NBC and other media outlets have recently reported findings from a study released this summer in the Journal of Allergy and Clinical Immunology. The media reports that hand-sanitizers and being "too clean" can actually produce unintended effects, including greater incidence of allergies and asthma among children.
And they are right. But for the wrong reasons. The study being quoted is from Swiss, German and U.S. researchers who combined a previous study comparing Swiss children who lived on farms with Swiss children not living on farms. The study showed that the Swiss children who lived on farms had significantly less incidence of allergies and asthma than did the Swiss children not living on farms.
In that Swiss study, nearly 14,000 children were surveyed between 2006 and 2007, including over 3,000 farming children and almost 11,000 non-farming children. In this study, 38% of the non-farming children had allergies compared to 19% of the farming children, and 19% of the non-farming children had asthma compared to 15% of the farming children. In addition, 19% of the non-farming children had allergic dermatitis compared to 16% of the farming children.
The 2012 report adds data to this study, taken from a survey of Amish children living in Indiana. The results found an even lower rate of allergies and asthma among the Amish children as compared to the non-farming Swiss children. Here 157 children were surveyed, and only 5% had asthma compared to 19% in Swiss non-farming children, while 6.4% had skin allergies compared to 19% in the Swiss non-farming children. In addition, 15.4% of the Amish children had hay fever compared to 38% of the non-farming children.
The national broadcast media reports, together with interviews of conventional medical doctors interprets the results as relating to exposure to germs on the farm. The farming children, they assume, have more exposure to germs than those not living on farms. This is combined with the fact that the farming children also tended to have more siblings, which is also attributed to more germ exposure.
NBC interviewed two immunologists that mirrored this interpretation. Dr. Samuel Friedlander with the University Hospitals Case Medical Center in Cleveland told NBC that, "I believe that the immune system is like an army. So, if the army doesn't have something to fight like microbes, it's going to fight things like allergens in many cases. People [who] live on farms are exposed to more microbes and as a result the immune system tries to fight those bugs and then, in turn, the body doesn't have to fight allergens."
University of California San Diego's Dr. Richard Gallo, carried this over to hand sanitizers. "It's a change in your allergic set point. So being too clean can lead you to have a high allergic set point that will overreact to the environment," he told NBC.
While the concept of greater exposure certainly has merit, it does not provide certainty, and largely misses the bigger picture. In fact, it could be said that the non-farming Swiss children – who lived in areas with greater human populations than the farming children – were likely exposed to more germs simply because they had more exposure to a greater number of people. Living in more populated areas, they were exposed to more crowding in the form of schools, transportation, entertainment and social activities. While farm children may have more animal exposure than non-farm children, this does not mean they necessarily had more contact with germs.
This theory of germ exposure alone has also been contradicted by some research showing that poorer metropolitan families in different countries have greater incidence of allergies and asthma, even though those poorer families had more siblings and greater exposure to germs due to less sanitary conditions. Thus, relying upon the so-called "hygiene hypothesis" alone to explain this farming versus non-farming result is short-sighted.
In other words, none of these studies took any bacteria exposure counts. The conventional interpretations are simply assuming the farming children have more germ exposure. What they are missing is the fact that during disease outbreaks, those living in cities will contract greater levels of the disease due to the increased exposure to germs being passed from one person to another. A person living on a farm is more isolated from this greater level of pathogenic germ exposure.
The researchers themselves admitted this short-sightedness. "Previous studies in Switzerland and Crete show a protective effect of farm life or rural living, with a 50% reduction in the prevalence of allergic sensitization as compared with nonfarm or urban living. Therefore, given the exceedingly low level of sensitization of 7.2% among Amish children, we feel that there may be additional protective factors in this population."
The more clear distinction between the farming children of both the Amish and the Swiss children lies within the type of germ exposure, and more importantly, their diets and lifestyles. Importantly, both the Swiss farm and the Amish children drank significantly greater amounts of raw milk and raw milk derivatives in the form of fermented dairy such as cheese and cottage cheese. These foods all contain generous quantities of probiotics. The study results show that between 79.5 and 87 percent of the farming children from both studies drank raw farm milk, as opposed to none of the non-farming Swiss children.
This is consistent with many other studies that have shown that probiotic supplementation results in fewer allergies and asthma.
There are a variety of reasons that probiotics boost immune response and help prevent allergies and asthma among children, and breast-feeding (another "raw milk" source of probiotics) results in fewer allergies, wheezing and asthma. Learn more about the science of how probiotics, herbs, diet and other natural strategies can help and prevent asthma.
While the "hygiene hypothesis" may have a role to play, the hygiene hypothesis does not differentiate between the kinds of germs being exposed to. This is despite the fact that hundreds of other studies have proven that it is the type of germ we are exposed to that matters. Some germs are pathogenic and some germs are probiotic, while still others are eubiotic.
Farm-living bolsters the probiotic conclusion even without raw and fermented dairy because children who play outside in the dirt will pick up soil-based organisms that grow into probiotic colonies within the gut. Having less exposure to outdoor recreation will thus certainly lead to fewer probiotic colonies within the gut among children.
This isn't saying that the overuse of hand sanitizers is also not an issue to consider. Hand sanitizers remove more than just the bad germs from our hands: They also remove the good germs from our hands that help prevent infection – and these good germs are called – you guessed it – probiotics.
- Holbreich M, Genuneit J, Weber J, Braun-Fahrländer C, Waser M, von Mutius E. Amish children living in northern Indiana have a very low prevalence of allergic sensitization. J Allergy Clin Immunol. 2012 Jun;129(6):1671-3.
- von Mutius E, Vercelli D. Farm living: effects on childhood asthma and allergy. Nat Rev Immunol. 2010;10:861–868
- Adams C. Asthma Solved Naturally: The Surprising Underlying Causes and Hundreds of Natural Strategies to Beat Asthma. Logical Books, 2011.
- Adams C. Hay Fever and Allergies: Discovering the Real Culprits and Natural Solutions for Reversing Allergic Rhinitis. Logical Books, 2012