The evolutionary context of chronic allergic conditions : The Hiwi of Venezuela

The question of why populations with ecologies that resemble our evolutionary past rarely experience allergic conditions such as asthma has intrigued many biomedical scientists. Here we present descriptive data on the ecological context of allergic sensitization among the Hiwi of southwestern Venezuela and suggest reasons for why this and other lowland South American Indian groups do not express the allergic response at levels seen in industrialized contexts. Allergic sensitization among the Hiwi appears to be negligible. This absence occurs in the context of high exposure to macroparasites (mainly hookworm), nutritional stress, frequent and prolonged breastfeeding, low indoor allergen deposition, and few hours spent per day indoors. We conclude that seeking unidimensional answers to the question of why isolated human groups generally experience few allergic conditions is potentially flawed because allergies are produced by a multifaceted immunoglobulin E (IgE) system that responds in complex ways to the environmental and behavioral exposures we examined. Instead, we propose a general model of physiological trade-offs in energy allocation between production of IgE of undefined specificity and production of allergen-specific IgE. In addition, we consider the simultaneous effects that exposures such as nutritional stress, allergen exposure, and breastfeeding may have on these trade-offs.