oa Current Allergy & Clinical Immunology - Infection and atopic disease burden in African countries : key to solving the 'hygiene hypothesis'? : review article

Volume 20 Number 4
  • ISSN : 1609-3607



While most African countries are experiencing an epidemic rise in chronic infectious diseases, such as tuberculosis, malaria, HIV and parasites, industrialised, westernised countries are experiencing an epidemic rise in atopic and auto-immune diseases. One of the most popular explanations for this increase is the so-called 'hygiene hypothesis', which suggests that a decrease or altered exposure to microbes in the environment, as a result of improved sanitation and personal hygiene, smaller family sizes, shorter duration of breastfeeding, immunisations and lack of serious childhood infections, results in alteration of the immunoregulation. It has been demonstrated in animal studies that some infections may modulate the expression of the immune system, resulting in the suppression of allergic inflammation. This is achieved through the priming of regulatory T-cell activity, and these cells may be responsible for the protection of populations with chronic infectious diseases against atopic disease. If the specific molecules involved in the immunomodulatory and protective defence mechanisms of the host against these infectious agents were to be defined or isolated, they could be manipulated in such a manner as to warrant application for the development of both novel therapeutic and prophylactic strategies against atopic disease. African countries, with both a high burden of chronic and persistent infection and an increasing burden of atopic diseases may form an ideal 'nature's own laboratory' to investigate the hygiene hypothesis.

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