Time to abandon the hygiene hypothesis: new perspectives on allergic disease, the human microbiome, infectious disease prevention and the role of targeted hygiene

被引:183
作者
Bloomfield, Sally F. [1 ,2 ]
Rook, Graham A. W. [3 ]
Scott, Elizabeth A. [4 ]
Shanahan, Fergus [5 ]
Stanwell-Smith, Rosalind [6 ]
Turner, Paul [7 ,8 ,9 ,10 ]
机构
[1] London Sch Hyg & Trop Med, Montacute TA15 6XL, Somerset, England
[2] Int Sci Forum Home Hyg, Montacute TA15 6XL, Somerset, England
[3] UCL, Dept Infect, Ctr Clin Microbiol, London, England
[4] Simmons Coll, Ctr Hyg & Hlth, Dept Biol, Boston, MA 02115 USA
[5] Natl Univ Ireland, Univ Coll Cork, APC Microbiome Inst, Cork, Ireland
[6] London Sch Hyg & Trop Med, London, England
[7] Imperial Coll London, Sect Paediat Allergy & Infect Dis, London, England
[8] Imperial Coll London, MRC, London, England
[9] Imperial Coll London, Asthma UK Ctr Allerg Mech Asthma, London, England
[10] Univ Sydney, Discipline Paediat & Child Hlth, Sydney, NSW, Australia
基金
爱尔兰科学基金会; 英国医学研究理事会;
关键词
allergy; infectious disease; hygiene; cleaning; antibiotics; diet; GUT MICROBIOTA; INTESTINAL MICROBIOTA; ATOPIC-DERMATITIS; REDUCED DIVERSITY; ANTIBIOTIC USE; OLD FRIENDS; EARLY-LIFE; HAY-FEVER; RISK; EXPOSURE;
D O I
10.1177/1757913916650225
中图分类号
R1 [预防医学、卫生学];
学科分类号
100235 [预防医学];
摘要
Aims: To review the burden of allergic and infectious diseases and the evidence for a link to microbial exposure, the human microbiome and immune system, and to assess whether we could develop lifestyles which reconnect us with exposures which could reduce the risk of allergic disease while also protecting against infectious disease. Methods: Using methodology based on the Delphi technique, six experts in infectious and allergic disease were surveyed to allow for elicitation of group judgement and consensus view on issues pertinent to the aim. Results: Key themes emerged where evidence shows that interaction with microbes that inhabit the natural environment and human microbiome plays an essential role in immune regulation. Changes in lifestyle and environmental exposure, rapid urbanisation, altered diet and antibiotic use have had profound effects on the human microbiome, leading to failure of immunotolerance and increased risk of allergic disease. Although evidence supports the concept of immune regulation driven by microbe-host interactions, the term hygiene hypothesis' is a misleading misnomer. There is no good evidence that hygiene, as the public understands, is responsible for the clinically relevant changes to microbial exposures. Conclusion: Evidence suggests a combination of strategies, including natural childbirth, breast feeding, increased social exposure through sport, other outdoor activities, less time spent indoors, diet and appropriate antibiotic use, may help restore the microbiome and perhaps reduce risks of allergic disease. Preventive efforts must focus on early life. The term hygiene hypothesis' must be abandoned. Promotion of a risk assessment approach (targeted hygiene) provides a framework for maximising protection against pathogen exposure while allowing spread of essential microbes between family members. To build on these findings, we must change public, public health and professional perceptions about the microbiome and about hygiene. We need to restore public understanding of hygiene as a means to prevent infectious disease.
引用
收藏
页码:213 / 224
页数:12
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