Search
Close
Search
Advanced Search
Search Menu
AI Discovery Assistant

Extract

Conflicts of interest None declared.

ORIGINAL ARTICLE, p1255

Much research on the aetiology of atopic dermatitis has been focused on genetics, particularly regarding filaggrin. However, fundamental questions on environmental factors remain unanswered. Between 1964 and 1999 the prevalence of atopic dermatitis, hay fever and asthma in Aberdeen increased by 300%, 400% and 500%, respectively,1 reflecting a general trend in industrialized countries. During the last decade this increased prevalence has persisted.2 So what has caused this increase?

For many years the favoured explanation has been the ‘hygiene hypothesis’.3 Over the last 50 years we have been having smaller families, and we encounter fewer microbes in childhood, so our immune systems do not mature so well. But the ‘hygiene hypothesis’, has been criticized for failing to explain several inconsistencies.4 One inconsistency, for example, is why infections with airborne viruses do not ‘protect’ from atopic allergic sensitization.4 So what else has changed in our lifestyle over the last 50 years? Exposure to protein allergens has been proposed by many as a key factor. The use of carpets and central heating has led to higher house dust mite exposure in some countries. But even with house dust mite as a causative influence on the development of atopic disease we again find conflicting and inconsistent results.5, 6 Despite exhaustive global research into the role of microbes and protein allergen exposure in atopic disease pathogenesis, no consistent causality emerges. So, if these changes to our lifestyle are not the full answer, what are we left with?

Issue Section:
Commentaries
You do not currently have access to this article.
Download all slides