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Let them eat dirt.

February 25, 2015

New Englanders have very bad memories.  That’s the only explanation for why anyone lives here.  Every year in the fall people reminisce about how bad last winter was, and hope that the winter to come will be better.  What these hardy souls don’t remember is that IT NEVER IS BETTER.  It hasn’t been better for the entire history of New England.  NPR did a bit a few days ago about how the Native Americans indigenous to this region survived winter.  Turns out they did just fine, thank you, with solutions to heating and keeping warm outdoors that used natural habitat and took cues from local animals.  The Europeans, having decided their way was better, froze with their wooden houses, smoky fireplaces, and inadequate wool clothing.  The takeaway of the piece was that the Native Americans worked with the environment, and the Europeans tried to change the environment.

The same thing seems to be happening in the world of microbes.  Population studies suggest that as infectious disease incidence goes down and socio-economic status goes up, allergic and immunological diseases become more prevalent.  This is what us medicine folks call “The Hygiene Hypothesis”.  Here’s how the FDA puts it: “This hypothesis suggests that the critical post-natal period of immune response is derailed by the extremely clean household environments often found in the developed world. In other words, the young child’s environment can be ‘too clean’ to pose an effective challenge to a maturing immune system.”

In other words, we have changed the environment.  Unlike the Europeans and New England winters, we have been very effective in changing it.  Now, most of this has been to the good, of course.  Antibiotics and vaccinations, clean water and sewage systems have vastly improved the chances of health and survival for children.  However, in areas of the world in which health and hygiene measures have lagged, infectious disease rates are higher but allergic conditions are more rare.  An excellent review of the hygiene hypothesis can be found in the journal Clinical and Experimental Immunology (H Okada, C Kuhn, H Feillet, and J-F Bach. Clin Exp Immunol. 2010 Apr; 160(1): 1–9)

 According to the ‘hygiene hypothesis’, the decreasing incidence of infections in western countries and more recently in developing countries is at the origin of the increasing incidence of both autoimmune and allergic diseases. The strongest evidence for a causal relationship between the decline of infections and the increase in immunological disorders originates from animal models and a number of promising clinical studies, suggesting the beneficial effect of infectious agents or their composites on immunological diseases. The leading idea is that some infectious agents – notably those that co-evolved with us – are able to protect against a large spectrum of immune-related disorders.
Hence my last post about the dangers of dishwashers.  But here’s my question: isn’t the exchange of infectious disorders for allergic ones kind of what we were going for?  Cholera kills a whole lot more kids than asthma does.  We could all go back to living off the land and having our kids rake hay and muck stalls, thus exposing them to all kinds of presumably useful microbes, but certainly we don’t wish upon them a return to the constant threat of illness.  I guess the best we can do is to be a little less obsessive about cleanliness, a little more accepting of the annual cold and flu season, and a little more willing to make mudpies.  I won’t, however, ever be accepting of New England winter.
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