The ‘microflora hypothesis’ of allergic diseases
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Summary: Increasingly, epidemiologic and clinical data support the hypothesis that perturbations in the gastrointestinal (GI) microbiota because of antibiotic use and dietary differences in ‘industrialized’ countries have disrupted the normal microbiota‐mediated mechanisms of immunological tolerance in the mucosa, leading to an increase in the incidence of allergic airway disease. The data supporting this ‘microflora hypothesis’ includes correlations between allergic airway disease and (1) antibiotic use early in life, (2) altered fecal microbiota and (3) dietary changes over the past two decades. Our laboratory has recently demonstrated that mice can develop allergic airway responses to allergens if their endogenous microbiota is altered at the time of first allergen exposure. These experimental and clinical observations are consistent with other studies demonstrating that the endogenous microbiota plays a significant role in shaping the development of the immune system. Data are beginning to accumulate that a ‘balanced’ microbiota plays a positive role in maintaining mucosal immunologic tolerance long after post‐natal development. Other studies have demonstrated that even small volumes delivered to the nasopharynx largely end up in the GI tract, suggesting that airway tolerance and oral tolerance may operate simultaneously. The mechanism of microbiota modulation of host immunity is not known; however, host and microbial oxylipins are one potential set of immunomodulatory molecules that may control mucosal tolerance. The cumulative data are beginning to support the notion that probiotic and prebiotic strategies be considered for patients coming off of antibiotic therapy.
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Several epidemiological studies have shown a clear inverse link between early exposure to microorganisms and the incidence of asthma, referred to as the hygiene hypothesis.
“Several epidemiological studies have shown a clear inverse link between early exposure to microorganisms and the incidence of asthma, referring to this phenomenon as the “hygiene hypothesis” [79] .”
From Intestinal microbiota in health and disease: Role of bifidobacteria in gut homeostasis (2014) · cites this paper as [79]
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Increased risk of childhood asthma from antibiotic use in early life
Kozyrskyj, A. L., Ernst, P., & Becker, A. B. (2007) · Chest · doi:10.1378/chest.06-3008 · Cited by 272 · see citing works
Fecal microbiota transplantation broadening its application beyond intestinal disorders
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Sbihi, H., Boutin, R. C., Cutler, C., Suen, M., Finlay, B. B., & Turvey, S. E. (2019) · Allergy · doi:10.1111/all.13812 · Cited by 199 · see citing works
Synbiotics prevent asthma-like symptoms in infants with atopic dermatitis
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Factors influencing the gut microbiome in children: from infancy to childhood
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On communication between gut microbes and the brain
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The gut microbiota and mucosal homeostasis: Colonized at birth or at adulthood, does it matter?
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Early Development of the Gut Microbiome and Immune-Mediated Childhood Disorders
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Health effects of probiotics on the skin
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- Authors
- Noverr, M. C., & Huffnagle, G. B.
- Affiliations
- University of Michigan (US)
- ORCID
- Noverr, M. C.
- Venue
- Clinical & Experimental Allergy
- Publisher
- Wiley
- Published
- 2005-12
- Volume
- 35
- Issue
- 12
- Pages
- 1511-1520
- ISSN
- 0954-7894 (ISSN-L)
- 1365-2222
- OpenAlex
- W2159590190
- Cited by
- 394
- References
- 197
- Citations by year
- 2026: 4 · 2025: 6 · 2024: 16 · 2023: 9 · 2022: 20 · 2021: 16 · 2020: 20 · 2019: 20 · 2018: 12 · 2017: 26 · 2016: 24 · 2015: 32 · 2014: 28 · 2013: 24 · 2012: 20
- FWCI
- 1.28
- Type
- journal article
- Language
- en
- Open access
- green
- hdl.handle.net
- Locations
- Clinical & Experimental Allergy (publishedVersion)
- PubMed (publishedVersion)
- Deep Blue (University of Michigan) (submittedVersion)
- Funders
- National Institute of Allergy and Infectious Diseases
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Gut microbiota and health
- Health Sciences › Medicine › Physiology › Asthma and respiratory diseases
- Health Sciences › Medicine › Immunology and Allergy › Food Allergy and Anaphylaxis Research
- Keywords
- gut microbiota, allergic airway disease, antibiotic use, fecal microbiota, dietary change, oral tolerance, oxylipins, probiotics, prebiotics, allergen sensitization
- MeSH terms
- Animals, Anti-Bacterial Agents, Diet, Humans, Hypersensitivity, Immune Tolerance, Intestinal Mucosa, Probiotics, Respiratory Mucosa
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