The hygiene theory: Fact or fiction?

Current Opinion in Otolaryngology and Head and Neck Surgery

Volumn 12, Issue 3, 2004, Pages 232-236

  Sheikh, Aziz ^a   Strachan, David P ^b  

^a UNIVERSITY OF EDINBURGH   (United Kingdom)

^b ST GEORGE'S UNIVERSITY OF LONDON   (United Kingdom)

Author keywords

Allergy; Atopy; Birth order; Hygiene hypothesis; Infection

Indexed keywords

CYTOKINE; PROBIOTIC AGENT;

ALLERGY; ATOPIC DERMATITIS; ATOPY; BIRTH ORDER; ENDEMIC DISEASE; HELICOBACTER INFECTION; HELICOBACTER PYLORI; HEPATITIS A; HUMAN; HYGIENE; INTESTINE FLORA; MONONUCLEAR CELL; PRIORITY JOURNAL; REVIEW; RISK REDUCTION; SOCIAL STATUS; TH1 CELL; TH2 CELL; TOXOPLASMOSIS;

ADULT; BIRTH ORDER; CAUSALITY; CHILD; CHILD, PRESCHOOL; COMMUNICABLE DISEASE CONTROL; ENVIRONMENTAL EXPOSURE; GASTROINTESTINAL TRACT; HUMANS; HYGIENE; HYPERSENSITIVITY; INFANT; INFANT, NEWBORN; PROBIOTICS; RISK FACTORS; SOCIOECONOMIC FACTORS;

EID: 2542424155     PISSN: 10689508     EISSN: None     Source Type: Journal    
DOI: 10.1097/01.moo.0000122311.13359.30     Document Type: Review

References (31)

1. UCB Institute of Allergy: European Allergy White Paper: Allergic Diseases as a Public Health Problem, Braine-l'Alleud: UCB Institute of Allergy; 1997.
2. Wright RJ, Weiss ST: Epidemiology of allergic disease. In Allergy, edn 2. Edited by Holgate ST, Church MK, Lichtenstein LM. London: Mosby; 2001:202-212.
3. International Study of Asthma and Allergies in Childhood: worldwide variation in prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and atopic eczema. ISAAC. Lancet 1998, 351:1225-1232.
4. European Community Respiratory Health Survey: variations in the prevalence of respiratory symptoms, self-reported asthma attacks, and use of asthma medication in the European Community Health Survey (ECRHS). Eur Respir J 1996, 9:687-695.
5. Strachan DP: Hay fever, hygiene and household size. BMJ 1989, 299:1259-1260.
6. Mossman TR, Coffman RL: Th1 and Th2 cells: different patterns of lymphokine secretion lead to different functional properties. Annu Rev Immunol 1989, 7:145-173.
7. Von Hertzen LC: The hygiene hypothesis in the development of atopy and asthma-still a matter of controversy? Q J Med 1998, 91:767-771.
8. Rao A, Avni O: Molecular aspects of T-cell differentiation. Br Med Bull 2000, 56:969-984.
9. Strachan DP: Family size, infection and atopy: the first decade of the "hygiene hypothesis." Thorax 2000, 55:S2-S10.
10. Da Costa Lima R, Victora CG, Menezes AM, et al.: Do risk factors for childhood infections and malnutrition protect against asthma? A study of Brazilian male adolescents. Am J Public Health 2003, 93:1858-1864.
11. Matricardi PM, Rosmini F, Ferrigno L, et al.: Cross-sectional retrospective study of prevalence of atopy among Italian military students with antibodies against hepatitis A virus. BMJ 1997, 314:999-1003.
12. Matricardi PM, Rosmini F, Riondino S, et al.: Exposure to food-borne and orofaecal microbes versus airborne viruses in relation to atopy and allergic asthma: epidemiological study. BMJ 2000, 320:412-417.
13. Kosunen TU, Hook-Nikanne J, Salomaa A, et al.: Increase of allergen-specific immunoglobulin E antibodies from 1973 to 1994 in a Finnish population and a possible relationship to Helicobacter pylori infections. Clin Exp Allergy 2002, 32:373-378.
14. Yazdanbakhsh M, Kremsner PG, van Ree R: Allergy, parasites, and the hygiene hypothesis. Science 2002, 296:490-494.
15. Uter W, Stock C, Pfahlberg A, et al.: Association between infections and signs and symptoms of 'atopic' hypersensitivity-results of a cross-sectional survey among first-year university students in Germany and Spain. Allergy 2003, 58:580-584. This is a large cross-sectional survey.
16. Linneberg A, Ostergaard C, Tvede M, et al.: IgG antibodies against microorganisms and atopic disease in Danish adults: the Copenhagen Allergy Study. J Allergy Clin Immunol 2003, 111:847-853. This is a large population-based cross-sectional study of 8000 adult Danes.
17. Cooper PJ, Chico ME, Rodrigues LC, et al.: Reduced risk of atopy among school-age children infected with geohelminth parasites in a rural area of the tropics. J Allergy Clin Immunol 2003, 111:995-1000. This is an analytic cross-sectional study of 2865 children from rural Ecuador.
18. Medeiros M Jr, Figueiredo JP, Almeida MC, et al.: Schistosoma mansoni infection is associated with a reduced course of asthma. J Allergy Clin Immunol 2003, 111:947-951.
19. Bjorksten B, Sepp E, Julge K, et al.: Allergy development and the intestinal micro-flora during the first year of life. J Allergy Clin Immunol 2001, 108:516-520.
20. Watanabe S, Narisawa Y, Arase S, et al.: Differences in faecal micro-flora between patients with atopic dermatitis and healthy control subjects. J Allergy Clin Immunol 2003, 111:587-591.
21. Karlsson H, Hessle C, Rudin A: Innate immune responses of human neonatal cells to bacteria from the normal gastrointestinal flora. Infect Immunol 2002, 70:6688-6696.
22. Kalliomaki M, Salminen S, Arvilommi H, et al.: Probiotics in primary prevention of atopic disease: a randomised placebo-controlled trial. Lancet 2001, 357:1076-1079.
23. Hattori K, Yamamoto A, Sasai M, et al.: Effects of administration of bifidobacteria on faecal micro-flora and clinical symptoms in infants with atopic dermatitis. Arerugi 2003, 52:20-30. This was a controlled clinical trial, but it is unclear whether this was a randomized or blinded study, raising an appreciable risk of bias.
24. Godfrey KM, Barker DJP, Osmond C: Disproportionate fetal growth and raised IgE concentration in adult life. Clin Exp Allergy 1994, 24:641-648.
25. Benn CS, Jeppesen DL, Hasselbalch H, et al.: Thymus size and head circumference at birth and the development of allergic diseases. Clin Exp Allergy 2001, 31:1862-1866.
26. Katz KA, Pocock SJ, Strachan DP: Neonatal head circumference, neonatal weight, and risk of hayfever, asthma and eczema in a large cohort of adolescents from Sheffield, England. Clin Exp Allergy 2003, 33:737-745.
27. Shirakaw T, Enomoto T, Shimazu S, et al.: The inverse relationship between tuberculin responses and atopic disorder. Science 1997, 275:77-79.
28. Hartung AD, Bohnert A, Hackstein H, et al.: Th2-mediated atopic disease protection in Th1-mediated rheumatoid arthritis. Clin Exp Rheumatol 2003, 21:481-484.
29. Sheikh A, Smeeth L, Hubbard R: There is no evidence of an inverse relationship between Th2-mediated atopy and Th1-mediated autoimmune disorders: lack of support for the hygiene hypothesis. J Allergy Clin Immunol 2003, 111:131-135. This is a large, cross-sectional analytic study of a nationally representative sample of US adults.
30. Liu AH, Murphy JR: Hygiene hypothesis: factor fiction? J Allergy Clin Immunol 2003, 111:471-478. This is a systematic epidemiologic critique of the literature examining whether a causal relationship exists between improved hygiene and risk of atopy.
31. Tedeschi A, Airaghi L: Common risk factors in type 1 diabetes and asthma. Lancet 2001, 357:1622.