01	1 202	21.5	1.61(1.46~1.78)	< 0.01	2 008	36.0	1.17(1.08~1.27)	< 0.01
年龄/岁	7	1 761	223	12.7	1.00		304	17.3	1.00		701	39.8	1.00
	8	2 049	309	15.1	1.22(1.02~1.48)	0.03	399	19.5	1.16(0.98~1.37)	0.08	766	37.4	0.90(0.79~1.03)	0.13
	9	2 070	318	15.4	1.25(1.04~1.51)	0.02	388	18.7	1.11(0.94~1.31)	0.24	688	33.2	0.75(0.66~0.86)	< 0.01
	10	1 998	269	13.5	1.07(0.89~1.30)	0.47	326	16.3	0.93(0.79~1.11)	0.44	632	31.6	0.70(0.61~0.80)	< 0.01
	11	1 990	250	12.6	0.99(0.82~1.20)	0.93	378	19.0	1.12(0.95~1.33)	0.17	618	31.1	0.68(0.60~0.78)	< 0.01
	12	604	84	13.9	1.10(0.84~1.44)	0.49	113	18.7	1.10(0.87~1.37)	0.42	182	30.1	0.64(0.53~0.79)	< 0.01
超重/肥胖	否	7 325	982	13.4	1.00		1 356	18.5	1.00		2 511	34.3	1.00
	是	3 147	471	15.0	1.14(1.01~1.28)	0.04	552	17.5	0.94(0.84~1.04)	0.24	1 076	34.2	1.00(0.91~1.09)	0.93
母亲学历	高中及以下	3 880	412	10.6	1.00		407	10.5	1.00		785	20.2	1.00
	本科及以上	6 806	1 074	15.8	1.58(1.40~1.78)	< 0.01	1 538	22.6	2.49(2.22~2.80)	< 0.01	2 880	42.3	2.89(2.64~3.17)	< 0.01
父亲学历	高中及以下	3 822	421	11.0	1.00		419	11.0	1.00		862	22.6	1.00
	本科及以上	6 864	1 065	15.5	1.48(1.32~1.67)	< 0.01	1 526	22.2	2.32(2.07~2.61)	< 0.01	2 803	40.8	2.37(2.17~2.59)	< 0.01
人均月收入	< 8 000	5 864	764	13.0	1.00		883	15.1	1.00		1 685	28.7	1.00
/元	≥8 000	4 822	722	15.0	1.18(1.05~1.31)	< 0.01	1 062	22.0	1.59(1.44~1.76)	< 0.01	1 980	41.1	1.73(1.59~1.87)	< 0.01
过敏性疾病家	否	8 181	830	10.1	1.00		953	11.6	1.00		2 271	27.8	1.00
族史	是	2 505	656	26.2	3.14(2.80~3.52)	< 0.01	992	39.6	4.97(4.48~5.52)	< 0.01	1 394	55.6	3.26(2.98~3.58)	< 0.01
独生子女	否	4 026	474	11.8	1.00		556	13.8	1.00		1 119	27.8	1.00
	是	6 660	1 012	15.2	1.34(1.20~1.51)	< 0.01	1 389	20.9	1.64(1.48~1.83)	< 0.01	2 546	38.2	1.61(1.48~1.75)	< 0.01
注：部分数据存在缺失值。

下载: 导出CSV

表 3 上海市学龄儿童过敏性疾病环境暴露因素单因素Logistic回归分析

Table 3. Univariate Logistic regression analysis of environmental exposure factors of allergic diseases in school-age children in Shanghai

因素	选项	人数	哮喘				过敏性鼻炎				特应性皮炎
因素	选项	人数	患病人数	患病率/%	OR值 (OR值95%CI)	P值	患病人数	患病率/%	OR值 (OR值95%CI)	P值	患病人数	患病率/%	OR值 (OR值95%CI)	P值
被动吸烟	否	4 762	610	12.8	1.00		842	17.7	1.00		1 599	33.6	1.00
	是	5 924	876	14.8	1.18(1.06~1.32)	< 0.01	1 103	18.6	1.07(0.96~1.18)	0.21	2 066	34.9	1.06(0.98~1.15)	0.16
居室墙面为乳	否	5 718	705	12.3	1.00		842	14.7	1.00		1 634	28.6	1.00
胶漆	是	4 968	781	15.7	1.33(1.19~1.48)	< 0.01	1 103	22.2	1.65(1.50~1.83)	< 0.01	2 031	40.9	1.73(1.59~1.87)	< 0.01
居室墙面为壁纸	是	2 310	265	11.5	1.00		397	17.2	1.00		704	30.5	1.00
	否	8 376	1 221	14.6	1.32(1.14~1.52)	< 0.01	1 548	18.5	1.09(0.97~1.23)	0.15	2 961	35.4	1.25(1.13~1.38)	< 0.01
窗帘清洗频率/	≥1	1 069	85	8.0	1.00		92	8.6	1.00		168	15.7	1.00
(次·月^-1)	< 1	9 617	1 401	14.6	1.97(1.58~2.49)	< 0.01	1 853	19.3	2.53(2.04~3.17)	< 0.01	3 497	36.4	3.06(2.59~3.64)	< 0.01
每天打扫房间	是	5 129	637	12.4	1.00		870	17.0	1.00		1 590	31.0	1.00
	否	5 557	849	15.3	1.27(1.14~1.42)	< 0.01	1 075	19.3	1.17(1.06~1.30)	< 0.01	2 075	37.3	1.33(1.22~1.44)	< 0.01
粉尘暴露频率/	< 1	10 074	1 370	13.6	1.00		1 789	17.8	1.00		3 417	33.9	1.00
(次·月^-1)	≥1	612	116	19.0	1.49(1.20~1.83)	< 0.01	156	25.5	1.59(1.31~1.91)	< 0.01	248	40.5	1.32(1.12~1.57)	< 0.01
是否养花	是	6 109	803	13.1	1.00		999	16.4	1.00		2 027	33.2	1.00
	否	4 577	683	14.9	1.16(1.04~1.29)	0.01	946	20.7	1.33(1.21~1.47)	< 0.01	1 638	35.8	1.12(1.04~1.22)	0.01

下载: 导出CSV

表 4 上海市学龄儿童过敏性疾病儿童行为因素单因素Logistic回归分析

Table 4. Univariate Logistic regression analysis of children's behavioral factors of allergic diseases in school-age children in Shanghai

因素	选项	人数	哮喘				过敏性鼻炎				特应性皮炎
因素	选项	人数	患病人数	患病率/%	OR值 (OR值95%CI)	P值	患病人数	患病率/%	OR值 (OR值95%CI)	P值	患病人数	患病率/%	OR值 (OR值95%CI)	P值
平均睡眠时间/	≥9	9 022	1 221	13.5	1.00		1 619	17.9	1.00		3 034	33.6	1.00
(h·d^-1)	< 9	1 664	265	15.9	1.21(1.05~1.40)	0.01	326	19.6	1.11(0.97~1.27)	0.11	631	37.9	1.21(1.08~1.34)	< 0.01
平时户外活动时间/	≥2	528	50	9.5	1.00		68	12.9	1.00		143	27.1	1.00
(h·d^-1)	< 2	10 158	1 436	14.1	1.57(1.18~2.14)	< 0.01	1 877	18.5	1.53(1.19~2.00)	< 0.01	3 522	34.7	1.43(1.18~1.74)	< 0.01
油炸食品食用频率/	< 2	9 121	1 220	13.4	1.00		1 603	17.6	1.00		2 991	32.8	1.00
(次·月^-1)	≥2	1 565	266	17.0	1.33(1.15~1.53)	< 0.01	342	21.9	1.31(1.15~1.49)	< 0.01	674	43.1	1.55(1.39~1.73)	< 0.01
海产品食用频率/	≤1	4 157	550	13.2	1.00		622	15.0	1.00		1 208	29.1	1.00
(次·周^-1)	> 1	6 529	936	14.3	1.10(0.98~1.23)	0.11	1 323	20.3	1.44(1.30~1.60)	< 0.01	2 457	37.6	1.47(1.35~1.60)	< 0.01
维生素D补充频率/	≥1	4 382	551	12.6	1.00		787	18.0	1.00		1 341	30.6	1.00
(次·周^-1)	< 1	6 304	935	14.8	1.21(1.08~1.36)	< 0.01	1 158	18.4	1.03(0.93~1.14)	0.60	2 324	36.9	1.32(1.22~1.44)	< 0.01
上网频率/	< 5	10 073	1 392	13.8	1.00		1 816	18.0	1.00		3 406	33.8	1.00
(次·周^-1)	≥5	613	94	15.3	1.13(0.90~1.41)	0.29	129	21.0	1.21(0.99~1.48)	0.07	259	42.3	1.43(1.21~1.69)	< 0.01

下载: 导出CSV

表 5 上海市学龄儿童过敏性疾病多因素Logistic回归分析[n=10 686，OR值(OR值95%CI)]

Table 5. Multivariate Logistic regression analysis of allergic diseases among school-age children in Shanghai [n=10 686, OR(OR 95%CI)]

自变量		哮喘	过敏性鼻炎	特应性皮炎
社会人口学特征	性别	1.52(1.35~1.70)^**	1.44(1.32~1.57)^**	1.22(1.12~1.33)^**
	年龄/岁
	8	1.27(1.05~1.54)^*		0.94(0.82~1.09)
	9	1.32(1.09~1.60)^**		0.77(0.67~0.89)^**
	10	1.19(0.98~1.45)		0.76(0.66~0.88)^**
	11	1.07(0.88~1.30)		0.71(0.61~0.82)^**
	12	1.18(0.90~1.56)		0.69(0.56~0.86)^**
	超重/肥胖	1.14(1.00~1.28)^*
	母亲学历	1.26(1.10~1.44)^**	1.77(1.57~1.99)^**	1.84(1.61~2.09)^**
	父亲学历		1.18(1.05~1.99)^**	1.14(1.00~1.29)^*
	人均月收入			1.15(1.05~1.27)^**
	过敏性疾病家族史	2.87(2.55~3.23)^**	4.24(3.83~4.71)^**	2.57(2.33~2.84)^**
	独生子女	1.16(1.02~1.32)^*	1.28(1.17~1.39)^**	1.22(1.11~1.34)^**
环境暴露因素	被动吸烟	1.16(1.03~1.31)^*
	居室墙面为乳胶漆		1.15(1.06~1.26)^**	1.17(1.07~1.28)^**
	居室墙面为壁纸	1.17(1.01~1.36)^*
	窗帘清洗频率	1.41(1.11~1.80)^**	1.79(1.53~2.09)^**	1.77(1.48~2.12)^**
	每天打扫房间	1.14(1.01~1.28)^*	1.18(1.08~1.28)^**	1.20(1.10~1.31)^**
	粉尘暴露频率	1.45(1.17~1.81)^**	1.56(1.30~1.87)^**	1.42(1.19~1.71)^**
	是否养花		1.19(1.09~1.29)^**	1.09(1.00~1.19)^*
儿童行为因素	平均睡眠时间			1.20(1.06~1.35)^**
	平时户外活动时间		1.26(1.06~1.57)^*
	油炸食品食用频率		1.20(1.07~1.35)^**	1.22(1.09~1.38)^**
	海产品食用频率		1.11(1.02~1.22)^*
	维生素D补充频率			1.20(1.10~1.31)^**
注： * P < 0.05，** P < 0.01。

下载: 导出CSV

参考文献(38)

[1]	FUCHS O, BAHMER T, RABE K F, et al. Asthma transition from childhood into adulthood[J]. Lancet Respir Med, 2017, 5(3): 224-234. doi: 10.1016/S2213-2600(16)30187-4
[2]	WEIDINGER S, NOVAK N. Atopic dermatitis[J]. Lancet, 2016, 387(10023): 1109-1122. doi: 10.1016/S0140-6736(15)00149-X
[3]	GBD 2016 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016[J]. Lancet, 2017, 390(10100): 1211-1259. http://eprints.soton.ac.uk/421542/
[4]	HUANG S, GARSHICK E, WESCHLER L B, et al. Home environmental and lifestyle factors associated with asthma, rhinitis and wheeze in children in Beijing, China[J]. Environ Pollut, 2020, 256: 113426. doi: 10.1016/j.envpol.2019.113426
[5]	张寅平, 李百战, 黄晨, 等. 中国10城市儿童哮喘及其他过敏性疾病现状调查[J]. 科学通报, 2013, 58(25): 2504-2523. https://www.cnki.com.cn/Article/CJFDTOTAL-KXTB201325002.htm ZHANG Y P, LI B Z, HUANG C, et al. Ten cities cross-sectional questionnaire survey of children asthma and other allergies in China[J]. Chin Sci Bull, 2013, 58(25): 2504-2523. https://www.cnki.com.cn/Article/CJFDTOTAL-KXTB201325002.htm
[6]	LI F, ZHOU Y, LI S, et al. Prevalence and risk factors of childhood allergic diseases in eight metropolitan cities in China: a multicenter study[J]. BMC Public Health, 2011, 11(1): 437-437. doi: 10.1186/1471-2458-11-437
[7]	中华人民共和国国家卫生和计划生育委员会. 学龄儿童青少年超重与肥胖筛查WS/T 586—2018[S]. 2018-08-01. National Health and Family Planning Commission of the People's Republic of China. Screening for overweight and obesity among school-age children and adolescents WS/T 586-2018[S]. 2018-08-01.
[8]	ASHER M I, KEIL U, ANDERSON H R, et al. International Study of Asthma and Allergies in Childhood (ISAAC): rationale and methods[J]. Eur Respir J, 1995, 8(3): 483-491. doi: 10.1183/09031936.95.08030483
[9]	NWARU B I, LUMIA M, KAILA M, et al. Validation of the Finnish ISAAC questionnaire on asthma against anti-asthmatic medication reimbursement database in 5-year-old children[J]. Clin Respir J, 2011, 5(4): 211-218. doi: 10.1111/j.1752-699X.2010.00222.x
[10]	BORNEHAG C G, SUNDELL J, SIGSGAARD T. Dampness in Buildings and Health (DBH): report from an ongoing epidemiological investigation on the association between indoor environmental factors and health effects among children in Sweden[J]. Indoor Air, 2004, 14(7): 59-66.
[11]	李生慧, 金星明, 沈晓明, 等. 儿童睡眠习惯问卷中文版制定及测量性能考核[J]. 中华儿科杂志, 2007, 45(3): 176-180. doi: 10.3760/j.issn:0578-1310.2007.03.005 LI S H, JIN X M, SHENG X M, et al. Development and psychometric properties of the Chinese Version of Children's Sleep Habits Questionnaire[J]. Chin J Pediatr, 2007, 45(3): 176-180. doi: 10.3760/j.issn:0578-1310.2007.03.005
[12]	肖惠迪, 书文, 李梦龙, 等. 中国2011—2018年儿童哮喘患病率Meta分析[J]. 中国学校卫生, 2020, 41(8): 1208-1211. doi: 10.16835/j.cnki.1000-9817.2020.08.023 XIAO H D, SHU W, LI M L, et al. Prevalence of childhood asthma in China from 2011 to 2018: a Meta-analysis[J]. Chin J Sch Health, 2020, 41(8): 1208-1211. doi: 10.16835/j.cnki.1000-9817.2020.08.023
[13]	CHONG S N, CHEW F T. Epidemiology of allergic rhinitis and associated risk factors in Asia[J]. World Aller Organ J, 2018, 11(1): 17. doi: 10.1186/s40413-018-0198-z
[14]	HASPESLAGH E, HEYNDRICKX I, HAMMAD H, et al. The hygiene hypothesis: immunological mechanisms of airway tolerance[J]. Curr Opin Immunol, 2018, 54: 102-108. doi: 10.1016/j.coi.2018.06.007
[15]	SCHUIJS M J, WILLART M A, VERGOTE K, et al. Farm dust and endotoxin protect against allergy through A20 induction in lung epithelial cells[J]. Science, 2015, 349(6252): 1106-1110. doi: 10.1126/science.aac6623
[16]	SANDFORD A, WEIR T, PARÉ P. The genetics of asthma[J]. Am J Respir Crit Care Med, 1996, 153(6): 1749-1765. doi: 10.1164/ajrccm.153.6.8665031
[17]	DENG X, MA J, YUAN Y, et al. Association between overweight or obesity and the risk for childhood asthma and wheeze: an updated meta-analysis on 18 articles and 73252 children[J]. Pediatr Obes, 2019, 14(9): e12532. http://www.ncbi.nlm.nih.gov/pubmed/31033249
[18]	KIM B J, LEE S Y, KIM H B, et al. Environmental changes, microbiota, and allergic diseases[J]. Aller Asthm Immunol Res, 2014, 6(5): 389-400. doi: 10.4168/aair.2014.6.5.389
[19]	FELESZKO W, RUSZCZYńSKI M, JAWORSKA J, et al. Environmental tobacco smoke exposure and risk of allergic sensitisation in children: a systematic review and meta-analysis[J]. Arch Dis Child, 2014, 99(11): 985-992. doi: 10.1136/archdischild-2013-305444
[20]	STRZELAK A, RATAJCZAK A, ADAMIEC A, et al. Tobacco smoke induces and alters immune responses in the lung triggering inflammation, allergy, asthma and other lung diseases: a mechanistic review[J]. Int J Environ Res Public Health, 2018, 15(5): 1033. doi: 10.3390/ijerph15051033
[21]	WANG B, CHEN H, CHAN Y L, et al. Why do intrauterine exposure to air pollution and cigarette smoke increase the risk of asthma?[J]. Front Cell Dev Biol, 2020, 8: 38.
[22]	ZHUGE Y, QIAN H, ZHENG X, et al. Residential risk factors for childhood pneumonia: a cross-sectional study in eight cities of China[J]. Environ Int, 2018, 116: 83-91. doi: 10.1016/j.envint.2018.03.022
[23]	VARDOULAKIS S, GIAGLOGLOU E, STEINLE S, et al. Indoor exposure to selected air pollutants in the home environment: a systematic review[J]. Int J Environ Res Public Health, 2020, 17(23): 8972. doi: 10.3390/ijerph17238972
[24]	MENG J F, ROSENWASSER L J. Unraveling the genetic basis of asthma and allergic diseases[J]. Aller Asthm Immunol Res, 2010, 2(4): 215-227. doi: 10.4168/aair.2010.2.4.215
[25]	CUI X, LI Z, TENG Y, et al. Association between bedroom particulate matter filtration and changes in airway pathophysiology in children with asthma[J]. JAMA Pediatr, 2020, 174(6): 533-542.
[26]	JERNELÖV S, LEKANDER M, ALMQVIST C, et al. Development of atopic disease and disturbed sleep in childhood and adolescence-a longitudinal population-based study[J]. Clin Exp Aller, 2013, 43(5): 552-559.
[27]	BAKOUR C, SCHWARTZ S W, WANG W, et al. Sleep duration patterns from adolescence to young adulthood and the risk of asthma[J]. Ann Epidemiol, 2020, 49: 20-26. doi: 10.1016/j.annepidem.2020.07.003
[28]	KOZYRSKYJ A L, KENDALL G E, ZUBRICK S R, et al. Frequent nocturnal awakening in early life is associated with nonatopic asthma in children[J]. Eur Respir J, 2009, 34(6): 1288-1295. http://www.europepmc.org/abstract/MED/19948910
[29]	IRWIN M R, OLMSTEAD R, CARROLL J E. Sleep disturbance, sleep duration, and inflammation: a systematic review and meta-analysis of cohort studies and experimental sleep deprivation[J]. Biol Psychiatry, 2016, 80(1): 40-52. http://europepmc.org/articles/pmc4666828
[30]	BESEDOVSKY L, LANGE T, HAACK M. The sleep-immune crosstalk in health and disease[J]. Physiol Rev, 2019, 99(3): 1325-1380. http://www.ncbi.nlm.nih.gov/pubmed/30920354
[31]	KUBO M. Innate and adaptive type 2 immunity in lung allergic inflammation[J]. Immunol Rev, 2017, 278(1): 162-172. http://www.ncbi.nlm.nih.gov/pubmed/28658559
[32]	HUANG Y S, GUILLEMINAULT C, HWANG F M, et al. Inflammatory cytokines in pediatric obstructive sleep apnea[J]. Medicine (Baltimore), 2016, 95(41): e4944. http://www.ncbi.nlm.nih.gov/pubmed/27741107
[33]	CEPEDA A M, THAWER S, BOYLE R J, et al. Diet and respiratory health in children from 11 Latin American Countries: evidence from ISAAC Phase Ⅲ[J]. Lung, 2017, 195(6): 683-692. doi: 10.1007/s00408-017-0044-z
[34]	KIM S Y, SIM S, PARK B, et al. High-fat and low-carbohydrate diets are associated with allergic rhinitis but not Asthma or atopic dermatitis in children[J]. PLoS One, 2016, 11(2): e0150202. http://europepmc.org/articles/PMC4769275/
[35]	SIMPSON R J, CAMPBELL J P, GLEESON M, et al. Can exercise affect immune function to increase susceptibility to infection?[J]. Exerc Immunol Rev, 2020, 26: 8-22.
[36]	LAMBRECHT B N, HAMMAD H. The immunology of the allergy epidemic and the hygiene hypothesis[J]. Nat Immunol, 2017, 18(10): 1076-1083. http://europepmc.org/abstract/MED/28926539
[37]	PRESTER L. Seafood allergy, toxicity, and intolerance: a review[J]. J Am Coll Nutr, 2016, 35(3): 271-283. http://www.ncbi.nlm.nih.gov/pubmed/26252073
[38]	KIM M J, KIM S N, LEE Y W, et al. Vitamin D status and efficacy of vitamin d supplementation in atopic dermatitis: a systematic review and meta-analysis[J]. Nutrients, 2016, 8(12): 789. http://europepmc.org/articles/PMC5188444/