Dirt, Germs and Allergies Did Charlie Brown’s friend, Pigpen, know something the rest of the Peanuts

gang didn’t know? Pigpen may have repelled his friends with his personal dust cloud, but that dirty shield also may have protected him from allergies and asthma. Without realizing it, Pigpen may have been demonstrating an extreme form of the “hygiene hypothesis.” In 1989, David Strachan, at the London School of Hygiene and Tropical Medicine, wondered if the increased incidence of asthma and allergies in Western populations might be due to improvements in sanitation, personal hygiene, and related social behaviors. This idea became known as the hygiene hypothesis and, in a nutshell, suggests we might be too clean for our own good. National surveys have noted more than fifty percent of Americans are sensitive to at least one type of allergen. Moreover, asthma prevalence has been increasing each decade for the last two or three decades. Chronic inflammatory conditions, such as colitis and Crohn’s disease, and other autoimmune diseases also appear to be increasing. These allergic reactions and inflammatory conditions are the result of overactive or misdirected immune responses. Why the aberrant immune responses? Over the last century, we have moved off the farms and out of the woods into hermetically sealed, air-conditioned buildings filled with antibacterial soaps, medicines, vaccines, and sterilized goods and foods. We have left nature—with all its dirt, livestock and unwashed masses—behind and so changed the once normal patterns of childhood exposures and immune responses to nature’s microbes. Consequently, our immune systems are not being primed and regulated to respond appropriately to what is self and non-self, and to what is harmful and what is not.

1

That’s the theory anyway. It’s an interesting idea, but it quickly becomes difficult to prove and, if true, difficult to address medically and socially. The theory suggests that fewer infections and less “normal” microbial exposure at critical stages of childhood leads to an imbalance in two types of immunity called Th1 and Th2. Type 1 helper T cells (Th1) are thought to play a dominant role in autoimmune diseases such as multiple sclerosis and Crohn’s disease. Type 2 helper T cells (Th2) are thought to dominate immune responses in allergic diseases such as asthma, dermatitis and hay fever. Somehow the absence of once common childhood infections tips the Th1-Th2 seesaw too far to one side, thereby causing harmful immune responses later in life. That immunological seesaw can be seen in Third World immigrants who were exposed to numerous infections and parasites in childhood, but raised their own children in Western countries. Their children experience rates of asthma and inflammatory diseases similar to rates of native-born children in Europe and North America. There is some direct evidence for the ability of pathogens and parasites from the “dirtier” environments of the world to protect against inflammatory diseases. Recently, patients suffering from inflammatory bowel disease were given regular doses of intestinal whipworms. The ingested worms stopped the symptoms of diarrhea and abdominal pain, presumably by causing subtle alterations to the immune system’s Th1-Th2 balancing act. Another study also suggested that stomach-dwelling bacteria (Helicobacter pylori) might protect children from asthma. This bacterium is common in the developing world, but less so in the sanitized, antibiotic-rich West. Somehow these bacteria protect the young against asthma, but later threaten the old with ulcers and stomach cancer. These sound like terrible trade-offs: worms versus inflammation, asthma versus ulcers. Is

2

there anything better to offer patients? In a tongue-in-cheek comment in the New England Journal of Medicine a few years ago, Scott Weiss of the Channing Laboratory in Boston wrote, “Eating dirt or moving to a farm are, at best, theoretical rather than practical clinical recommendations….” A more reasonable recommendation might be to stay out of the grocery store aisles that contain all those anti-bacterial products. Alcohol- and Clorox-based wipes. Hand wipes. Face wipes. Baby wipes. Waterless hand soaps. Disinfecting bleach wipes and sprays. It’s a chemical arsenal with which to wage war against the microbial world. Some experimental data from Belgium suggests that these bleach-based sanitizing products may actually promote “allergic sensitization be compromising the permeability or the immunoregulatory function” of the skin. It’s the Chlorine Hypothesis versus the Hygiene Hypothesis. What to do? Well, it my be helpful to remember the Pigpen Hypothesis, which states that childhood sniffles are not fatal, and that no one ever came to much harm from walking barefoot in the backyard, playing with the neighborhood dogs, or slapping together a few mud pies.

Read more about the Hygiene Hypothesis at: http://www.sciencenews.org/pages/sn_arc99/8_14_99/bob2.htm

3