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By Susan McCarthy

May 4, 2000 |  Through vaccination, sanitation and antibiotics, medicine has beaten back most of the childhood diseases that have sickened and killed so many children throughout history. We can't give up that achievement, but it may turn out that we've overdone it a little.

At least that's the opinion of the proponents of the hygiene hypothesis. Led by a group of British immunologists, these scientists postulate that our immune systems are not encountering the same kinds of challenges they have encountered in millennia past. We evolved to cope with dirt and germs, not soap and ethyl alcohol. As a result, our immune systems may be developing differently now and becoming overly touchy about allergens that we'd prefer they ignored.

As evidence the scientists point to a number of disturbing trends in developed countries: Allergies are booming, the asthma rate has doubled since 1988 and diseases like inflammatory bowel disease are on the rise.

To date, much of medicine's attack on asthma and allergies has been directed at whatever substances the immune system takes a dislike to -- environmental triggers like pollen, mold, dust mites and cockroach effluvia. If you can't get rid of allergies, it makes sense to get rid of the allergens. But if we could get the immune system to see reason, that would be even better. (I envision the ad campaign now, with shots of beautiful young people romping through fields of goldenrod, their arms full of kittens while a family of dust mites looks on with fond smiles.)

When British scientists looked at data suggesting that too much cleanliness led to sniffling, wheezing kids, they wondered if maybe the children weren't getting sick often enough. Could it be that early childhood infections help prime the immune system?

But this possibility didn't seem to hold up when looking at American inner-city kids, who have high rates of childhood infections and very high rates of asthma.

Dr. Graham Rook, an immunologist at University College, London, and one of the most enthusiastic proponents of the hygiene hypothesis, surmises that the immune system benefits from exposure to mycobacteria, a family of bacteria species that live primarily in soil and fresh water. Mycobacteria don't live in the human body, so grubbing around in the dirt is the best way to meet them. Most city kids don't see much soil, and what they do see outside is less than inviting.

"If in the course of everyday life we don't meet enough bacteria," Rook told New Scientist, "we're just going to have to inject them ourselves." Just such a method was used in a recent study of Japanese kids, who had been given a tuberculosis vaccination consisting of a weakened form of T.B. mycobacteria. Results showed that they had a much lower rate of allergies and asthma.

Similar studies are underway regarding the treatment of asthma. Rook is among the researchers conducting studies to see if inhaling or injecting mycobacteria can prevent asthma attacks. Preliminary results suggest that the immune system can be at least partly reprogrammed in adulthood. Professor Tony Basten, director of the Centenary Institute of Cancer Medicine and Cell Biology in Sydney, Australia, envisions a future vaccine, to be given to children with a family history of asthma, that would contain genes from dust mites.

If you dislike the idea of inhaling soil bacteria or being shot full of dust mites, how does worm therapy strike you?

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