Too clean, or not too clean: the Hygiene Hypothesis and home hygiene

Abstract

Summary The ‘hygiene hypothesis’ as originally formulated by Strachan, proposes that a cause of the recent rapid rise in atopic disorders could be a lower incidence of infection in early childhood, transmitted by unhygienic contact with older siblings. Use of the term ‘hygiene hypothesis’ has led to several interpretations, some of which are not supported by a broader survey of the evidence. The increase in allergic disorders does not correlate with the decrease in infection with pathogenic organisms, nor can it be explained by changes in domestic hygiene. A consensus is beginning to develop round the view that more fundamental changes in lifestyle have led to decreased exposure to certain microbial or other species, such as helminths, that are important for the development of immunoregulatory mechanisms. Although this review concludes that the relationship of the hypothesis to hygiene practice is not proven, it lends strong support to initiatives seeking to improve hygiene practice. It would however be helpful if the hypothesis were renamed, e.g. as the ‘microbial exposure’ hypothesis, or ‘microbial deprivation’ hypothesis, as proposed for instance by Bjorksten. Avoiding the term ‘hygiene’ would help focus attention on determining the true impact of microbes on atopic diseases, while minimizing risks of discouraging good hygiene practice.

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References 251

1. 1.

   Strachan DP. Hay fever, hygiene and household size. Br Med J. 1989;299:1259-60.

   Not in our library10.1136/bmj.299.6710.1259

2. 2.

   Stanwell-Smith R, Bloomfield SF. The Hygiene Hypothesis and the implications for hygiene.

   Not in our library

3. 3.

   Isolauri E, Huurre A, Salminen S, Impivaara O. The allergy epidemic extends beyond the past few decades. Clin Exp Allergy. 2004;34:1007-10.

   Not in our library10.1111/j.1365-2222.2004.01999.x

4. 4.

   Warner JO. Worldwide variations in the prevalence of atopic symptoms: what does it all mean? Thorax. 1999;54(Suppl 2):546-51.

   Not in our library10.1136/thx.54.2008.s46

5. 5.

   Platts-Mills TAE, Carter MC, Heymann PW. Specific and non-specific obstructive lung disease in childhood: causes of changes in the prevalence of asthma. Environ Health Persp. 2000;108(Suppl 4):725-31.

   Not in our library10.1289/ehp.00108s4725

6. 6.

   Russell G, Helms PJ. Trends in occurrence of asthma among children and young adults. BMJ. 1997;315:1014-15.

   Not in our library

7. 7.

   Upton MN, McConnachie A, McSharry C, et al. Intergenerational 20 year trends in the prevalence of asthma and hay fever in adults: the Midspan family study surveys of parents and offspring. BMJ. 2000;321:88-92.

   Not in our library10.1136/bmj.321.7253.88

8. 8.

   Beasley R, Keil U, von Mutius E, Pearce N. Worldwide variation in prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and atopic eczema: ISAAC. Lancet. 1988;351:1225-32.

   Not in our library

9. 9.

   von Mutius E, Weiland SK, Fritzsch C, Duhme H, Keil U. Increasing prevalence of hay fever and atopy among children in Leipzig, East Germany. Lancet. 1998;351:862-6.

   Not in our library10.1016/s0140-6736(97)10100-3

10. 10.

    Fleming DM, Sunderland R, Cross KW, Ross AM. Declining incidence of episodes of asthma: a study of trends in new episodes presenting to general practitioners in the period 1989–98. Thorax. 2000;55:657-61.

    Not in our library10.1136/thorax.55.8.657

11. 11.

    Ronchetti R, Villa MP, Barreto M, et al. Is the increase in childhood asthma coming to an end? Findings from three surveys of schoolchildren in Rome, Italy. Eur Respir J. 2001;17:881-6.

    Not in our library10.1183/09031936.01.17508810

12. 12.

    Zöllner IK, Weiland SK, Piechotowski I, et al. No increase in the prevalence of asthma, allergies, and atopic sensitisation among children in Germany: 1992–2001. Thorax. 2005;60:545-8.

    Not in our library10.1136/thx.2004.029561

13. 13.

    Rook GWA. Mycobacteria and other environmental organisms as immunomodulators for immunoregulatory disorders. Springer Semin Immunopathol. 2004;25:237-55.

    Not in our library10.1007/s00281-003-0148-9

14. 14.

    Romagnani S. The increased prevalence of allergy and the hygiene hypothesis: missing immune deviation, reduced immune suppression, or both? Immunology. 2004;112:352-63.

    Not in our library10.1111/j.1365-2567.2004.01925.x

15. 15.

    Strachan DP, Harkins LS, Johnston IDA, Anderson HR. Clinical aspects of allergic disease. Childhood antecedents of allergic sensitisation in young British adults. J Allergy Clin Immunol. 1997;99:6-12.

    Not in our library10.1016/s0091-6749(97)70294-x

16. 16.

    von Mutius E, Martinez FD, Fritzsch C, Nicolai T, Roell G, Thiemann HH. Prevalence of asthma and atopy in two areas of West and East Germany. Am J Respir Crit Care Med. 1994;49:358-64.

    Not in our library10.1164/ajrccm.149.2.8306030

17. 17.

    Jarvis D, Chinn S, Luczynska C, Burney P. The association of family size with atopy and atopic disease. Clin Exp Allergy. 1997;27:240-5.

    Not in our library

18. 18.

    Haby MM, Peat JK, Marks GB, Woolcock AJ, Leeder SR. Asthma in preschool children: prevalence and risk factors. Thorax. 2001;56:589-95.

    Not in our library10.1136/thorax.56.8.589

19. 19.

    Infante-Rivard C, Amre D, Gautrin D, Malo JL. Family size, day-care attendance and breastfeeding in relation to the risk of childhood asthma. Am J Epidemiol. 2001;153:653-8.

    Not in our library10.1093/aje/153.7.653

20. 20.

    Strachan D. Socioeconomic factors and the development of allergy. Toxicol Lett. 1996;86:199-203.

    Not in our library10.1016/0378-4274(96)03691-0

21. 21.

    Svanes C, Jarvis D, Chinn S, Burney P. Childhood environment and adult atopy: results from the European Community Respiratory Health Survey. J Allergy Clin Immunol. 1999;103:415-20.

    Not in our library10.1016/s0091-6749(99)70465-3

22. 22.

    Strachan DP, Harkins LS, Golding J. Sibship size and self-reported inhalant allergy among adult women. Clin Exp Allergy. 1997;27:151-5.

    Not in our library

23. 23.

    Bodner C, Godden D, Seaton A. Family size, childhood infections and atopic disease. Thorax. 1998;53:28-32.

    Not in our library10.1136/thx.53.1.28

24. 24.

    Seaton A, Devereux G. Diet, infection and wheezy illness: lessons from adults. Pediatr Allergy Immunol. 2000;11(Suppl 13):37-40.

    Not in our library10.1034/j.1399-3038.2000.00509.x

25. 25.

    Mattes J, Karmaus W, Moseler M, Frischer T, Kuehr J. Accumulation of atopic disorders within families: a sibling effect only in the offspring of atopic fathers. Clin Exp Allergy. 1998;28:1480-6.

    Not in our library10.1046/j.1365-2222.1998.00420.x

26. 26.

    Wickens K, Crane J, Pearce N, Beasley R. The magnitude of the effect of smaller family sizes on the increase in the prevalence of asthma and hay fever in the United Kingdom and New Zealand. J Allergy Clin Immunol. 1999;104:554-8.

    Not in our library10.1016/s0091-6749(99)70323-4

27. 27.

    Karmaus W, Arshad H, Mattes J. Does the sibling effect have its origin in utero? Investigating birth order, cord serum immunoglobulin E concentration and allergic sensitisation at age 4 years. Am J Epidemiol. 2001;154:909-15.

    Not in our library10.1093/aje/154.10.909

28. 28.

    Karmaus W, Arshad H, Sadeghnejad A, Twistleton R. Does maternal immunoglobulin E decrease with increasing order of live offspring? Investigation into maternal immune tolerance. Clin Exp Allergy. 2004;34:853-9.

    Not in our library10.1111/j.1365-2222.2004.01959.x

29. 29.

    Devereux G, Barker RN, Seaton A. Antenatal determinants of neonatal immune response to allergens. Clin Exp Allergy. 2002;32:43-50.

    Not in our library10.1046/j.0022-0477.2001.01267.x

30. 30.

    Strachan DP. Family size, infection and atopy: the first decade of the “hygiene hypothesis”. Thorax. 2000;55(Suppl 1):S2-10.

    Not in our library10.1136/thorax.55.suppl_1.s2

31. 31.

    Ball TM, Castro-Rodriguez JA, Griffith KA, Holberg CJ, Martinez FD, Wright AL. Siblings, day-care attendance and the risk of asthma and wheezing during childhood. N Engl J Med. 2000;343:538-43.

    Not in our library10.1056/nejm200008243430803

32. 32.

    von Mutius E, Fritzsch C, Weiland SK, Roll G, Magnussen H. Prevalence of asthma and allergic disorders among children in the united Germany: a descriptive comparison. BMJ. 1992;305:1395-9.

    Not in our library10.1136/bmj.305.6866.1395

33. 33.

    Krämer U, Heinrich J, Wjist M, Wichmann HE. Age of entry to day nursery and allergy in later childhood. Lancet. 1999;353:450-4.

    Not in our library10.1016/s0140-6736(98)06329-6

34. 34.

    de Meer G, Janssen NAH, Brunekreef B. Early childhood environment related to microbial exposure and the occurrence of atopic disease at school age. Allergy. 2005;60:619-25.

    Not in our library10.1111/j.1398-9995.2005.00746.x

35. 35.

    Backman A, Bjorksten F, Ilmonen S, Juntunen K, Suonemi I. Do infections in infancy affect sensitisation to airborne allergens and development of atopic disease? Allergy. 1984;39:309-15.

    Not in our library10.1111/j.1398-9995.1984.tb00867.x

36. 36.

    Braun-Fährlander C, Gassner M, Grize L, et al. Prevalence of hay fever and allergic sensitisation in farmers' children and their peers living in the same rural community. Clin Exp Allergy. 1999;29:28-34.

    Not in our library10.1046/j.1365-2222.1999.00479.x

37. 37.

    Gassner-Bachman M, Wuthrich B. Farmers' children suffer less from hay fever and asthma. [in German, English abstract]. Dtsch Med Wochenschr. 2000;125:924-31.

    Not in our library10.1055/s-2000-6778

38. 38.

    von Ehrenstein OS, Von Mutius E, Illi S, Baumann L, Bohm O, von Kri. Reduced risk of hay fever and asthma among children of farmers. Clin Exp Allergy. 2000;30:187-93.

    Not in our library10.1046/j.1365-2222.2000.00801.x

39. 39.

    Riedler J, Braun-Fährlander C, Eder W, et al. Exposure to farming in early life and development of asthma and allergy: a cross-sectional survey. Lancet. 2001;358:1129-33.

    Not in our library10.1016/s0140-6736(01)06252-3

40. 40.

    Maziak W. Asthma and farming [letter]. Lancet. 2000;359:623-4.

    Not in our library10.1016/s0140-6736(02)07721-8

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