Time to abandon the hygiene hypothesis: new perspectives on allergic disease, the human microbiome, infectious disease prevention and the role of targeted hygiene.
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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DOI：
10.1177/1757913916650225
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发表时间：
2016-07
影响因子：
5.8
通讯作者：
Turner P
中科院分区：
文献类型：
--
作者：
Bloomfield SF;Rook GA;Scott EA;Shanahan F;Stanwell-Smith R;Turner P
回顾过敏性疾病和传染病的负担以及与微生物暴露、人类微生物组和免疫系统之间的联系的证据，并评估我们是否可以制定一种生活方式，将我们与暴露重新联系起来，从而降低过敏性疾病的风险，同时预防传染病。使用基于德尔菲技术的方法，对六位传染病和过敏性疾病专家进行了调查，以便就与目标相关的问题得出群体判断和共识。出现了一些关键主题，有证据表明，与自然环境中的微生物和人类微生物组的相互作用在免疫调节中发挥着重要作用。生活方式和环境暴露的变化、快速城市化、饮食改变和抗生素使用对人类微生物组产生了深远影响，导致免疫耐受失败和过敏性疾病风险增加。尽管证据支持微生物与宿主相互作用驱动的免疫调节概念，但“卫生假说”一词是一个误导性的用词不当。没有充分的证据表明，正如公众所理解的那样，卫生是导致微生物暴露的临床相关变化的原因。有证据表明，一系列策略的组合，包括自然分娩、母乳喂养、通过运动增加社交接触、其他户外活动、减少在室内的时间、饮食和适当使用抗生素，可能有助于恢复微生物组，并可能降低过敏性疾病的风险。预防工作必须集中于生命早期。 “卫生假说”一词必须被抛弃。推广风险评估方法（有针对性的卫生）提供了一个框架，可以最大限度地防止病原体暴露，同时允许基本微生物在家庭成员之间传播。为了以这些发现为基础，我们必须改变公众、公共卫生和专业人士对微生物组和卫生的看法。我们需要恢复公众对卫生作为预防传染病手段的认识。
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. 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. 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. 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.