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The hygiene hypothesis revisited: does exposure to infectious agents protect us from allergy?

Fishbein, Anna B.; Fuleihan, Ramsay L.

Current Opinion in Pediatrics:
doi: 10.1097/MOP.0b013e32834ee57c
INFECTIOUS DISEASES AND IMMUNIZATION: Edited by Robert S. Baltimore and Hal B. Jenson
Abstract

Purpose of review: The increase in incidence and prevalence of allergic disease remains a mystery and cannot be explained solely by genetic factors. The hygiene hypothesis provides the strongest epidemiological explanation for the rise in allergic disease. This review evaluates the recent epidemiological and mechanistic research in the role of infectious agents in the pathogenesis of or protection from allergic disease.

Recent findings: Recent literature has extended the epidemiological findings of the protective effect of being born and reared in a farm environment and associates an increased diversity of organisms in house-dust samples with protection from allergic disease. Furthermore, human and animal studies provide increasing evidence for the role of both the innate and adaptive immune systems, including regulatory cells, as mediators of this protective effect.

Summary: There is evidence that exposure to some infectious organisms can protect from atopy, whereas other infections appear to promote allergic diseases. The timing of exposure to infection and the properties of the infectious agent, in addition to the genetic susceptibility of the host, play an important role in the future development of allergic disease.

Author Information

Division of Allergy and Immunology, Children's Memorial Hospital and Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA

Correspondence to Ramsay L. Fuleihan, Division of Allergy and Immunology, Children's Memorial Hospital and Northwestern University Feinberg School of Medicine, 2300 Children's Plaza Box 60, Chicago, IL 60614, USA. Tel: +1 312 227 6010; fax: +1 312 227 9401; e-mail: r-fuleihan@northwestern.edu

© 2012 Lippincott Williams & Wilkins, Inc.