A modern epidemic现代流行病

A modern epidemic现代流行病

The first indication that something was not quite right with Matteo came when he was 1 month old:oozing skin rash on his face.Over the next few months it got so bad that his skin lesions weren’t healing properly .”Instead of oohing and aahing over my baby,people were disgusted”,says his mom,Cristina.At 5 months,doctors ran some tests and found that Mateo was among the 6 to 8 percent of children under the age of 3 with an allergy to food-in this case,breast milk.His mother put him on soy milk,but after a few months the skin rashes returned,and Meatteo began vomiting.His doctors put him on a predigested chemical milk made from amino acids.Now 2 and a half,Matteo is allergic to tomatoes,many vegetables and can’t even touch milk.Doctors haven’t made any promises,but when Matteo turns 5 they plan to administrer a controlled test of his allergic response to milk and other substances.They are hoping he simply outgrows his allergies.

第一次察觉到马特奥不太对劲是他1个月大的时候：他的脸上渗出了皮疹。在接下来的几个月里，情况变得非常糟糕，以至于他的皮损无法正常愈合。他的妈妈克里斯蒂娜说：“人们没有为我的孩子感到惊讶和同情，它们反而感到厌恶。”5个月大的时候，医生做了一些测试，发现马特奥是6 - 8%对食物过敏的3岁以下儿童之一——在这个例子中，食物过敏是母乳。他的母亲给他喝了豆奶，但几个月后，他的皮疹复发，马特奥开始呕吐。医生给他喝了一种由氨基酸制成的化学牛奶。现在两岁半了，马特奥对西红柿和许多蔬菜过敏，甚至不能接触牛奶。医生们还没有做出任何承诺，但当马特奥5岁时，他们计划对他的牛奶和其他物质过敏进行一项对照实验，希望他能摆脱过敏症状。

Implausible as it seems,Matteo’s condition is at the cutting edge of modern pediatric medicine,right up there with hay fever.If a popular magazine had run a children’s health issue a hundred years ago,the first article might have been about diphtheria or cholera-external threats that the West has largely conquered by antibiotics and sanitation.Instead we are examining allergies,a self-generated danger,the result of an immune system out of sync with its surroundings.It’s a threat that may in part be an unintended consequence of our triumph over the infectious scourges of the past.And the urgency is growing .All allergies seem to be on the rise,in fact,but “it’s not just that more kids have allergies”,says Dr.Marc,director of allergy and immunology at hospital.The severity of those allergies has also increased.

虽然听起来难以置信，但马特奥的病情处于现代儿科医学的前沿，与花粉热不相上下。如果一百年前一本流行杂志刊登儿童健康问题，第一篇文章可能是关于白喉或霍乱--西方在很大程度上通过抗生素和消毒克服了外部威胁。相反，我们正在研究过敏，这是一种自我产生的危险，是免疫系统与周围环境不同步的结果。这一威胁在一定程度上可能是我们战胜过去传染病的意外后果。而且这种威胁的紧迫性正在增加。事实上，所有过敏似乎都是在增加，但“不仅仅是更多的孩子有过敏症”，医院过敏和免疫学主任马克博士说，这些过敏症的严重程度也在增加。

An allergy is an overreaction by the immune system to a foreign substance.According to the Food Allergy ,almost any food can trigger an allergy,although eight categories account for 90 percent of all reactions:milk,eggs, peanuts(technically,a legume),tree nuts,fin fish,shellfish,soy and wheat .For reasons not fully understood ,in some people these otherwise harmless substances provoke the same reactions by which the body attempts to rid itself of dangerous pathogens.These may include sneezing,vomiting and the all-purpose localized immune-system arousal known as inflammation .The lungs may affected;allergies are a leading trigger for asthma attacks.In extreme cases,the reaction involves virtually all organ systems and proceed to anaphylaxis ,a dramatic drop in blood pressure accompanied by extreme respiratory distress that may be fatal without prompt treatment.

过敏是免疫系统对外来物质的过度反应。根据《食物过敏》，几乎任何食物都能引发过敏，尽管有八类食物占所有反应的90%:牛奶、鸡蛋、花生(严格来说，是一种豆类)、树坚果、鳍鱼、贝类、大豆和小麦。由于不完全了解的原因，在一些人身上，这些原本无害的物质引发了身体试图清除危险病原体的相同反应。这些症状可能包括打喷嚏、呕吐和被称为炎症的通用局部免疫系统亢奋。肺部可能受到影响;过敏是哮喘发作的主要诱因.在极端情况下，反应几乎涉及所有器官系统，并发展为过敏反应，血压急剧下降，伴有严重的呼吸窘迫，如果不及时治疗，可能会致命。

What can underlie such a self-destructive reaction?An infant who grows violently ill in the presence of as little as one hundredth of a peanut almost surely has some sort of genetic predisposition.Indeed,if one parent has an allergy ,chances are one in three that the child will be allergic,according to the Asthma and Allergy Foundation of America,If both parents have allergies,the odds rise to 70 percent.But the children aren’t necessarily allergic to the same things as the parents-strongly suggesting that some other factors must be at work as well.And genetics cannot explain the rapid rise in allergies over the past few years or for that matter,centuries.

是什么导致了这种自我毁灭的反应？一个婴儿哪怕在只有百分之一颗花生的情况下严重生病，几乎肯定有某种遗传倾向。事实上，根据美国哮喘和过敏基金会的数据，如果父母一方过敏，三分之一的孩子会过敏，如果父母双方都过敏，几率上升到70%。但是孩子不一定和父母一样过敏--这强烈表明一定还有其他一些因素在起作用。在过去几年甚至几个世纪遗传学不能解释过敏的快速上升 。

So something must have changed in the environment.One obvious place to look is air pollution.Studies by Dr Saxon,chief of a clinical immunology at UCLA,and his colleague David,have found a strong correlation between pollutants-diesel exhaust and cigarette smoke-and the development of allergies.Researchers don’t believe pollution is the whole story,though;allergies have continued to climb even as smoking and air-pollution rates have fallen.But industrialization has also brought about declines in infectious diseases and close exposure to farm animals.The “hygiene hypothesis” holds that these trends have contributed to the rise in allergies.The human immune system,which evolved in a natural environment teeming with hostile bacteria and parasites,finds itself uncomfortably idle in the antiseptic confines of the modern suburb,and failing to mature properly takes out its frustration on harmless peanuts and shrimp.Numerous studies have lent support to this general notion.But although many researchers accept the hygiene hypothesis in outline,the emerging picture is of a complicated relationship,where does and timing of exposure play important but still uncertain roles,say Dr Scott .

所以环境一定发生了什么变化。一个显而易见的地方是空气污染。加州大学洛杉矶分校临床免疫学主任博士和他的同事大卫的研究发现，污染物--柴油尾气和香烟烟雾--与过敏的发展之间存在很强的相关性。然而，研究人员并不认为污染就是事情的全部；尽管吸烟和空气污染率下降，过敏症仍在继续攀升。但工业化也带来了传染病的减少和与农场动物的近距离接触。“卫生假说”认为这些趋势导致了过敏的增加。人类免疫系统在充满自然环境的环境中进化 与敌对的细菌和寄生虫一起，它发现自己不适地闲置在现代郊区的消毒围墙内，未能适当成熟,只得在无害的花生和虾上发泄它的挫败感。许多研究支持了这一普遍观点。斯科特博士说，尽管许多研究人员初步接受了卫生假说，但新出现的图景是一种复杂的关系， 暴露在何处以及暴露的时间起着重要作用，但仍不确定。

So the hygiene hypothesis has yet to generate any concrete prescriptions.The eventual hope is for a way to artificially stimulate the immune system to reduce allergy risk without having all these diseases .Meanwhile,though,researchers are developing new drug therapies that go beyond epinephrine (for emergency treatment of anaphylaxis) and the growing array over-the-counter antihistamines(Histamine is a key substance in the cascade of biochemical events that constitute an allergic reaction).Newer drugs ,like Singulair in the chain.

因此，卫生假说还没有产生任何具体的处方。最终的希望是找到一种人为刺激免疫系统的方法，以降低过敏风险，而不发生所有这些疾病。然而，与此同时，研究人员正在开发新的药物疗法，超越肾上腺素（用于过敏反应的紧急治疗）和越来越多的非处方药抗组胺药（组胺是构成过敏反应的一连串生化事件中的关键物质）。更新的药物，如比如链中的Singulair。

Pediatricians have also begun taking allergies more seriously.One key bit of advice to mothers is to breast-feed infants exclusively for six months.Delaying children’s exposure to novel foods in this way is the hallmark for food-allergy prevention,says the American Academy of Pediatrics.once an allergy has been diagnosed,the only thing to do is draw a cordon sanitaire around the child .Susan is allergic to milk products,eggs,fish,nuts and mustard,goes so far as to check out school art supplies;a fourth-grade teacher once mentioned adding eggs to tempera paint for a better texture.Thanks to her vigilance ,her home-cooked and prefrozen meals and New York’s ubiquitous fruit and vegetable markets,David is a healthy,normal boy,an avid skier ——and alive

儿科医生也开始更加认真地对待过敏。给母亲的一个关键建议是六个月内完全母乳喂养婴儿。美国儿科学会说，以这种方式推迟孩子接触新奇食物是预防食物过敏的标志。一旦诊断出过敏，唯一能做的就是在孩子周围画一条警戒线。苏珊对奶制品、鸡蛋、鱼、坚果和芥末过敏，甚至去检查学校的美术用品；一位四年级老师曾经提到，为了更好的纹理，在坦培拉油漆中添加鸡蛋。多亏了她的警惕，她的家常菜和预冷冻餐 在纽约无处不在的水果和蔬菜市场，大卫是一个健康、正常的男孩，一个狂热的滑雪者--而且活着 。