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Sgrulletta R, Bonini S, Lambiase A, Bonini S. Allergy and Infections: Long-Term Improvement of Vernal Keratoconjunctivitis following Viral Conjunctivitis. Eur J Ophthalmol 2018; 16:470-3. [PMID: 16761253 DOI: 10.1177/112067210601600319] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE Vernal keratoconjunctivitis (VKC) is a severe, chronic allergic inflammatory disease of the ocular surface poorly responsive to antiallergic treatments and possibly leading to permanent visual impairment. VKC, because of mast cell, eosinophil, and Th2-type inflammation, polyclonal IgE activation, and tissue remodeling, is considered to be a typical Th2- driven disease. Viral infection stimulates a Th1 type immune response, potentially attenuating allergen-induced inflammation. The purpose of this report is to describe the effect of viral keratoconjunctivitis in a patient with VKC. METHODS The authors report on a patient with a severe form of VKC, poorly responsive to antiallergic treatments, who developed a viral keratoconjunctivitis. Signs, symptoms, and cytologic findings were recorded during the 5-year follow-up period. RESULTS The authors observed a prompt and permanent improvement of signs and symptoms of the allergic condition after the viral infection. Conjunctival scraping confirms that the inhibition of the eosinophilic inflammation lasts at least for 5 years. CONCLUSIONS In this case, the viral infection seemed to induce a clinical recovery of allergic disease, suggesting that an immune deviation induced by Th1-polarizing agents may revert an ongoing Th2 inflammation.
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Affiliation(s)
- R Sgrulletta
- Interdisciplinary Center for Biomedical Research (CIR), Laboratory of Ophthalmology, University of Roma 'Campus Bio-Medico' and G.B. Bietti Eye Foundation, IRCCS, Roma--Italy
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2
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Chang M, Kelvin EA. Differing asthma prevalence by gross national index of country of birth among New York City residents. Allergy 2014; 69:494-500. [PMID: 24475906 DOI: 10.1111/all.12367] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/25/2013] [Indexed: 12/27/2022]
Abstract
BACKGROUND The hygiene hypothesis suggests that higher exposure to infectious agents may be one reason for regional differences in asthma. This would suggest that immigrants from less developed countries, where infections are more common, to highly developed countries will have lower risk of asthma compared with natives, as has been found in a number of studies. We expand the research on immigrants to look at the level of development in country of origin as a predictor of asthma in New York City residents. METHODS Data came from the 2009 cross-sectional Community Health Survey. We used logistic regression to assess the relationship of country of birth and the gross national income (GNI), an indicator of the level of development, of country of birth with asthma among immigrants and US-born New York City residents. RESULTS Those who were foreign born had lower odds of having asthma compared with those US born (OR = 0.43, P < 0.001). There was a dose relationship between GNI and asthma with decreasing odds of having asthma associated with lower GNI in country of birth (low GNI country: OR = 0.26, P = 0.014; middle GNI country: OR = 0.36, P < 0.001; and high GNI country = reference). CONCLUSIONS These findings lend support to the hygiene hypothesis in that the odds of having asthma among New York City residents was lowest among people born in the least developed countries, as indicated by GNI, where infections are likely the most common.
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Affiliation(s)
- M. Chang
- Epidemiology & Biostatistics Program; CUNY School of Public Health; Hunter College; New York NY USA
| | - E. A. Kelvin
- Epidemiology & Biostatistics Program; CUNY School of Public Health; Hunter College; New York NY USA
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3
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Cozen W, Yu G, Gail MH, Ridaura VK, Nathwani BN, Hwang AE, Hamilton AS, Mack TM, Gordon JI, Goedert JJ. Fecal microbiota diversity in survivors of adolescent/young adult Hodgkin lymphoma: a study of twins. Br J Cancer 2013; 108:1163-7. [PMID: 23443674 PMCID: PMC3619077 DOI: 10.1038/bjc.2013.60] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Revised: 01/09/2013] [Accepted: 01/20/2013] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Adolescent/young adult Hodgkin lymphoma (AYAHL) survivors report fewer exposures to infections during childhood compared with controls, and they have functional lymphocyte aberrations. The gut microbiota plays a central role in immunity. METHODS We investigated whether fecal microbial diversity differed between 13 AYAHL survivors and their unaffected co-twin controls. Pyrosequencing of fecal bacterial 16S rRNA amplicons yielded 252 943 edited reads that were assigned to species-level operational taxonomic units (OTUs) and standardised for sequencing depth by random sampling. Microbial diversity was compared within vs between twin pairs and by case-control status. RESULTS The number of unique OTUs was more similar within twin pairs compared with randomly paired participants (P=0.0004). The AYAHL cases had fewer unique OTUs compared with their co-twin controls (338 vs 369, P=0.015); this difference was not significant (169 vs 183, P=0.10) when restricted to abundant OTUs. CONCLUSION In this small study, AYAHL survivors appear to have a deficit of rare gut microbes. Further work is needed to determine if reduced microbial diversity is a consequence of the disease, its treatment, or a particularly hygienic environment.
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Affiliation(s)
- W Cozen
- Department of Preventive Medicine, USC Keck School of Medicine, Los Angeles, CA 90089-9175, USA
- Norris Comprehensive Cancer Center, University of Southern California Keck School of Medicine, Los Angeles, CA 90089-9175, USA
- Department of Pathology, University of Southern California Keck School of Medicine, Los Angeles, CA 90089-9175, USA
| | - G Yu
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, 6120 Executive Boulevard, Room 7068, Rockville, MD 20852, USA
| | - M H Gail
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, 6120 Executive Boulevard, Room 7068, Rockville, MD 20852, USA
| | - V K Ridaura
- Center for Genome Sciences and Systems Biology, Washington University in St Louis, St Louis, MO 63108, USA
| | - B N Nathwani
- Department of Pathology, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - A E Hwang
- Department of Preventive Medicine, USC Keck School of Medicine, Los Angeles, CA 90089-9175, USA
| | - A S Hamilton
- Department of Preventive Medicine, USC Keck School of Medicine, Los Angeles, CA 90089-9175, USA
- Norris Comprehensive Cancer Center, University of Southern California Keck School of Medicine, Los Angeles, CA 90089-9175, USA
| | - T M Mack
- Department of Preventive Medicine, USC Keck School of Medicine, Los Angeles, CA 90089-9175, USA
- Norris Comprehensive Cancer Center, University of Southern California Keck School of Medicine, Los Angeles, CA 90089-9175, USA
- Department of Pathology, University of Southern California Keck School of Medicine, Los Angeles, CA 90089-9175, USA
| | - J I Gordon
- Center for Genome Sciences and Systems Biology, Washington University in St Louis, St Louis, MO 63108, USA
| | - J J Goedert
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, 6120 Executive Boulevard, Room 7068, Rockville, MD 20852, USA
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Abstract
The incidence of type 1 diabetes (T1D), as with several other autoimmune diseases and conditions, began to notably rise in the latter half of the last century. Most cases of T1D are not solely attributable to genetics and therefore, environmental influences are proposed to account for the difference. Humans live today in general under much more hygienic conditions than their ancestors. Although human enteroviruses (HEV) have been strongly implicated as causative environmental agents of T1D, recent work has shown that the bacterial genera in the gut of diabetics compared with non-diabetics, can vary significantly. Here, we consider these data in light of our non-hygienic human past in order to discuss a possible relationship between the resident bacterial biome and acute infectious events by HEV, suggesting how this may have influenced T1D incidences in the past and the risk for developing T1D today.
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Affiliation(s)
- Nora M Chapman
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, USA.
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5
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Ahrens B, Quarcoo D, Buhner S, Matricardi PM, Hamelmann E. Oral Administration of Bacterial Lysates Attenuates Experimental Food Allergy. Int Arch Allergy Immunol 2011; 156:196-204. [DOI: 10.1159/000322352] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2010] [Accepted: 10/22/2010] [Indexed: 12/18/2022] Open
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Nandakumar S, Kumaraguru U. Heterologous CD8 T cell immune response to HSV induced by toll like receptor ligands. Cell Immunol 2009; 261:114-21. [PMID: 20022593 DOI: 10.1016/j.cellimm.2009.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2009] [Revised: 11/11/2009] [Accepted: 11/24/2009] [Indexed: 11/26/2022]
Abstract
A memory response is established following primary antigen exposure that stays more or less constant. It appears to adopt a set-point in magnitude but upon re-exposure the response is quicker and better and there is an upward shift in memory frequency that varies with individuals based on the exposure pattern to other microbes or its components. Our investigations were designed to test such differences of non-specific stimulation by PAMPs in lowering the threshold of activation. Neonatal mice were pre-exposed to TLR-ligands intermittently and later analyzed for its resilience to challenge with virus during adult-life. Secondly, adult mice with pre-existing memory to virus were exposed to various TLR-ligands and analyzed for their quality of memory response. The TLR-ligands exposed animals were better responders to a new agent exposure compared to the animals kept in sterile surroundings. Moreover, immune memory recall and the viral specific CD8(+) T cells response with TLR-ligands were comparable to the recall response with the cognate antigen. The results provide insights into the role of hyper-sanitized environment versus PAMPs mediated signaling in adaptive immunity and long-term immune memory.
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Affiliation(s)
- Subhadra Nandakumar
- Department of Microbiology, East Tennessee State University, Johnson City, TN 37614, USA
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7
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Bowman C, Delrieu O. Immunogenetics of drug-induced skin blistering disorders. Part II: Synthesis. Pharmacogenomics 2009; 10:779-816. [DOI: 10.2217/pgs.09.23] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The overall immunopathogenesis relevant to a large series of disorders caused by a drug or its associated hyperimmune condition is discussed based upon examining the genetics of severe drug-induced bullous skin problems (sporadic idiosyncratic adverse events including Stevens–Johnson syndrome and Toxic epidermal necrolysis). New results from an exemplar study on shared precipitating and perpetuating inner causes with other related disease phenotypes including aphtous stomatitis, Behçets, erythema multiforme, Hashimoto’s thyroiditis, pemphigus, periodic fevers, Sweet’s syndrome and drug-induced multisystem hypersensitivity are presented. A call for a collaborative, wider demographic profiling and deeper immunotyping in suggested future work is made.
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Affiliation(s)
- Clive Bowman
- School of Biological Sciences, University of Reading, Whiteknights, Reading, RG6 6AH, UK
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8
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von Hertzen LC, Savolainen J, Hannuksela M, Klaukka T, Lauerma A, Mäkelä MJ, Pekkanen J, Pietinalho A, Vaarala O, Valovirta E, Vartiainen E, Haahtela T. Scientific rationale for the Finnish Allergy Programme 2008-2018: emphasis on prevention and endorsing tolerance. Allergy 2009; 64:678-701. [PMID: 19383025 DOI: 10.1111/j.1398-9995.2009.02024.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
In similarity to many other western countries, the burden of allergic diseases in Finland is high. Studies worldwide have shown that an environment rich in microbes in early life reduces the subsequent risk of developing allergic diseases. Along with urbanization, such exposure has dramatically reduced, both in terms of diversity and quantity. Continuous stimulation of the immune system by environmental saprophytes via the skin, respiratory tract and gut appears to be necessary for activation of the regulatory network including regulatory T-cells and dendritic cells. Substantial evidence now shows that the balance between allergy and tolerance is dependent on regulatory T-cells. Tolerance induced by allergen-specific regulatory T-cells appears to be the normal immunological response to allergens in non atopic healthy individuals. Healthy subjects have an intact functional allergen-specific regulatory T-cell response, which in allergic subjects is impaired. Evidence on this exists with respect to atopic dermatitis, contact dermatitis, allergic rhinitis and asthma. Restoration of impaired allergen-specific regulatory T-cell response and tolerance induction has furthermore been demonstrated during allergen-specific subcutaneous and sublingual immunotherapy and is crucial for good therapeutic outcome. However, tolerance can also be strengthened unspecifically by simple means, e.g. by consuming farm milk and spending time in nature. Results so far obtained from animal models indicate that it is possible to restore tolerance by administering the allergen in certain circumstances both locally and systemically. It has become increasingly clear that continuous exposure to microbial antigens as well as allergens in foodstuffs and the environment is decisive, and excessive antigen avoidance can be harmful and weaken or even prevent the development of regulatory mechanisms. Success in the Finnish Asthma Programme was an encouraging example of how it is possible to reduce both the costs and morbidity of asthma. The time, in the wake of the Asthma Programme, is now opportune for a national allergy programme, particularly as in the past few years, fundamentally more essential data on tolerance and its mechanisms have been published. In this review, the scientific rationale for the Finnish Allergy Programme 2008-2018 is outlined. The focus is on tolerance and how to endorse tolerance at the population level.
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Affiliation(s)
- L C von Hertzen
- Skin and Allergy Hospital, Helsinki University Central Hospital, Helsinki, Finland
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Jiao L, Han X, Wang S, Fan Y, Yang M, Qiu H, Yang X. Imprinted DC mediate the immune-educating effect of early-life microbial exposure. Eur J Immunol 2009; 39:469-80. [PMID: 19180467 DOI: 10.1002/eji.200838367] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
It has been long proposed that exposure to environmental factors early in life may have an educating effect on the development of immune regulatory functions. However, experimental studies on this issue are limited and the related molecular and cellular basis remains unclear. Here we report that neonatal exposure to killed bacteria (Chlamydia muridarum, originally called Chlamydia trachomatis mouse pneumonitis (MoPn)) changed the pattern of the hosts' immune responses to a model allergen (OVA) in adulthood. This was associated with altered phenotype and function of DC. We found that DC from adult mice treated neonatally with UV-killed MoPn exhibited distinct patterns of surface marker and TLR expression and cytokine production from control mice (DC from adult mice neonatally treated with vehicle, (Sham-DC)). More importantly, DC from adult mice treated neonatally with UV-killed MoPn induced significantly lower type-2 antigen-specific T-cell responses than Sham-DC shown in DC:T co-culture experiments in vitro and in adoptive transfer experiments in vivo. In addition, depletion of T cells in vivo largely abolished the phenotypic and functional alterations of DC caused by bacterial exposure, suggesting the involvement of T cell in this process. Our study demonstrates a central role of DC in linking the early-life exposure to microbial products and the balanced development of immune regulatory functions and the involvement of T cells in imprinting of the DC function.
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Affiliation(s)
- Lei Jiao
- Department of Medical Microbiology and Immunology, Faculty of Medicine, University of Manitoba, Winnipeg, Man, Canada
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10
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Büyüköztürk S, Gelincik A, Ozşeker F, Genç S, Savran FO, Kiran B, Yillar G, Erden S, Aydin F, Colakoğlu B, Dal M, Ozer H, Bilir A. Nigella sativa (black seed) oil does not affect the T-helper 1 and T-helper 2 type cytokine production from splenic mononuclear cells in allergen sensitized mice. JOURNAL OF ETHNOPHARMACOLOGY 2005; 100:295-8. [PMID: 16125022 DOI: 10.1016/j.jep.2005.03.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2004] [Revised: 02/23/2005] [Accepted: 03/04/2005] [Indexed: 05/04/2023]
Abstract
Nigella sativa Linn. (Ranunculaceae) is known to have beneficial effects on a wide range of diseases including asthma. However, the mechanism of action in asthma and other allergic diseases is not entirely clear. The present study was planned to evaluate the effects of Nigella sativa on cytokine production of splenic mononuclear cells in ova-sensitized mice. Nineteen two-month-old BALB/c mice were given 0.3 mL of Nigella sativa oil by oro-eosophageal cannula once a day for a month. The control group consisting of 10 mice took 0.3 mL of 0.9% saline solution by the same route for the same period. In the third week of the study, all mice were sensitized by means of intraperitoneal injections of 20 microg of ovalbumin (OVA-Grade VI, Sigma). Ova injections were repeated three times with 7-day intervals. After another week, all mice were sacrificed by means of cervical dislocation. Then the splenic mononuclear cells (MNCs) of mice were cultured with OVA or Concavalin A (Con-A). From the culture supernatants, IL-4, IL-10 and IFN-gamma were assessed by means of ELISA. The cytokine production of splenic MNCs of mice that were given Nigella sativa for 30 days was not significantly different than those who took saline solution instead. In conclusion, Nigella sativa oil seems not to have an immunomodulatory effect on Th1 and Th2 cell responsiveness to allergen stimulation.
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Affiliation(s)
- Suna Büyüköztürk
- Istanbul University, Istanbul Faculty of Medicine, Department of Allergy and Clinical Immunology, Ataköy, 7-8.Kisim Deniz 5/37 Istanbul, Turkey
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11
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Czeresnia D. The hygienic hypothesis and transformations in etiological knowledge: from causal ontology to ontogenesis of the body. CAD SAUDE PUBLICA 2005; 21:1168-76. [PMID: 16021254 DOI: 10.1590/s0102-311x2005000400019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The objective of this article is to systematize the principal recent research results pertaining to the so-called hygienic hypothesis, which establishes an etiological link between the increasing incidence of allergic diseases and the decreasing incidence of infectious diseases in the industrialized countries of the Western world. The author contends that the current debate on the hygienic hypothesis indicates significant transformations in the understanding of disease etiology, perhaps even as important as the transformations in the 19th century during the process leading to the constitution of modern medicine and the identification of infectious disease causal agents.
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Affiliation(s)
- Dina Czeresnia
- Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil.
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12
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Wilson MS, Maizels RM. Regulation of allergy and autoimmunity in helminth infection. Clin Rev Allergy Immunol 2005; 26:35-50. [PMID: 14755074 DOI: 10.1385/criai:26:1:35] [Citation(s) in RCA: 134] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Parasitic infections are a major theme in the "hygiene hypothesis", as allergies and autoimmune diseases are less prevalent in countries with higher burdens of helminths and other parasitic organisms. Helminths"-the grouping of multicellular worm parasites including nematodes, cestodes and trematodes-tend to establish long-lived, chronic infections indicating successful down-modulation of the host immune system. In this review, we describe the intricate immunology of host-helminth interactions and how parasites manipulate immune responses to enhance their survival. In so doing, they often minimise immunopathology and, it is suggested, reduce host susceptibility to, and severity of allergic and autoimmune diseases. Studies on helminth-infected communities and individuals support the hypothesis that an immuno-regulatory network promoted by parasites extends its influence to limiting allergies. Experimental models are now probing more deeply into the area of immune modulation by helminths, and we discuss the likely mechanisms by which helminths could be establishing a strongly regulatory environment. Understanding and harnessing the modulatory capacity of helminths may uncover novel therapeutic interventions, mimicking and exploiting their evolution for our benefit. Parasitic infections are a major theme in the "hygiene hypothesis", as allergies and autoimmune diseases are less prevalent in countries with higher burdens of helminths and other parasitic organisms. Helminths"-the grouping of multicellular worm parasites including nematodes, cestodes and trematodes-tend to establish long-lived, chronic infections indicating successful down-modulation of the host immune system. In this review, we describe the intricate immunology of host-helminth interactions and how parasites manipulate immune responses to enhance their survival. In so doing, they often minimise immunopathology and, it is suggested, reduce host susceptibility to, and severity of allergic and autoimmune diseases. Studies on helminth-infected communities and individuals support the hypothesis that an immuno-regulatory network promoted by parasites extends its influence to limiting allergies. Experimental models are now probing more deeply into the area of immune modulation by helminths, and we discuss the likely mechanisms by which helminths could be establishing a strongly regulatory environment. Understanding and harnessing the modulatory capacity of helminths may uncover novel therapeutic interventions, mimicking and exploiting their evolution for our benefit.
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Affiliation(s)
- Mark S Wilson
- Institute of Cell, Animal and Population Biology, University of Edinburgh, Edinburgh, UK
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Koppen S, de Groot R, Neijens HJ, Nagelkerke N, van Eden W, Rümke HC. No epidemiological evidence for infant vaccinations to cause allergic disease. Vaccine 2004; 22:3375-85. [PMID: 15308362 DOI: 10.1016/j.vaccine.2004.02.033] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2003] [Accepted: 02/29/2004] [Indexed: 10/26/2022]
Abstract
CONTEXT The prevalence of allergic diseases has increased considerably over the last decades. The hygiene hypothesis has emerged, linking reduced microbial exposure and infections early in life with the development of allergic diseases. Especially some of currently available non-replicating infant vaccines are unlikely to mimic a natural infection-mediated immune response that protects against the development of allergic diseases. Moreover, several studies suggested infant vaccinations to increase the risk of allergic diseases. OBJECTIVE To determine whether infant vaccinations increase the risk of developing allergic disease. DATA SOURCES We searched MEDLINE from 1966 to March 2003 and bibliography lists from retrieved articles, and consulted experts in the field to identify all articles relating vaccination to allergy. STUDY SELECTION AND DATA EXTRACTION We selected epidemiological studies with original data on the correlation between vaccination with diphtheria, pertussis, tetanus (DPT), measles, mumps, rubella (MMR) and Bacillus Calmette-Guérin (BCG) vaccine in infancy and the development of allergic diseases, and assessed their quality and validity. DATA SYNTHESIS Methodological design and quality varied considerably between the studies we reviewed. Many studies did not address possible confounders, such as the presence of lifestyle factors, leaving them prone to bias. The studies that offer the stronger evidence, including the only randomized controlled trial at issue published to date, indicate that the infant vaccinations we investigated do not increase the risk of developing allergic disease. Furthermore, BCG does not seem to reduce the risk of allergies. CONCLUSIONS The reviewed epidemiological evidence indicates that, although possibly not contributing to optimal stimulation of the immune system in infancy, current infant vaccines do not cause allergic diseases.
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Affiliation(s)
- S Koppen
- Vaxinostics, Vaccine Center Erasmus University Rotterdam, C/o Erasmus MC--Sophia Children's Hospital, Secretariat Pediatric Infectious Diseases and Immunology, Room Sp 3533, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands
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Fritz GJ, Herbarth O. Asthmatic disease among urban preschoolers: an observational study. Int J Hyg Environ Health 2004; 207:23-30. [PMID: 14762971 DOI: 10.1078/1438-4639-00264] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Asthma is of increasing concern especially in industrialized countries. This cross-sectional study was to assess the influence of spatial and temporal variations in the urban air pollution profile on asthmatic disease. The prevalences presented are based on physician-diagnosed asthmatic and allergic disease data, collected between 1993 and 1995. Seven hundred and thirty-six preschool children (age 2 to 7, mean 5.7 years) of 37 daycare centres in the City of Leipzig participated in the study. Variations were observed in the lifetime prevalences of asthma and allergy with differences in a residential area's ambient pollution profile. Depending on the level of traffic (high or low), children residing in areas with a dominant coal-heating emission profile had more frequently a diagnosis of asthma, 17.5% and 8.8% (95% confidence intervals [CI]: 10.8...23.5 and 5.8...11.6, respectively), as compared to those, living in centrally heated areas 13.4% and 5.8% (CI: 6.6...19.3 and 1.2...9.6, respectively). Allergic disorders occurred more often in areas with a predominantly traffic-associated pollution profile, 14.3% and 9.6% vs. 5.8% and 3.7% (CI: 7.4...20.3 and 6.4...12.5; 1.2...9.6 and 0.2...6.5, respectively). Interestingly, asthmatic disease was not necessarily associated with a clinical history of allergies. Of the children with physician-diagnosed asthma, 83.7% were not reported to have a concurrent diagnosis of allergies nor to show clinical symptoms. This suggests that environmental exposures (i.e., complex pollution mixtures associated with residential coal-heating and/or traffic) may have differentially influenced the phenotypic expression of asthma. A qualitative discussion is presented on the occurrence of "asthma without reported allergies" in Leipzig.
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Affiliation(s)
- Gisela J Fritz
- Medical Faculty, University of Leipzig, Leipzig, Germany.
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Bukowski JA, Lewis RJ. Is the hygiene hypothesis an example of hormesis? NONLINEARITY IN BIOLOGY, TOXICOLOGY, MEDICINE 2003; 1:155-166. [PMID: 19330119 PMCID: PMC2651604 DOI: 10.1080/15401420391434306] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
UNLABELLED The "hygiene hypothesis" has been suggested to explain the rising incidence of allergic disorders in developed countries. The postulated mechanism is that infectious and/or microbial agents stimulate the immune system toward Th1 (allergy fighting) rather than Th2 (allergy promoting) response. This paper reviews the evidence related to early life infectious/microbial exposures and subsequent atopic disorders and evaluates whether these data suggest a hormetic effect. Our review indicates an insufficient and contradictory association for bacterial/viral infections, with protective effects being either absent or specific to certain infections and/or populations. Chronic, heavy parasitic burdens appear to confer protection against atopic disorders, but are associated with considerable pathology. Moreover, light parasitic burden may increase allergic responses (i.e., no "low dose" beneficial effect). In contrast, there is consistent evidence that general microbial exposures, particularly gut commensals, may be protective against allergy development, which is consistent with a hormetic effect (i.e., potentially beneficial effects at low doses and detrimental effects at high levels). CONCLUSION General microbial exposures in relation to the "hygiene hypothesis" may represent a hormetic effect, although further research with more rigorous study methods (i.e., prospective designs and measurement of exposure timing, dose, route, etc.) are needed.
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Affiliation(s)
- John A. Bukowski
- ExxonMobil Biomedical Science, Inc., 1545 Route 22 East, P.O. Box 971, Annandale, NJ 08801–0971
| | - R. Jeffrey Lewis
- ExxonMobil Biomedical Science, Inc., 1545 Route 22 East, P.O. Box 971, Annandale, NJ 08801–0971
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16
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Abstract
OBJECTIVE Our goals were to analyze some of the similarities and differences in the increase in asthma, hay fever, and atopic sensitization between Europe and the United States and attempt to explain "inner-city asthma" within the framework of the hygiene hypothesis. DATA SOURCES We reviewed historical descriptions of hay fever and asthma as well as the currently available related literature. STUDY SELECTION The authors' judgment was used in the selection of historical and epidemiologic evidence. RESULTS Analyses of patterns of risk factors for allergic rhinoconjunctivitis and asthma in Europe led to a causal theory of the epidemic: the hygiene hypothesis. This theory claims that hygiene removed a protective influence against atopy and asthma that was once provided by exposure to infections in early life. This hypothesis has been questioned in the United States, where allergic asthma since the 1970s has increased among minorities living in poverty and with suboptimal hygienic conditions (inner-city asthma). When seen from a historical perspective, the recent increasing trend in respiratory allergies among the less advantaged in the United States may be explained as the consequence of several epiphenomena linked to westernization (including declining exposure to foodborne and orofecal infections) that first affected the richest socioeconomic strata during the 19th century, expanded among the middle classes during the first half of the 20th century, and eventually cascaded down to affect the least-advantaged Americans. CONCLUSION Inner-city asthma may be the final stage of a class-driven urbanization and westernization that began 2 centuries ago in the United States and that is now coming full circle.
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Affiliation(s)
- Paolo M Matricardi
- Institute of Neurobiology and Molecular Medicine, Italian National Research Council, Rome, Italy.
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Matricardi PM, Bonini S. High microbial turnover rate preventing atopy: a solution to inconsistencies impinging on the Hygiene hypothesis? Clin Exp Allergy 2000; 30:1506-10. [PMID: 11069557 DOI: 10.1046/j.1365-2222.2000.00994.x] [Citation(s) in RCA: 88] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- P M Matricardi
- DASRS, RMAS, Laboratory of Immunology and Allergy, Pomezia, Rome, Italy
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