Role of microbial burden in aetiology of allergy and asthma

Martinez, F. D.; Holt, Patrick G.

doi:10.1016/s0140-6736(99)90437-3

Cited by 380 publications

(291 citation statements)

References 43 publications

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“…exposure to a wide spectrum of microorganisms from diverse sources). The immunological basis and the mechanisms that are thought to operate in this immunomodulation, have been discussed in detail in several recent reviews and will not be reiterated here (49)(50)(51)(52)(53)(54). In addition, a number of animal experiments have provided support for the hygiene hypothesis (55)(56)(57)(58), but these data are also beyond the scope of this review.…”

Section: The Hygiene Hypothesismentioning

confidence: 98%

Asthma and atopy – the price of affluence?

Hertzen

Haahtela²

2004

Allergy

122

110

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Irrespective of improved knowledge of many aspects of atopic diseases, the unfavorable trends in their prevalence particularly among children could not have been reversed. A growing body of evidence suggests that something may lack from our societal affluence that has the capacity to provide protection against the development of atopic diseases. Much attention during the last years has been devoted to the hygiene hypothesis. This review outlines the impact of environment and lifestyle, particularly from the perspective of the East–West gradient, on the development of atopic diseases, with a special emphasis on the hygiene hypothesis in its broadest sense.

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Section: The Hygiene Hypothesismentioning

confidence: 98%

Asthma and atopy – the price of affluence?

Hertzen

Haahtela²

2004

Allergy

122

110

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“…How these factors impact disease by promoting immune responses to allergens is a subject of considerable debate, which has led to the "hygiene hypothesis" (Wills- Karp et al 2001;Liu & Murphy 2003). According to the theory, in its simplest iteration, the increase in hygienic living conditions and in the use of antibiotic and sterile food preparations resulted in the separation of the immune system from positive microbial exposure early in life (Martinez and Holt, 1999). The immunoregulatory mechanisms remain underdeveloped, and an imbalance in immune homeostasis predisposes to the development of T helper type 2-biased immune responses and, consequently, allergic disease (Feleszko et al 2005).…”

Section: Role Of Regulatory T Cells In Allergy Airway Diseasesmentioning

confidence: 99%

Allergic Airway Inflammation

Morán¹,

Henríquez²,

Folch³

2012

Allergic Diseases - Highlights in the Clinic, Mechanisms and Treatment

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“…• infections due to a sibling effect (more brothers or sisters) protect against asthma [4]; • infections due to day care protect against allergy and asthma [5]; • microbial products due to farming protect against allergy and asthma [6]; • inhalant allergens due to cats and dogs protect against allergy [7]; • breast feeding induces allergy and asthma [2].…”

mentioning

confidence: 99%

“…It is interesting that the hygiene hypothesis is more and more accepted as explanation for the increase in allergy and asthma in the western world in the last decade [2,3]. What actual evidence do we have for the hygiene hypothesis?…”

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confidence: 99%

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No clinical evidence base to support the hygiene hypothesis

Schayck

Knottnerus

2004

Primary Care Respiratory Journal

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KEYWORDS Clinical evidence;Allergy; Hygiene hypothesisSummary The hygiene hypothesis is a popular explanation for recent increases in allergy in the western world. This hypothesis suggests that development of allergy (or asthma) could be prevented by exposure to immune stimulants such as viruses, bacteria and endotoxins, in particular in the prenatal period or early childhood. How evidence-based are the observations which support the hygiene hypothesis? All clinical epidemiological indications in favour of the hypothesis are based on observational (cross-sectional and cohort) studies and not on observations in randomised controlled intervention studies. In cross-sectional studies no causal relationships can be assessed with sufficient validity. Also in cohort studies there are validity problems, as the exposure is not determined by chance (by means of randomisation) and could be influenced by behaviour. And behaviour might well be a confounder, since it can be associated with both exposure and outcome. A problem is that, without being appropriately tested in well designed prospective research, the hygiene hypothesis has currently already become so popular in the news media that an increased occurrence of asthma might even be induced as a result of an increased exposure. Although the currently available evidence to support the hygiene hypothesis is poor, it appears that the hypothesis has to some become a matter of faith or ideology. Scientists should take care that messages imparted to the general public do not go beyond or conflict with existing evidence. © 2004 General Practice Airways Group. Published by Elsevier Ltd. All rights reserved.General practitioners and other health care providers are in receipt of conflicting information on the pathopysiology of allergy (and asthma), especially in relation to the hygiene hypothesis. It is difficult for these health care professionals to translate this information into practical advice for their patients who want to know how to avoid the development of these diseases in their children. 1

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Role of microbial burden in aetiology of allergy and asthma

Cited by 380 publications

References 43 publications

Asthma and atopy – the price of affluence?

Asthma and atopy – the price of affluence?

Allergic Airway Inflammation

No clinical evidence base to support the hygiene hypothesis

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