Exposure to foodborne and orofecal microbes versus airborne viruses in relation to atopy and allergic asthma: epidemiological study

doi:10.1136/bmj.320.7232.412

BMJ 2000;320:412-417 ( 12 February )

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Exposure to foodborne and orofecal microbes versus airborne viruses in relation to atopy and allergic asthma: epidemiological study

Paolo M Matricardi, research director, ^a Francesco Rosmini, scientist, ^b Silvia Riondino, research fellow, ^a Michele Fortini, research assistant, ^a Luigina Ferrigno, research assistant, ^b Maria Rapicetta, research director, ^c Sergio Bonini, research unit director. ^d

^a Laboratorio di Immunologia ed Allergologia, Divisione Aerea Studi Ricerche e Sperimentazioni, 00040 Pomezia, Rome, Italy, ^b Laboratorio di Epidemiologia e Biostatistica, Istituto Superiore di Sanita, Rome, Italy, ^c Laboratorio di Virologia, Istituto Superiore di Sanita, ^d Istituto di Medicina Sperimentale, Consiglio Nazionale delle Ricerche, Rome, Italy

Correspondence to: P M Matricardi matricardi.pm{at}mclink.it

Objective: To investigate if markers of exposure to foodborneand orofecal microbes versus airborne viruses are associated withatopy and respiratoryallergies.
Design: Retrospective case-controlstudy.
Participants: 240 atopic cases and 240 non-atopic controlsfrom a population sample of 1659 participants, all Italian malecadets aged 17-24.
Setting: Air force school in Caserta,Italy.
Main outcome measures: Serology for Toxoplasma gondii, Helicobacterpylori, hepatitis A virus, measles, mumps, rubella, chickenpox,cytomegalovirus, and herpes simplex virus type 1; skin sensitisationand IgE antibodies to relevant airborne allergens; total IgE concentration;and diagnosis of allergic asthma orrhinitis.
Results: Compared with controls there was a lower prevalenceof T gondii (26% v 18%, P=0.027), hepatitis A virus (30% v 16%,P=0.004), and H pylori (18% v 15%, P=0.325) in atopic participants.Adjusted odds ratios of atopy decreased with a gradient of exposureto H pylori, T gondii, and hepatitis A virus (none, odds ratio1; one, 0.70; two or three, 0.37; P for trend=0.000045) but notwith cumulative exposure to the other viruses. Conversely, totalIgE concentration was not independently associated with any infection.Allergic asthma was rare (1/245, 0.4%) and allergic rhinitis infrequent(16/245, 7%) among the participants (245/1659) exposed to at leasttwo orofecal and foodborne infections (H pylori, T gondii, hepatitisAvirus).
Conclusion: Respiratory allergy is less frequent in peopleheavily exposed to orofecal and foodborne microbes. Hygiene anda westernised, semisterile diet may facilitate atopy by influencingthe overall pattern of commensals and pathogens that stimulatethe gut associated lymphoid tissue thus contributing to the epidemicof allergic asthma and rhinitis in developedcountries.

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