The allergy epidemics: 1870-2010

Abstract

Before the first description of hay fever in 1870, there was very little awareness of allergic disease, which is actually similar to the situation in prehygiene villages in Africa today. The best explanation for the appearance and subsequent increase in hay fever at that time is the combination of hygiene and increased pollen secondary to changes in agriculture. However, it is important to remember that the major changes in hygiene in Northern Europe and the United States were complete by 1920. Asthma in children did not start to increase until 1960, but by 1990, it had clearly increased to epidemic numbers in all countries where children had adopted an indoor lifestyle. There are many features of the move indoors that could have played a role; these include increased sensitization to indoor allergens, diet, and decreased physical activity, as well as the effects of prolonged periods of shallow breathing. Since 1990, there has been a remarkable increase in food allergy, which has now reached epidemic numbers. Peanut has played a major role in the food epidemic, and there is increasing evidence that sensitization to peanut can occur through the skin. This suggests the possibility that changes in lifestyle in the last 20 years could have influenced the permeability of the skin. Overall, the important conclusion is that sequential changes in lifestyle have led to increases in different forms of allergic disease. Equally, it is clear that the consequences of hygiene, indoor entertainment, and changes in diet or physical activity have never been predicted.

Keywords: Hay fever; asthma; hygiene; indoor environment; lifestyle; peanut.

Copyright © 2015 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

Figures

Fig 1

The Resort at Bretton Woods, which was recognized before 1900 as a retreat for hay-fever suffers during the ragweed pollen season [A]. A map of the pollen free areas in the White Mountains published in the 1870s [B]. The apparatuses used by Charles Blackley in his pollen counting experiments in 1872 [C] Attribution: Panel A: Mount Washington Hotel Resort Bretton Woods New Hampshire By user Buddymydog1972. Licensed under CC BY 2.0 via Wikimedia Commons - http://commons.wikimedia.org/wiki/File:Mount_Washington_Hotel_Resort_Bretton_Woods_New_Hampshire.JPG Panel B: Autumnal catarrh (hay fever), map of White Mountains 1872 By user Fæ Licensed under CC BY 2.0 via Wikimedia Commons - http://commons.wikimedia.org/wiki/File:Autumnal_catarrh_(hay_fever),_map_of_White_Mountains_1872_Wellcome_L 0040001.jpg Panel C: From book “Experimental Researches on the Causes and Nature of Catarrhus Aestivus”, C. H. Blackley, 1873. ISBN 1-871395-00-3.

Fig 2

London water supplies in 1854 used by John Snow as evidence that typhoid and Cholera were spread through the water [A] Typhoid fever deaths in Chicago 1892, which were controlled by extending the water intake into the lake and pumping 407 million gallons per day from the Chicago River into the Mississippi. [B] Figure Attribution: Panel A: Mylne, Robert W. - Map of the Contours of London and Its Environs, showing the Districts and Areas supplied by the Nine Metropolitan Water Companies, Published for the Author by Edward Stanford, Charing Cross, London. Published by Waterlow and Sons, 1856. Accessed via: http://www.ph.ucla.edu/epi/snow/watermap1856/watermap_1856.html Panel B: From book “Annual Report of the Department of Health of the City of Chicago for the Year Ended December 31, 1894”. Published by the Department of Health, City of Chicago, 1895 (public domain)

Fig 3

Published data on the rise in hospitalizations of children and young adults due to asthma in four countries during the 20th century: asthmatics in the United Kingdom [A, See Ref 34]; children with asthma at the Medical College of South Carolina [B, See Ref 35]; children in Australia, New Zealand, Canada and the USA [C, See Ref 36]; and Finnish army recruits [D, See Ref 27]. All figures are used with permission but have been colorized differently than the original source material.

Fig 4

Sequential rises in allergic rhinitis, pediatric asthma and peanut allergy with respect to key events in the adoption of modern hygiene of Western society.