Revisiting The Hygiene Theory; Hepatitis A And Tuberculosis Versus Atopy
Abstract
Objective: According to the hygiene hypothesis an inverse association between allergic sensitization and exposure to infections and has been reported. In this study, we investigated the relationship between atopy and tuberculosis (TB) and hepatitis A virus (HAV) infections in children.
Methods: A cross-sectional study was performed and included 39 healthy children who were followed up with TB, 40 healthy children who were with HAV seropositive, and 30 healthy children who were seronegative for HAV and tuberculin skin test (TST) response as negative. Serological tests for HAV (anti-HAV immunoglobulin G), skin prick test (SPT) investigations for the detection of atopy, and TST were carried out.
Results: The study included 39 (16 males, 23 females) with TB, 40 (16 males, 24 females) with HAV seropositive, and 30 (10 males, 20 females) healthy controls. There was no statistically significant difference between the groups in terms of age and gender (p>0.05). The SPT positivity was 28.2% (n=11) in the TB group, 15% (n=6) in the HAV group, and 30% (n=9) in the control group. There was no statistically significant difference between the groups in terms of SPT positivity (p=0.148). There was no statistically significant difference between the groups in terms of total serum IgE level (p=0.776).
Conclusion: Our study does not support the hypothesis that HAV and TB suppress the development of atopy. We think that encountering infections during the immune maturation period is a condition that is protective in the development of atopy due to multifactorial reasons
Keywords
Hygiene hypothesis, asthma, atopy, hepatitis A, tuberculosis
Supporting Institution
This work was funded by the Scientific Research Projects Coordination Unit of Istanbul University with the number T-936/06102006.
Ethical Statement
The study was approved by the local ethics committee of Istanbul University-Cerrahpaşa, Cerrahpaşa Medical Faculty (Project number: 14647).
References
- Bloomfield SF, Rook GAW, Scott EA, Shanahan F, Stanwell-Smith R, Turner P. Time to abandon the hygiene hypothesis: New perspectives on allergic disease, the human microbiome, infectious disease prevention and the role of targeted hygiene. Perspect Public Health. 2016 Jul;136(4):213–24.
- Mallol J, Crane J, von Mutius E, Odhiambo J, Keil U, Stewart A. The International Study of Asthma and Allergies in Childhood (ISAAC) Phase Three: A global synthesis. Allergol Immunopathol (Madr). 2013;41(2):73–85.
- Jatzlauk G, Bartel S, Heine H, Schloter M, Krauss-Etschmann S. Influences of environmental bacteria and their metabolites on allergies, asthma, and host microbiota. Allergy. 2017 Dec;72(12):1859-67.
- Strachan DP. Hay fever, hygiene, and household size. Br Med J. 1989;299(6710):1259–60.
- Jutel M, Akdis CA. T-cell subset regulation in atopy. Curr Allergy Asthma Rep. 2011 Apr;11(2):139-45.
- Rook GAW. Review series on helminths, immune modulation and the hygiene hypothesis: The broader implications of the hygiene hypothesis. Immunology. 2009 Jan;126(1):3-11.
- Blaser MJ, Falkow S. What are the consequences of the disappearing human microbiota? Nat Rev Microbiol. 2009;7(12):887–94.
- Von Mutius E. Infection: Friend of foe in the development of atopy and astma? The epidemiological evidence. European Respiratory Journal. 2001;18(5):872–81.
- van Tilburg Bernardes E, Arrieta MC. Hygiene Hypothesis in Asthma Development: Is Hygiene to Blame? Arch Med Res. 2017 Nov;48(8):717-26.
- Perkin MR, Strachan DP. The hygiene hypothesis for allergy - conception and evolution. Frontiers in allergy. 2022;3:1051368.