家戶燃香對嬰兒期異位性皮膚炎之影響

Abstract

異位性皮膚炎在現代工業化國家中發生率逐漸增加，並且有許多研究結果認為，空氣汙染物包含懸浮顆粒，有機揮發物，運輸燃料相關的廢氣，香煙等，皆與異位性皮膚炎有關。在台灣，宗教信仰相關的燃香、燒金紙與放鞭炮是特殊的空氣汙染議題，由於公眾對空氣品質和環境保護的重視，寺廟逐漸禁止燃香或減少香支使用。許多地方政府部門也禁止燒金紙和鞭炮。然而，未被法令規範的家戶燃香與異位性皮膚炎的相關性則尚未有詳細的文獻探討。 臺灣出生世代研究計畫(TBCS)為台灣第一個大規模田野世代追蹤調查。將臺灣2005年全年度的活產嬰兒隨機抽樣24,200個調查樣本，持續追蹤其情形至今。本研究將以此計畫出生後6個月及出生後18個月的結構化問卷調查結果作基礎，以出生後6個月時家戶燃香作為暴露因子，出生後18月才診斷有異位性皮膚炎作為疾病結果，並將完全無家戶燃香族群設為參考組，進行簡單和多次邏輯式回歸分析計算粗勝算比與調整後勝算比。 本研究共納入了14,829個案數。家戶內空氣影響因子，除了燃香煙霧，另有飼養寵物、壁癌、油漆、殺蟲劑、二手菸、母親抽菸等因素，這些因素彼此或與家戶燃香之間皆為低相關性。由無校正任何干擾因子開始，逐漸校正各項模型並得到調整後勝算比。對照雙親原有疾病，懷孕期間的環境，本研究結果顯示，家戶燃香並非異位性皮膚炎加重因子。 燃香不會加重異位性皮膚炎的原因可能來自於衛生假說與不夠精確的暴露量及疾病評估。燃香與起居區域是否分隔無法確認；每位醫師的嬰兒期異位性皮膚炎診斷標準莫衷一是，更不用提症狀嚴重度的客觀評估。然而要在如此全國規模的世代追蹤中進行仔細且精準的評估相當困難。總而言之，燃香在台灣及其他亞洲地區是個特殊的議題，本篇研究中發現台灣的家戶燃香對嬰兒期異位性皮膚炎並無加重情形。家戶燃香與異位性皮膚炎之間的相關性需要更多的文獻與世代研究後續追蹤來證實。

The incidence of atopic dermatitis is increasing in modern industrialized countries, and there have been many research results indicating that air pollution, including suspended particles, organic volatiles, transportation fuel-related exhaust gas, cigarettes, etc. are different Related to dermatitis. Except industrial waste gas, transportation and industrial fuel products, the burning of religious beliefs, burning gold paper, and setting off firecrackers also belong to local air pollution factors in Taiwan,. In recent years, due to the public’s demand to improve air quality and protect the environment temples in Taiwan were gradually called for reducing or extinguishing incense burning. The burning of gold paper and firecrackers have also been restricted by many local government departments. In order to evaluate the relation between household incense burning and the increasing occurrence of atopic dermatitis, TBCS, a large-scale cohort study in Taiwan is analyzed. This research is based on the 6 -month and 18 -month follow-up cohort cases. Control-Parental health conditions, conditions during pregnancy, infant birth outcomes, and other demographic factors were obtained by home interview with structured questionnaires. It is intended to use 6-month household incense burning as an exposure factor, and 18-month atopic dermatitis diagnosis as a possible result. Simple and multiple logistic regressions were performed to calculate the crude and adjusted odds ratios. The group that has no household incense burning is used as a reference group. A total of 14,829 samples were analyzed in this study. In-house air pollution factors, in addition to household incense burning, there are other factors such as pets, moldy wall(s), paint usage, pesticides usage, second-hand smoke, and maternal smoking. There is low correlation between each other or with household incense burning. The crude and adjusted odds ratios for atopic dermatitis are evaluated. Starting with no adjust model, gender and parity correction, family history of atopic dermatitis, maternal socioeconomic status and behavioral patterns, maternal smoking or secondhand smoke exposure, indoor mold, pet and pesticide exposure, urbanicity and traditional medicine use, are all adjusted. From above analysis, the household incense burning is not an aggravating factor for atopic dermatitis. The reason for this may come from the hygiene hypothesis or incomplete exposure and outcome evaluation. Whether the living area settings are divided could not be assured. The infantile atopic dermatitis diagnostic criteria could not be unified of each physician, neither. Not to mention the symptoms severity was difficult to be evaluated. However, it is hard to perform dedicated investigation in such nation-wide survey. In summary, incense burning is a special issue in Taiwan and other Asian regions, and this study found that household incense burning in Taiwan did not aggravate atopic dermatitis in infants. The correlation between household Incense burning on atopic dermatitis or other atopic disease needs further research and cohort follow-up to investigate.