[Skip to Content]
[Skip to Content Landing]
Views 1,110
Citations 0
Editorial
June 15, 2020

Keep the Worms in the Mud

Author Affiliations
  • 1Mellen Center for Multiple Sclerosis, Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, Ohio
JAMA Neurol. Published online June 15, 2020. doi:10.1001/jamaneurol.2020.0519

The hygiene hypothesis postulates that the absence or delay of certain infections, primarily in childhood, results in an increased risk of allergic and autoimmune conditions.1 Exposure to intestinal colonizers, from microbiota to parasitic organisms, plays a role in the maturation of the immune system and these organisms may have coevolved with us in a way that makes classification as routine parasites untenable.2 Urbanization and decreased exposure to particular potentially infectious organisms have been implicated in the increasing prevalence of allergic and autoimmune disease.3 As a consequence, some of these symbiotic relationships may be more accurately considered as forms of mutualism because of the benefit that accrues to the host. The presence of these organisms is not associated with significant morbidity and may cause negligible mortality. Therefore, their decreased frequency under heightened hygienic conditions has been implicated in causing a dysregulated immune response.4

Limit 200 characters
Limit 25 characters
Conflicts of Interest Disclosure

Identify all potential conflicts of interest that might be relevant to your comment.

Conflicts of interest comprise financial interests, activities, and relationships within the past 3 years including but not limited to employment, affiliation, grants or funding, consultancies, honoraria or payment, speaker's bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued.

Err on the side of full disclosure.

If you have no conflicts of interest, check "No potential conflicts of interest" in the box below. The information will be posted with your response.

Not all submitted comments are published. Please see our commenting policy for details.

Limit 140 characters
Limit 3600 characters or approximately 600 words
    ×