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.authorBloomfield, Sally F.
dc.contributor.authorRook, Graham A. W.
dc.contributor.authorScott, Elizabeth A.
dc.contributor.authorShanahan, Fergus
dc.contributor.authorStanwell-Smith, Rosalind
dc.contributor.authorTurner, Paul
dc.contributor.funderMedical Research Councilen
dc.contributor.funderNIHR Imperial Biomedical Research Centreen
dc.contributor.funderScience Foundation Irelanden
dc.contributor.funderAbbVieen
dc.contributor.funderAlimentary Healthen
dc.contributor.funderDanoneen
dc.contributor.funderGeneral Millsen
dc.contributor.funderJanssen Biotechen
dc.contributor.funderNutricia Research Foundationen
dc.contributor.funderFriesland Campinaen
dc.contributor.funderKerryen
dc.contributor.funderMead Johnson Nutritionen
dc.contributor.funder4D Pharmaen
dc.contributor.funderSecond Genomeen
dc.contributor.funderSigmoid pharmaen
dc.date.accessioned2019-11-27T09:29:49Z
dc.date.available2019-11-27T09:29:49Z
dc.date.issued2016-06-27
dc.description.abstractAims: 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.description.statusPeer revieweden
dc.description.versionPublished Versionen
dc.format.mimetypeapplication/pdfen
dc.identifier.citationBloomfield, 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: 10.1177/1757913916650225en
dc.identifier.doi10.1177/1757913916650225en
dc.identifier.eissn1757-9147
dc.identifier.endpage224en
dc.identifier.issn1757-9139
dc.identifier.issued4en
dc.identifier.journaltitlePerspectives in Public Healthen
dc.identifier.startpage213en
dc.identifier.urihttps://hdl.handle.net/10468/9258
dc.identifier.volume136en
dc.language.isoenen
dc.publisherSageen
dc.relation.projectinfo:eu-repo/grantAgreement/SFI/SFI Research Centres/12/RC/2273/IE/Alimentary Pharmabiotic Centre (APC) - Interfacing Food & Medicine/en
dc.relation.projectinfo: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.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.urihttp://www.creativecommons.org/licenses/by-nc/3.0/en
dc.subjectAllergyen
dc.subjectInfectious diseaseen
dc.subjectHygieneen
dc.subjectCleaningen
dc.subjectAntibioticsen
dc.subjectDieten
dc.titleTime to abandon the hygiene hypothesis: New perspectives on allergic disease, the human microbiome, infectious disease prevention and the role of targeted hygieneen
dc.typeArticle (peer-reviewed)en
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