What Is the Evidence Linking Changes in the Microbiota to the Development of Allergic Disease?
Two lines of evidence suggest that environmental changes are a major factor in the development of allergies: the increase in the incidence of allergic diseases over the past 20–30 years and the dichotomy in the rate of allergic disease between industrialized and developing countries. These observations have led researchers to propose the “hygiene hypothesis” for allergies and asthma. Simply stated, a lack of early microbial stimulation results in aberrant immune responses to innocuous antigens later in life [1]. However, an alternative interpretation of the evidence supporting the hygiene hypothesis forms the foundation of the “microbiota (microflora) hypothesis” [2], [3]. The concept is that significant perturbations in gastrointestinal (GI) microbiota composition in westernized areas (due to antibiotic use, dietary changes, and other lifestyle differences) have disrupted the mechanisms of mucosal immunologic tolerance. Epidemiologic and clinical data supporting this interpretation in
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