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It's official - the medical community has accepted that a key element in preventing allergies and asthma is early childhood exposure to allergens - whether peanuts, dust, or pets. Instead of avoiding the allergens (which was the medical advice for decades) - getting early exposure to them is key to preventing allergies. Apparently growing up on a farm is best (with exposure to farm dirt and dust), especially a dairy farm with animals and raw milk (a number of studies have found that unprocessed raw milk and its microbes also helps health). But if one doesn't live on a farm, then having furry pets in early childhood is also beneficial in reducing the incidence of allergies. The following study shows that microbes are involved - pet microbes were found in the guts of many of those children who did not develop early allergies! From Medscape:

Furry Pets 'Enrich' Gut Bacteria of Infants at Risk for Allergies

In a small, preliminary study, infants in households with furry pets were found to share some of the animals' gut bacteria - possibly explaining why early animal exposure may protect against some allergies, researchers say. The infants' mothers had a history of allergy, so the babies were at increased risk. It was once thought that pets might be a trigger for allergies in such children, the authors pointed out online September 3 in the Journal of Allergy and Clinical Immunology.

"Earlier it was thought that exposure to pets early in childhood was a risk factor for developing allergic disease," coauthor Dr. Merja Nermes, of the University of Turku in Finland, told Reuters Health by email. "Later epidemiologic studies have given contradictory results and even suggested that early exposure to pets may be protective against allergies, though the mechanisms of this protective effect have remained elusive."Adding pet microbes to the infant intestinal biome may strengthen the immune system, she said.  ...continue reading "Early Childhood Experiences Key to Preventing Allergies"

The key finding in this research (they studied mice, but this process would also happen in humans) is that: the presence of microbes specifically blocks the immune cells responsible for triggering allergies. Once again we see the importance of a healthy and diverse microbiota (the community of microbes within us), and the need to nurture it from birth. Studies have shown the importance of the first year of life in establishing a healthy microbiome and the development of the immune system. A number of studies have shown that the presence of pets or animals (e.g., living on a farm) reduces the incidence of allergies in children.From Science Daily:

Role of microbiota in preventing allergies

The human body is inhabited by billions of symbiotic bacteria, carrying a diversity that is unique to each individual. The microbiota is involved in many mechanisms, including digestion, vitamin synthesis and host defense. It is well established that a loss of bacterial symbionts promotes the development of allergies. Scientists at the Institut Pasteur have succeeded in explaining this phenomenon, and demonstrate how the microbiota acts on the balance of the immune system: the presence of microbes specifically blocks the immune cells responsible for triggering allergies. 

The hygiene hypothesis suggests a link between the decline in infectious diseases and the increase in allergic diseases in industrialized countries. Improvements in hygiene levels necessarily lead to reduced contact with microbes that is paralleled by an increased incidence in allergic and autoimmune diseases, such as type 1 diabetes.

Epidemiological studies have substantiated this hypothesis, by showing that children living in contact with farm animals -- and therefore with more microbial agents -- develop fewer allergies during their lifetime. Conversely, experimental studies have shown that administering antibiotics to mice within the first days of life results in a loss of microbiota, and subsequently, in an increased incidence in allergy.

However, until now, the biological mechanisms underlying this phenomenon remained unclear. In this study published in Science, the team led by Gérard Eberl (head of the Microenvironment and Immunity Unit at the Institut Pasteur) shows that, in mice, symbiotic intestinal microbes act on the immune system by blocking allergic reactions.

Several types of immune response can be generated in order to defend the organism. The presence of bacterial or fungal microbes provokes a response from immune cells known as type 3 cells. These immune cells coordinate the phagocytosis and killing of the microbes. However, in the case of infection by pathogenic agents that are too large to be handled by type 3 cells (such as parasitic worms and certain allergens), the cells that organize the elimination of the pathogen, but also allergic reactions, are known as type 2 cells.

In this study, scientists at the Institut Pasteur have shown that type 3 cells activated during a microbial aggression act directly on type 2 cells and block their activity. Type 2 cells are consequently unable to generate allergic immune responses. This work demonstrates that the microbiota indirectly regulates type 2 immune responses by inducing type 3 cells.

These results explain how an imbalance in microbiota triggers an exaggerated type 2 immune response normally used to fight large parasites, but that also leads to allergic responses....In terms of allergy treatment, a hitherto unexplored therapeutic approach consists therefore in stimulating type 3 cells by mimicking a microbial antigen in order to block allergy-causing type 2 cells.

The researchers were interested in lifestyle factors that are associated with lower rates of allergies.  Prior research has shown that such lifestyle factors are : living on a farm, introducing fish into the child’s diet at an early age, having pets early in life, parental cleaning of the child’s pacifier by sucking it, crowded living conditions, early daycare attendance, and having siblings. This study found that in households washing dishes by hand, rather than in a dishwasher, there are lower rates of allergies and eczema in children. In addition, the study found that consuming fermented or farm-bought food could decrease the likelihood of allergies further. It is thought that early exposure to microbes stimulates the immune system in beneficial ways. Dishwashers leave fewer bacteria behind on dishes than hand washing dishes. Living in a household that hand-washes means family members are eating off of plates and cutlery that have more bacteria, and therefore they are getting more microbial exposure. There could also be more bacteria in the air when dishes are hand washed or even some other lifestyle factor that these households have in common.From NPR:

Kids, Allergies And A Possible Downside To Squeaky Clean Dishes

Could using a dishwashing machine increase the chances your child will develop allergies? That's what some provocative new research suggests — but don't tear out your machine just yet.The study involved 1,029 Swedish children (ages 7 or 8) and found that those whose parents said they mostly wash the family's dishes by hand were significantly less likely to develop eczema, and somewhat less likely to develop allergic asthma and hay fever.

The findings are the latest to support the "hygiene hypothesis," a still-evolving proposition that's been gaining momentum in recent years. The hypothesis basically suggests that people in developed countries are growing up way too clean because of a variety of trends, including the use of hand sanitizers and detergents, and spending too little time around animals.As a result, children don't tend to be exposed to as many bacteria and other microorganisms, and maybe that deprives their immune system of the chance to be trained to recognize microbial friend from foe.That may make the immune system more likely to misfire and overreact in a way that leads to allergies, eczema and asthma, Hesselmar says.

"The hypothesis was that these different dishwashing methods ... are not equally good in reducing bacteria from eating utensils and so on," Hesselmar says. "So we thought that perhaps hand dishwashing was less effective, so that you are exposed to more bacteria" in a way that's helpful.

In a study released Monday in the online version of the journal Pediatrics, the researchers report what they found: In families who said they mostly wash dishes by hand, significantly fewer children had eczema, and somewhat fewer had either asthma or hay fever, compared to kids from families who let machines wash their dishes.

Still, there are other possible explanations, Hesselmar and Mahr both caution. Though the researchers took economic status into account in the study, it could be that people who don't have dishwashers are alike in some other way that reduces their tendency to get allergies. Interestingly, for example, certain other lifestyle characteristics — eating fermented foods regularly, and tending to buy some foods straight from the farm — seemed to strengthen the "protective" effect in families without dishwashers.

This research supports the growing evidence for the importance of microbes in the health of young children. Even the type of milk a child drinks is important. From Science Daily:

Pediatric allergology: Fresh milk keeps infections at bay

A study by researchers of Ludwig-Maximilians-Universitaet (LMU) in Munich shows that infants fed on fresh rather than UHT (ultra-pasteurized) cow's milk are less prone to infection. 

A pan-European study, led by Professor Erika von Mutius, Professor of Pediatric Allergology at LMU and Head of the Asthma and Allergy Department at Dr. von Hauner's Children's Hospital, reports that fresh cow's milk protects young children from respiratory infections, febrile illness and inflammation of the middle ear. As untreated cow's milk may itself contain pathogenic microorganisms and could pose a health risk, the researchers argue for the use of processing methods that preserve the protective agents present in raw milk.

The findings are the latest to emerge from the long-term PASTURE study, which is exploring the role of dietary and environmental factors in the development of allergic illness. The study initially recruited 1000 pregnant women who were asked to document their children's diet and state of health at weekly intervals during the first year of life.

"Among children who were fed on fresh, unprocessed cow's milk the incidence of head colds and other respiratory infections, febrile and middle-ear inflammation was found to be significantly lower than in the group whose milk ration consisted of the commercially processed ultra-pasteurized product," says Dr. Georg Loss. Ingestion of farm milk reduced the risk of developing these conditions by up to 30%, and the effect was diminished if the milk was heated at home before consumption. Conventionally pasteurized milk retained the ability to reduce the risk of febrile illness, while exposure to the higher temperatures used in UHT processing eliminated the effect altogether. 

"The effects of diverse milk treatments are presumably attributable to differentially heat-resistant components present in fresh milk. Compounds that are sensitive to heating seem to play a particularly important role in protection against respiratory-tract and ear infections," says Loss.

At the end of the first year of life, blood samples were obtained from the children enrolled in the study, and tested for biochemical indicators of immunological function. Infants fed on unprocessed milk were found to have lower levels of the C-reactive protein, which is a measure of inflammation status. "Other studies have shown that higher levels of inflammation are related to the subsequent emergence of chronic conditions such as asthma and obesity. Consumption of unprocessed milk may therefore reduce the risk of developing asthma," Loss explains.

Industrial processing of milk involves short-term heating of the raw product. Conventionally pasteurized milk has been exposed to temperatures of 72-75°C for 15 seconds, while ultra-pasteurized milk undergoes heating at around 135°C for a few seconds. The latter is also homogenized to disperse the milk fats, which prevents the formation of cream. 

In addition to fats and carbohydrates, cow's milk contains proteins that can modulate the function of the immune system. "In many respects, the composition of cow's milk is similar to that of human milk," says Loss. It has long been known that breast-feeding protects infants from infection, although how milk actually affects the early immune function remains unclear. It is possible that some of the factors involved interact directly with viruses or that they promote the development of a healthy immune system by altering the composition of the gut microflora.

That living in the country has positive effects on the immune system has been demonstrated in several previous studies. Together these investigations show, as Erika von Mutius notes, that "children who grow up on traditional dairy farms are least likely to develop allergies.

Study after study is suggesting that exposure to lots of diverse bacteria and microorganisms (think farms with animals) is healthy for the developing immune system. From Science Daily:

Growing up on livestock farm halves risk of inflammatory bowel diseases

New research conducted at Aarhus University has revealed that people who have grown up on a farm with livestock are only half as likely as their urban counterparts to develop the most common inflammatory bowel diseases: ulcerative colitis and Crohn's disease

"It is extremely exciting that we can now see that not only allergic diseases, but also more classic inflammatory diseases appear to depend on the environment we are exposed to early in our lives," relates Vivi Schlünssen, Associate Professor in Public Health at Aarhus University.

"We know that development of the immune system is finalized in the first years of our lives, and we suspect that environmental influences may have a crucial effect on this development. The place where you grow up may therefore influence your risk of developing an inflammatory bowel disease later in life."

However, the researchers have a theory that the body may be dependent on exposure to a wide variety of microorganisms to develop a healthy immune system -- in the same way as has been established in studies on allergies and asthma.

"We know that the difference in the microbial environment between city and country has increased over the past century, and that we are exposed to far fewer different bacteria in urban environments today than we were previously. This may in part explain our findings," says Signe Timm.

Over the past 40-50 years, incidence of the diseases has sky-rocketed in Northern Europe -- including Denmark -- as well as in Canada and the United States, although they are still relatively rare in developing countries.

Obviously children on farms are exposed to a lot of dirt and animals, both teaming with microorganisms. But I wonder, and it's not discussed, is whether people living on dairy farms are drinking raw milk, which contains lots of microorganisms. After all, the point of milk pasteurization is to kill off bacteria. Will we go back to drinking raw milk to try to prevent allergies? From Science Daily:

Children on dairy farms run one-tenth the risk of developing allergies; Dairy farm exposure also beneficial during pregnancy

Children who live on farms that produce milk run one-tenth the risk of developing allergies as other rural children. According to researchers at The University of Gothenburg in Sweden, pregnant women may benefit from spending time on dairy farms to promote maturation of the fetal and neonatal immune system.

The occurrence of allergic diseases has risen dramatically in Western societies. One frequently cited reason is that children are less exposed to microorganisms and have fewer infections than previous generations, thereby delaying maturation of the immune system.

A study by researchers at Sahlgrenska Academy, University of Gothenburg, monitored children until the age of three to examine maturation of the immune system in relation to allergic disease. All of the children lived in rural areas of the Västra Götaland Region, half of them on farms that produced milk. The study found that children on dairy farms ran a much lower risk of developing allergies than the other children.

"Our study also demonstrated for the first time that delayed maturation of the immune system, specifically B-cells, is a risk factor for development of allergies," says Anna-Carin Lundell, one of the researchers. Children with an allergic disease at the age of 18 and 36 months had a higher percentage of immature B-cells in their blood circulation at birth and during the first month of life. 

"We need to identify the specific factors on dairy farms that strengthen protection against allergies and appear to promote maturation of the immune system as early as the fetal stage," Ms. Lundell says.

It seems like the more microbe exposure in the first year of life, the better for the immune system. From Science Daily:

Newborns exposed to dirt, dander, germs may have lower allergy, asthma risk

Infants exposed to rodent and pet dander, roach allergens and a wide variety of household bacteria in the first year of life appear less likely to suffer from allergies, wheezing and asthma, according to results of a study conducted by scientists at the Johns Hopkins Children's Center and other institutions.

Previous research has shown that children who grow up on farms have lower allergy and asthma rates, a phenomenon attributed to their regular exposure to microorganisms present in farm soil. Other studies, however, have found increased asthma risk among inner-city dwellers exposed to high levels of roach and mouse allergens and pollutants. The new study confirms that children who live in such homes do have higher overall allergy and asthma rates but adds a surprising twist: Those who encounter such substances before their first birthdays seem to benefit rather than suffer from them. Importantly, the protective effects of both allergen and bacterial exposure were not seen if a child's first encounter with these substances occurred after age 1, the research found.

"What this tells us is that not only are many of our immune responses shaped in the first year of life, but also that certain bacteria and allergens play an important role in stimulating and training the immune system to behave a certain way."

The study was conducted among 467 inner-city newborns from Baltimore, Boston, New York and St. Louis whose health was tracked over three years.

Infants who grew up in homes with mouse and cat dander and cockroach droppings in the first year of life had lower rates of wheezing at age 3, compared with children not exposed to these allergens soon after birth. The protective effect, moreover, was additive.  In addition, infants in homes with a greater variety of bacteria were less likely to develop environmental allergies and wheezing at age 3.

When researchers studied the effects of cumulative exposure to both bacteria and mouse, cockroach and cat allergens, they noticed another striking difference. Children free of wheezing and allergies at age 3 had grown up with the highest levels of household allergens and were the most likely to live in houses with the richest array of bacterial species. Some 41 percent of allergy-free and wheeze-free children had grown up in such allergen and bacteria-rich homes. By contrast, only 8 percent of children who suffered from both allergy and wheezing had been exposed to these substances in their first year of life.

From Medscape:

Allergic Rhinitis Patients Live Longer

Their runny noses might drive them crazy, but people with allergic rhinitis are likely to outlive the rest of us, a new study suggests.

"We found that allergic rhinitis patients had a decreased risk of heart attack, a decreased risk of stroke and, most strikingly, a decreased risk of all-cause mortality," said lead investigator Angelina Crans Yoon, MD, from the Department of Allergy and Clinical Immunology at the Kaiser Permanente Los Angeles Medical Center.

"They were basically half as likely to die during the study period," she told Medscape Medical News. 

Researchers studying data from the National Health and Nutrition Examination Survey (NHANES) found that people who tested positive for allergies were less likely to suffer cardiovascular events.

To explore the issue further, Dr. Crans Yoon and her team looked at a database of Southern California patients.The cohort consisted of 109,229 patients with allergic rhinitis and 109,229 people without allergic rhinitis who were matched for age, sex, and ethnicity. It also consisted of 92,775 patients with asthma who were matched with a similar group without asthma.

Risk for acute myocardial infarction was 25% lower in patients with allergic rhinitis than in those without, risk for a cerebrovascular event was 19% lower, and risk for all-cause mortality was 49% lower. Risk for all cardiovascular events was similar in the allergic rhinitis and control groups.

In contrast, risk for all cardiovascular events was 36% higher in patients with asthma than in those without, whereas risk for cerebrovascular disease and all-cause mortality were similar.

This could be the result of a difference in phenotypes in asthma patients, said Dr. Crans Yoon. People whose asthma is caused by allergies could be at less risk for cardiovascular events than people whose asthma has other causes.

Why should allergic rhinitis decrease someone's risk for death? 

Another explanation could be that the immune systems of patients with allergic rhinitis are hyperalert, aggressively fighting off disease, as well as causing symptoms, when it is not necessary. More work is needed to evaluate that.