Respiratory Flora Intervention: A New Strategy for the Prevention and Treatment of Occupationally Related Respiratory Allergy in Healthcare Workers

Abstract

Occupational allergic respiratory disease in healthcare workers due to occupational exposure has received widespread attention. At the same time, evidence of altered respiratory flora associated with the development of allergy has been found in relevant epidemiologic studies. It is of concern that the composition of nasopharyngeal flora in healthcare workers differs significantly from that of non-healthcare workers due to occupational factors, with a particularly high prevalence of carriage of pathogenic and drug-resistant bacteria. Recent studies have found that interventions with upper respiratory tract probiotics can significantly reduce the incidence of respiratory allergies and infections. We searched PubMed and other databases to describe the burden of allergic respiratory disease and altered respiratory flora in healthcare workers in this narrative review, and we summarize the mechanisms and current state of clinical research on the use of flora interventions to ameliorate respiratory allergy, with the aim of providing a new direction for protecting the respiratory health of healthcare workers.

Keywords: flora interventions; healthcare workers; occupational allergic respiratory diseases; occupational exposure.

Figure 1

Dysbiosis of the nasal flora can induce allergic respiratory diseases. In dysbiosis, pathogenic bacteria cause airway inflammation and, together with respiratory viruses, lower respiratory tract infections. Occupational allergen exposure increases the body’s susceptibility to pathogens, and continued exposure can lead to airway inflammation or even induce respiratory allergies.

Figure 2

Differences in the composition of the upper respiratory tract flora in asthmatics and healthy individuals. In the upper airways of healthy individuals, all genera were at normal levels; in the upper airways of asthmatics, Haemophilus and Moraxella were elevated, whereas the levels of commensal bacteria were reduced, such as Mogibacteriaceae.

Figure 3

Mechanisms of probiotic-assisted treatment of respiratory allergy. Firstly, probiotics directly compete with pathogens for nutrients and space and inhibit pathogen colonization of epithelial cells. Secondly, it regulates mucosal immunity and promotes secretion of antimicrobial peptides and interferon by immune cells. Thirdly, it enhances innate and adaptive immunity in the lungs.