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

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dc.contributor.author Bloomfield, Sally F.
dc.contributor.author Rook, Graham A. W.
dc.contributor.author Scott, Elizabeth A.
dc.contributor.author Shanahan, Fergus
dc.contributor.author Stanwell-Smith, Rosalind
dc.contributor.author Turner, Paul
dc.date.accessioned 2019-11-27T09:29:49Z
dc.date.available 2019-11-27T09:29:49Z
dc.date.issued 2016-06-27
dc.identifier.citation Bloomfield, S. F., Rook, G. A. W., Scott, E. A., Shanahan, F., Stanwell-Smith, R. and Turner, P. (2016) 'Time to abandon the hygiene hypothesis: new perspectives on allergic disease, the human microbiome, infectious disease prevention and the role of targeted hygiene', Perspectives in Public Health, 136(4), pp. 213-224. doi: 10.1177/1757913916650225 en
dc.identifier.volume 136 en
dc.identifier.issued 4 en
dc.identifier.startpage 213 en
dc.identifier.endpage 224 en
dc.identifier.issn 1757-9139
dc.identifier.uri http://hdl.handle.net/10468/9258
dc.identifier.doi 10.1177/1757913916650225 en
dc.description.abstract 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. en
dc.format.mimetype application/pdf en
dc.language.iso en en
dc.publisher Sage en
dc.rights © The Author(s) 2016. This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 3.0 License (http://www.creativecommons.org/licenses/by-nc/3.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page (https://us.sagepub.com/en-us/nam/open-access-at-sage). en
dc.rights.uri http://www.creativecommons.org/licenses/by-nc/3.0/ en
dc.subject Allergy en
dc.subject Infectious disease en
dc.subject Hygiene en
dc.subject Cleaning en
dc.subject Antibiotics en
dc.subject Diet en
dc.title Time to abandon the hygiene hypothesis: New perspectives on allergic disease, the human microbiome, infectious disease prevention and the role of targeted hygiene en
dc.type Article (peer-reviewed) en
dc.internal.authorcontactother Fergus Shanahan, APC Microbiome Institute, University College Cork, Cork, Ireland. +353-21-490-3000 Email:f.shanahan@ucc.ie en
dc.internal.availability Full text available en
dc.description.version Published Version en
dc.contributor.funder Medical Research Council en
dc.contributor.funder NIHR Imperial Biomedical Research Centre en
dc.contributor.funder Science Foundation Ireland en
dc.contributor.funder AbbVie en
dc.contributor.funder Alimentary Health en
dc.contributor.funder Danone en
dc.contributor.funder General Mills en
dc.contributor.funder Janssen Biotech en
dc.contributor.funder Nutricia Research Foundation en
dc.contributor.funder Friesland Campina en
dc.contributor.funder Kerry en
dc.contributor.funder Mead Johnson Nutrition en
dc.contributor.funder 4D Pharma en
dc.contributor.funder Second Genome en
dc.contributor.funder Sigmoid pharma en
dc.description.status Peer reviewed en
dc.identifier.journaltitle Perspectives in Public Health en
dc.internal.IRISemailaddress f.shanahan@ucc.ie en
dc.relation.project info:eu-repo/grantAgreement/SFI/SFI Research Centres/12/RC/2273/IE/Alimentary Pharmabiotic Centre (APC) - Interfacing Food & Medicine/ en
dc.relation.project info:eu-repo/grantAgreement/RCUK/MRC/MR/K010468/1/GB/Mechanisms underlying the physiological and cellular response to food allergen challenge in human subjects with peanut allergy/ en
dc.identifier.eissn 1757-9147


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© The Author(s) 2016. This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 3.0 License (http://www.creativecommons.org/licenses/by-nc/3.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page (https://us.sagepub.com/en-us/nam/open-access-at-sage). Except where otherwise noted, this item's license is described as © The Author(s) 2016. This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 3.0 License (http://www.creativecommons.org/licenses/by-nc/3.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page (https://us.sagepub.com/en-us/nam/open-access-at-sage).
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