The Hygiene Hypothesis– On the Downside of Hygiene

When we type in “allergies” on the search bar on Google, an endless list of possible allergies pops up. Some of it can be the usual dust or seafood but some of them are rather weird and peculiar. A recent study shows that around 30% of Indians suffer from at least one form of allergy. As a person with a rather allergy prone immune system, sneezing and rashes have become a part of my daily life. This has indeed created a peculiar interest in allergies for me. How much weirder can they get? The story gets even more peculiar than we can imagine.

When we look around in the world today, the developed nations have attained very high levels of public hygiene and sanitation. The developing world is making advances by the minute. And yet, the incidence of allergies has also been increasing manifold. This presents a huge public health paradox especially in the developed nations where allergies have come under the purview of public policy. A debatable theory was developed in 1989 to explain this paradox. Rather old, it has come to explain other problems as well along the years.

The hygiene hypothesis states that as environments get cleaner, individuals tend to become more prone to allergies. The idea of cleaner environments as presented by this hypothesis is a very broad term which extends to the include lifestyle in terms of food habits, child rearing practices, family structure and other related factors. This may seem misleading at first but research points the other way. In 1999, Charolette Braun-Fahrlander in Switzerland showed that children growing up in farms were less likely to develop hay fever and other related allergies. Many other studies have also brought out similar results.

There is a delicate balance between the body’s immune system and the microbes that have co-evolved with human beings. These microbes have helped strengthen the immune system. Researchers at the University of Virginia in their works showed that apart from hygiene ways of living, especially in the context of asthma, which involved reduced physical activity, mites in carpets etc. have led to increased rates of asthma. In the context of food allergy, research has shown that early exposure to foods reduces the risk of food allergies but contrary to the fact, most parents are reluctant to expose their infants to foods at an early age.

Talking about food allergies, we have this perception that food allergies are non-existent in India. The Institute of Food Research, UK undertook a cross-sectional study of the Asian region and concluded that in India, food allergies were nearly negligent and a similar pattern was found in most of Asia other than Hong Kong where it was found that the trends were more similar to that of the West. The rationale that they arrived at was that the nature of processed food have changed the way in which the digestive system breaks down and absorbs food and also the kind of microflora and microbes that grow in the intestines. This could indicate to a possible increase in food allergies in the future among the Indian diaspora.

There is a lot of insight that we can get from these paradoxical findings. The perception that being very clean is beneficial always is challenged. After all, we cannot take everything as a given without critical thought. Cleanliness to an extent is important for our health and quality of life but being obsessed about it is not going to make anything better. Another important thing to take away from this is the waysin which parenting can be changed. Many parents are very sceptical of introducing their children to solid foods at early ages. The mechanism behind this is that early exposure while the immune system is developing makes development of oral tolerance quicker and stronger. Reducing an emphasis on the use of anti-bacterial soaps and other such newly developed hygiene products can increase exposure to useful microbes, strengthening the immune system and consequently reducing the proneness to allergies.

For a person with a lot of allergies, this hypothesis is a big relief. Trying to keep oneself in vacuum to prevent an allergy episode is no longer going to be on my checklist of things to do in a new environment. It is time that we rethink the ways in which we have come to conceptualise health and hygiene. There might be benefits from things that we have disregarded without any second thought like the unpasteurised milk or that clay and mud that we once used to play with.

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