The Relationship Between Advances in Understanding the Microbiome and the Maturing Hygiene Hypothesis
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Expanding knowledge about an interaction of the bacterial colonization with pathogenic and non-pathogenic bacteria and the human immune system leads to speculation on potential effects on health and disease. Recent advances in sequencing technologies and new bioinformatic possibilities now allow investigating the microbes that colonize the human gut, skin and airways in more detail. In light of the hygiene hypothesis, the impact of the microbial composition of individuals with allergic sensitization and/or atopic diseases, i.e., allergic asthma or atopic eczema, were investigated in several clinical trials. Altered diversity of gut microbiota during infancy as well as colonization with specific pathogenic and apathogenic bacteria has been linked with an elevated risk for allergy. There are ongoing attempts to establish intervention strategies aimed at modifying initial colonization patterns in early life. While results from animal models, in-vitro data and epidemiological studies encourage the concept of a relationship between the microbiome and the development of allergic diseases, the transfer of these findings to intervention strategies still seems to be a major challenge.
KeywordsHygiene hypothesis Microbiome Children Allergy Asthma Allergic rhinitis Probiotics Bacterial lysates Prebiotics Airway pathogens Wheeze
Compliance with Ethics Guidelines
Conflict of Interest
Meike Bendiks has had travel/accommodations expenses covered/reimbursed by Nestle Infant Nutrition and Abbott GmbH.
Matthias Volkmar Kopp has served on boards for ALK-Abello and Novartis Pharma GmbH; has served as a consultant for Chiesi GmbH, Nestle Nutrition, InfectoPharm, Thermo Fisher Scientific and Bencard GmbH; and has had travel/accommodations expenses covered/reimbursed by Chiesi GmbH.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: •• Of major importance
- 16.•• The Human Microbiome Project Consortium. Structure, function and diversity of the healthy human microbiome. Nature. 2012;486:207–14. In a large population, microbiome samples were collected from healthy volunteers. The authors observed a wide variation of diversity even among healthy subjects.CrossRefGoogle Scholar
- 23.•• Azad MB, Konya T, Maughan H, Guttman DS, Field CJ, Chari RS, et al. Gut microbiota of healthy Canadian infants: profiles by mode of delivery and infant diet at 4 months. CMAJ. 2013;185:385–94. The authors found that formula-fed infants had increased richness of species, with overrepresentation of Clostridium difficile compared with breastfed infants. Escherichia-Shigella and Bacteroides species were underrepresented in infants born by cesarean delivery.PubMedGoogle Scholar
- 24.Shen Q, Tuohy KM, Gibson GR, Ward RE. In vitro measurement of the impact of human milk oligosaccharides on the faecal microbiota of weaned formula-fed infants compared to a mixture of prebiotic fructooligosaccharides and galactooligosaccharides. Lett Appl Microbiol. 2011;52:337–43.PubMedCrossRefGoogle Scholar
- 26.•• Azad MB, Konya T, Maughan H, Guttman DS, Field CJ, Sears MR, et al. Infant gut microbiota and the hygiene hypothesis of allergic disease: impact of household pets and siblings on microbiota composition and diversity. Allergy Asthma Clin Immunol. 2013;9:15–23. The study population comprised a small sub-sample of 24 healthy, full-term infants from the Canadian Healthy Infant Longitudinal Development (CHILD) birth cohort and provides new evidence that exposure to siblings and/or pets may influence the gut microbiota in early life. The authors speculate that this might have implications for allergic disease in later life.PubMedCrossRefGoogle Scholar
- 32.•• van Nimwegen FA, Penders J, Stobberingh EE, Postma DS, Koppelman GH, Kerkhof M, et al. Mode and place of delivery, gastrointestinal microbiota, and their influence on asthma and atopy. J Allergy Clin Immunol. 2011;128:948–55. This trial investigated the relationship among microbiota composition, delivery and atopic manifestations at the age of 6–7 years. The authors observed that mode and place of delivery affected the microbiome in the gut, which might subsequently influence the risk of atopic manifestations.PubMedCrossRefGoogle Scholar
- 39.•• Pfefferle PI, Prescott SL, Kopp M. Microbial influence on tolerance and opportunities for intervention with prebiotics/probiotics and bacterial lysates. J Allergy Clin Immunol. 2013;131:1453–63. A comprehensive review on the influence of probiotics, prebiotics and other microorganisms on tolerance development and an overview of clinical trials that investigated several intervention strategies.PubMedCrossRefGoogle Scholar
- 46.Taylor AL, Dunstan JA, Prescott SL. Probiotic supplementation for the first 6 months of life fails to reduce the risk of atopic dermatitis and increases the risk of allergen sensitization in high-risk children: a randomized controlled trial. J Allergy Clin Immunol. 2007;119:184–91.PubMedCrossRefGoogle Scholar
- 49.•• Lau S, Gerhold K, Zimmermann K, Ockeloen CW, Rossberg S, Wagner P, et al. Oral application of bacterial lysate in infancy decreases the risk of atopic dermatitis in children with 1 atopic parent in a randomized, placebo-controlled trial. J Allergy Clin Immunol. 2012;129:1040–7. The trial examines the use of a bacterial lysate. The primary endpoint was negative.PubMedCrossRefGoogle Scholar
- 54.•• Schwerk N, Brinkmann F, Soudah B, Kabesch M, Hansen G. Wheeze in preschool age is associated with pulmonary bacterial infection and resolves after antibiotic therapy. PLoS One. 2011;6:e27913. Investigating a group of preeschool children with therapy-resistant wheeze, Schwerk showed that chronic bacterial infections are relevant and such children benefit significantly from antibiotic therapy.PubMedCrossRefGoogle Scholar
- 57.United Nations: World Urbanization Prospects: The 2007 Revision; United Nations, New York, 2008Google Scholar