The hygiene hypothesis has gained much attention as an explanatory model for increases in the incidence of allergic diseases. Since epidemiological evidence mainly comes from cross-sectional studies, which are not able to elucidate cause— effect relationships, this concept is still in conflict with opposite results. The role of microbial compounds as important exogenous triggers of immuno-programming is central to the hygiene hypothesis. Several prototypical components from both gram-positive and gram-negative bacteria have been investigated under experimental and clinical conditions. These approaches clearly demonstrate that the route of exposure, the time of exposure, and the dose are critical variables, which determine the outcome of downstream immune responses. The innate immune system plays a central role in the initiation of effector responses, by signaling through pattern recognition receptors, particularly toll-like receptors (TLRs) and balancing the type of T-cell effector response, including TH-1, TH-2, and regulatory T cells. Recent studies focus on the role of microbiota and the commensal gut and skin flora as immuno-modulators. Most recently, Acinetobacter lwoffii and Lactococcus lactis have been identified in the environment of traditional farms further supporting the concept that environmental components play a decisive role in programming early immune responses.
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Pfefferle, P.I., Teich, R., Renz, H. (2009). The Immunological Basis of the Hygiene Hypothesis. In: Pawankar, R., Holgate, S.T., Rosenwasser, L.J. (eds) Allergy Frontiers: Epigenetics, Allergens and Risk Factors. Allergy Frontiers, vol 1. Springer, Tokyo. https://doi.org/10.1007/978-4-431-72802-3_19
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