As we close out the most incredible year in most of our memories, we reflect back on the challenges that this year has produced for many of us – personal or family health issues, impact on our patients, practices and business, a totally virtual annual meeting for the first time, and continued uncertainty about the future of this pandemic. If you are anything like me, there is a strong desire to escape – yet life does not allow that. Great reassurance can come from surrounding ourselves with people (at a safe distance of course) or things that are familiar and comforting to us and that challenge us to look ahead to the time when this pandemic is no longer the centerpiece of our existence. In that context, I offer the December issue of the Annals of Allergy, Asthma and Immunology.
This month’s focus is on a “new field” called exposomics, which is a systematic study of the impact of environmental exposures on health and disease. I put the new field phrase in quotes because this is, of course, not new at all to allergists-immunologists. We have been taking careful environmental and exposure histories for decades. It is central to our practices. Yet the science behind linking exposures to disease is growing steadily in many exciting ways that offer improved opportunities for diagnosis and more effective therapies for our patients. Additionally, tracing impact of environmental exposures back to the earliest parts of life (even in utero) offers a hope to actually prevent, rather than just treat, allergic and immune diseases.
There are several articles that should command your interest. One is our CME article from Gurjit K. Khurana Hershey, MD, and colleagues that describes the impact of the skin microbial exposome on the development of allergic diseases. Homeostasis between the commensal microbiome and the epidermis is important in protecting against allergic disease. Commensals promote anti-allergic Th1 and Th17 immunophenotypes within the skin and induce keratinocytes to secrete antimicrobial peptides and alarmins that enhance barrier function and antagonize pro-allergic organisms. Perturbations in this homeostasis, however, are associated with allergic disease development. For example, atopic dermatitis is associated with decreases in skin commensals and increases in the pathogen Staphylococcus aureus. This article provides great context for the valuable role of systemic study of the exposome in susceptible patients.
On behalf of the editors and staff of the Annals, I want to wish all of you a very Merry Christmas and a happy holiday season. I hope you can spend some time (even virtually) with friends and loved ones as we look ahead to a better year in 2021.
Gailen D. Marshall, Jr., MD, PhD, FACAAI