Conclusions about type 1 diabetes and hygiene hypothesis are premature

doi:10.1136/bmj.322.7299.1429

BMJ 2001;322:1429 ( 9 June )

Letters

Conclusions about type 1 diabetes and hygiene hypothesis are premature

The first 150 words of the full text of this article appear below.

EDITOR $---$ Johnston and Openshaw state that children are born with strong interleukin 4 based (type 2) immune responses and matureto interferon $gamma$ based (type 1) responses, and that this processis under genetic and environmental influence.¹ They go on tostate that asthma and atopy are rising in prevalence and thathaving older siblings and being exposed to infections promotesthe normal maturation of the immune system towards a type 1response.

This argument fails to take account of the evidence from type 1 diabetes, which is an interferon $gamma$ based disease. Type 1 diabetesis rising in incidence in children from Western societies andis commoner in first born children and in the children of thewell off.^2-4 Infection may have a role in the changing epidemiologyof disease, but the evidence contradicts the suggestion that thisis due to a failure of normal immune development towards a type1response.

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