Revisiting The Hygiene Theory; Hepatitis A And Tuberculosis Versus Atopy

Yıl 2024, Cilt: 10 Sayı: 2, 163 - 173, 30.06.2024

Yavuz Özer , Haluk Çokuğraş

https://doi.org/10.19127/mbsjohs.1441583

Öz

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

Anahtar Kelimeler

Hygiene hypothesis, asthma, atopy, hepatitis A, tuberculosis

Etik Beyan

The study was approved by the local ethics committee of Istanbul University-Cerrahpaşa, Cerrahpaşa Medical Faculty (Project number: 14647).

Destekleyen Kurum

This work was funded by the Scientific Research Projects Coordination Unit of Istanbul University with the number T-936/06102006.

Kaynakça

• 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.
• Anlar FY, Kabasakal E, Karşi R. Tuberculosis and atopy: A study in an endemic area. Respir Med. 2006;100(9):1647–50.
• Soysal A, Bahçeciler N, Barlan I, Bakir M. Lack of an inverse association between tuberculosis infection and atopy: By T-cell-based immune assay (RD1-ELISpot). Pediatric Allergy and Immunology. 2008;19(8):709–15.
• Linneberg A, Østergaard C, Tvede M, Andersen LP, Nielsen NH, Madsen F, et al. IgG antibodies against microorganisms and atopic disease in Danish adults: The Copenhagen Allergy Study. Journal of Allergy and Clinical Immunology. 2003;111(4):847–53.
• Law M, Morris JK, Wald N, Luczynska C, Burney P. Changes in atopy over a quarter of a century, based on cross sectional data at three time periods. Br Med J. 2005;330(7501):1187–8.
• Uter W, Stock C, Pfahlberg A, Guillén-Grima F, Aguinaga-Ontoso I, Brun-Sandiumenge C, et al. Association between infections and signs and symptoms of “atopic” hypersensitivity - Results of a cross-sectional survey among first-year university students in Germany and Spain. Allergy: European Journal of Allergy and Clinical Immunology. 2003;58(7):580–4.
• Matricardi PM, Rosmini F, Panetta V, Ferrigno L, Bonini S. Hay fever and asthma in relation to markers of infection in the United States. Journal of Allergy and Clinical Immunology. 2002;110(3):381–7.
• Baris S, Abolhassani H, Massaad MJ, Al-Nesf M, Chavoshzadeh Z, Keles S, et al. The Middle East and North Africa Diagnosis and Management Guidelines for Inborn Errors of Immunity. J Allergy Clin Immunol Pract. 2023 Jan;11(1):158-180.e11.
• Rook GAW, Bloomfield SF. Microbial exposures that establish immunoregulation are compatible with targeted hygiene. J Allergy Clin Immunol. 2021 Jul;148(1):33–9.
• Kocabaş E, Yapicioǧlu H, Yildizdaş D, Kendirli SG, Burgut R. The prevalence of atopy in children with antibodies against hepatitis A virus and hepatitis B virus. Turkish Journal of Pediatrics. 2006;48(3):189–96.
• Alvarez CS, Avilés-Santa ML, Freedman ND, Perreira KM, Garcia-Bedoya O, Kaplan RC, et al. Associations of Helicobacter pylori and hepatitis A seropositivity with asthma in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL): addressing the hygiene hypothesis. Allergy, Asthma and Clinical Immunology. 2021 Nov;17(1):120.
• Gonzalez-Quintela A, Gude F, Boquete O, Aguilera A, Rey J, Meijide LM, et al. Association of hepatitis A virus infection with allergic sensitization in a population with high prevalence of hepatitis A virus exposure. Allergy: European Journal of Allergy and Clinical Immunology. 2005;60(1):98–103.
• Aggarwal R, Goel A. Hepatitis A: Epidemiology in resource-poor countries. Curr Opin Infect Dis. 2015;28(5):488–96.
• Byrne AL, Marais BJ, Mitnick CD, Garden FL, Lecca L, Contreras C, et al. Asthma and atopy prevalence are not reduced among former tuberculosis patients compared with controls in Lima, Peru. BMC Pulm Med. 2019 Feb;19(1):40.
• Yeşil Ş, Kan A, Abdulmajed O, Bakirtaş A, Sultan N, Demirsoy MS. Role of hygienic factors in the etiology of allergic disorders in children. Turk J Med Sci. 2017;47(2):627–32.
• Yazdanbakhsh M, Van Den Biggelaar A, Maizels RM. Th2 responses without atopy: Immunoregulation in chronic helminth infections and reduced allergic disease. Trends Immunol. 2001 Jul;22(7):372-7.
• Obihara CC, Kimpen JLL, Gie RP, Van Lill SW, Hoekstra MO, Marais BJ, et al. Mycobacterium tuberculosis infection may protect against allergy in a tuberculosis endemic area. Clinical and Experimental Allergy. 2006;36(1):70–6.
• Cakir M, Akcay S, Karakas T, Gedik Y, Okten A, Orhan F. Prevalence of atopy in children with type 1 diabetes mellitus, hepatitis B virus carriers, and healthy children: Role of T helper 1 (Th1)-type immune response. Allergy Asthma Proc. 2008;29(2):166–70.
• Grüber C, Illi S, Plieth A, Sommerfeld C, Wahn U. Cultural adaptation is associated with atopy and wheezing among children of Turkish origin living in Germany. Clinical and Experimental Allergy. 2002;32(4):526–31.
• Brooks C, Pearce N, Douwes J. The hygiene hypothesis in allergy and asthma: An update. Curr Opin Allergy Clin Immunol. 2013 Feb;13(1):70-7.
• Kim HY, Eyheramonho MB, Pichavant M, Cambaceres CG, Matangkasombut P, Cervio G, et al. A polymorphism in TIM1 is associated with susceptibility to severe hepatitis A virus infection in humans. Journal of Clinical Investigation. 2011;121(3):1111–8.
• Gupta V, Kumar R, Sood U, Singhvi N. Reconciling Hygiene and Cleanliness: A New Perspective from Human Microbiome. Indian J Microbiol. 2020 Mar;60(1):37-44.
• Pierau M, Arra A, Brunner-Weinzierl MC. Preventing Atopic Diseases During Childhood - Early Exposure Matters. Front Immunol. 2021;12:617731.