Hygiene and Other Early Childhood Influences on the Subsequent Function of the Immune SystemRook G.A.W.
University College London (UCL), London, UK
The current ‘Darwinian’ synthesis of the hygiene (or ‘Old Friends’) hypothesis suggests that the increase in chronic inflammatory disorders that started in Europe in the mid-19th century and progressed until the late 20th century is at least partly attributable to immunodysregulation resulting from lack of exposure to microorganisms that were tasked by co-evolutionary processes with establishing the ‘normal’ background levels of immunoregulation, a role that they perform in concert with the normal microbiota. This is an example of ‘evolved dependence’. The relevant organisms co-evolved with mammals, already accompanied early hominids in the Paleolithic era and are associated with animals, mud and faeces. These organisms often establish stable carrier states, or are encountered continuously in primitive environments as ‘pseudocommensals’ from mud and water. These organisms were not lost during the first epidemiological transition, which might even have resulted in increased exposure to them. However, the crucial organisms are lost progressively as populations undergo the second epidemiological transition (modern urban environment). Recently evolved sporadic ‘childhood infections’ are not likely to have evolved immunoregulatory roles, and epidemiology supports this contention. The consequences of the loss of the Old Friends and distortion of the microbiota are aggravated by other modern environmental changes that also lead to enhanced inflammatory responses (obesity, vitamin D deficiency, pollution (dioxins), etc.). The range of chronic inflammatory disorders affected may be larger than had been assumed (allergies, autoimmunity, inflammatory bowel disease, but also coeliac disease, food allergy, vascular disease, some cancers, and depression/anxiety when accompanied by raised inflammatory cytokines).
Prof. Graham A.W. Rook
Department of Infection, Windeyer Institute for Medical Sciences
University College London (UCL), 46 Cleveland Street
London W1T 4JF (UK)
Tel. +44 20 7679 9489, E-Mail firstname.lastname@example.org
Published online: July 05, 2011
Number of Print Pages : 10
Number of Figures : 3, Number of Tables : 0, Number of References : 64
Digestive Diseases (Clinical Reviews)
Vol. 29, No. 2, Year 2011 (Cover Date: July 2011)
Journal Editor: Malfertheiner P. (Magdeburg)
ISSN: 0257-2753 (Print), eISSN: 1421-9875 (Online)
For additional information: http://www.karger.com/DDI