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Atopic dermatitis and the hygiene hypothesis revisited.
Current Problems in Dermatology
|May 18, 2011
Summary
Exposure to microbes, like helminths and farm environments, may protect against atopic dermatitis (AD). Antibiotic use increases AD risk, while childhood vaccinations show no effect. Further research into gene-environment interactions is recommended.
Area of Science:
- Immunology
- Epidemiology
- Environmental Health
Background:
- The hygiene hypothesis suggests reduced microbial exposure increases atopic dermatitis (AD) risk.
- Significant new research has emerged since the last systematic review in 2005.
Purpose of the Study:
- To systematically review population-based studies on AD risk factors.
- To examine associations between AD and infections, immunizations, antibiotics, and environmental exposures impacting microbial burden.
Main Methods:
- Systematic literature search of Medline from 1966 to June 2010.
- Inclusion of 49 additional relevant studies.
- Analysis of epidemiological data on AD risk.
Main Results:
- Inverse relationship found between AD and endotoxin, early daycare, and farm/dog exposure.
- Helminth infections show a protective effect against AD.
- Antibiotic use is associated with increased AD risk; vaccinations show no effect.
- Cat exposure with skin barrier impairment is positively associated with AD.
- Unpasteurized farm milk consumption appears protective.
Conclusions:
- Strong evidence supports helminth infections inversely correlating with AD.
- Increased exposure to non-pathogenic microbes (e.g., farm environments, unpasteurized milk) likely explains protective effects.
- Broad-spectrum antibiotic use may increase AD risk.
- Future research should investigate gene-environment interactions and skin barrier integrity in AD.
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