Allergy in Children in Hand Versus Machine Dishwashing

Abstract

BACKGROUND AND OBJECTIVE: The hygiene hypothesis stipulates that microbial exposure during early life induces immunologic tolerance via immune stimulation, and hence reduces the risk of allergy development. Several common lifestyle factors and household practices, such as dishwashing methods, may increase microbial exposure. The aim of this study was to investigate if such lifestyle factors are associated with allergy prevalence.METHODS: Questionnaire-based study of 1029 children aged 7 to 8 years from Kiruna, in the north of Sweden, and Mölndal, in the Gothenburg area on the southwest coast of Sweden. Questions on asthma, eczema, and rhinoconjunctivitis were taken from the International Study of Asthma and Allergies in Childhood questionnaire. RESULTS:Hand dishwashing was associated with a reduced risk of allergic disease development (multivariate analysis, odds ratio 0.57; 95% confidence interval: 0.37-0.85). The risk was further reduced in a dose-response pattern if the children were also served fermented food and if the family bought food directly from farms. CONCLUSIONS:In families who use hand dishwashing, allergic diseases in children are less common than in children from families who use machine dishwashing. We speculate that a less-efficient dishwashing method may induce tolerance via increased microbial exposure. WHAT'S KNOWN ON THIS SUBJECT:Microbial exposure during early life may prevent, or reduce, the risk of allergy development. WHAT THIS STUDY ADDS:Allergic diseases are less common in children whose parents use hand dishwashing instead of machine dishwashing, and we hypothesize that this allergy-preventive effect is mediated via an increased microbial exposure. Dr Hesselmar has been involved in the planning and design of the study, the design of the protocols used, the writing of the manuscript, the data/statistical analyses, and in the interpretation of the results; Dr Hicke-Roberts has been involved in the planning and design of the study, in the design of the protocols used, data collection and data handling, and in the writing of the manuscript and the interpretation of the results; and Dr Wennergren has been involved in the writing of the manuscript and the interpretation of the results. The hygiene hypothesis stipulates that microbial exposure during early life induces immunologic tolerance via immune stimulation, and hence reduces the risk of allergy development. In this epidemiologic study, we wanted to explore daily-life exposure patterns, presumed to affect microbial exposure, to test if these exposure patterns are associated with less allergy development in children. We postulated that there is an allergy-preventing effect associated with dishwashing practices and dietary habits; lifestyle factors that, if proven, could be used in allergy prevention in affluent countries. METHODSIn September 2007, a questionnaire was sent to the parents/guardians of all children aged 7 to 8 years resident in Kiruna or Mölndal. Kiruna is a town in the north of Sweden; Mölndal is an integrated p...

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