It is already difficult for illness of high purity
to imagine that all of some
Only in the second half of the 19th century, after opening of causative agents of infectious diseases, mass introduction of hygienic skills under the acquaintance to all of us begins em with the childhood the slogan: “Purity - guarantee of health!“ And it is valid, the more people got used to regular washing, the indicators of mortality, especially children`s became lower. Of course, business was not only in change of household habits: then were developed and entered medical practice of a vaccine, in the cities constructed water supply systems and the sewerage. There were effective antibacterial preparations a bit later - sulfanylamides, and then and antibiotics. But modern researches in a number of the Asian countries (just now passing through similar changes) show that simple regular washing of hands makes a bigger contribution to health of the population, than the most modern inoculations. For example, clean hands half reduce death of children from zheludochno - intestinal infections - one of the most important reasons of child mortality in these countries.
Meanwhile the developed countries stepped much further. Daily use of their inhabitants strongly included bactericidal detergents (for a body, clothes, ware, bathroom equipment etc. ), the double-glazed windows, insuperable to microbes, disinfecting filters in systems of ventilation and conditioners. From the point of view of microbiology the dwelling of the modern person represents the fruitless desert: the maintenance of microorganisms in it very little also continues to decrease. It is possible to tell that the hygienic ideal of modern society - absolute sterile environment - is almost reached.Mysterious epidemic
New hygienic standards proved to
the efficiency: infectious diseases mortality in the developed countries rather low also continues to decrease today. Emergence of new fatal diseases, such as AIDS, atypical pneumonia or the African hemorrhagic fevers, unexpected counterattacks of the known activators do not influence long ago a situation.
However exactly here in economically safe areas the last decades began to gain illness strength, almost unknown to inhabitants of the poorest regions. For the last 30 years the number of cases of an allergy in the world doubled every decade, and almost all gain is reached at the expense of the countries with a high standard of living. In a number of the European countries (Germany, England, France, etc.) chronic allergic persons in different districts make from 10 to 30% of the population. Everything, according to WHO data, allergic diseases about 5% of adult population of the planet and 15% - children`s have today. On socially - to economic damage and influence on the level of health and quality of life of patients they were in the top three diseases of the person. In other words - taming of infections and “deficiency diseases“ (dystrophies, avitaminosis etc.) raised a role of other misfortunes. New “murderers“ (in the developed countries it is warm - vascular and cancer diseases) most often overtake the victims in an after-life: the risk of development of a malignant tumor naturally grows with age. On the other hand, these diseases were familiar to mankind earlier and if in modern society their frequency increased, then only because much more people began to live up to age at which they usually develop.
But epidemic of allergies behaves absolutely in a different way: almost all new cases are found in children or teenagers. At adults new allergies develop much less often. On the contrary, at many people of mature age (approximately after 35 years) spontaneous easing or even a total disappearance tormenting them in youth of allergies is observed. The problem of their unexpected explosion is complicated also that the mechanism of development of this illness is still not quite clear. Since the beginning of scientific research of an allergy it was clear that extraordinary rough immune reaction to some anti-gene is the cornerstone of it (which in this case is called as allergen). At the same time the anti-gene - allergen can be absolutely safe for an organism: in “a hit - parade“ allergens cat`s wool, pollen of plants (especially cereals), chocolate, nuts, fruit of family of a citrus steadily are registered... Scientists found out many details of the mechanism of allergic reaction, established what substances, biochemical systems, cages and fabrics are involved in it, but so still did not find the answer to the main issue: what forces immune system to take up arms suddenly on this or that absolutely innocent substance?
However, allergens - all this is alien substances. And happens and so that the immune system so suddenly directs the destructive activity to these or those cages and fabrics of own organism. Such diseases (multiple sclerosis, considerable part of cases of diabetes of the I type etc. belong to them, in particular, system red a wolf cub) are called autoimmune. They are often provoked by a burn, a trauma, an inflammation, an infection, pathological regeneration of the attacked fabrics, but in general their reasons and the mechanism of development are still quite not clear. In the last decades their frequency quickly grows and too generally at the expense of the developed countries.It is known that where the knowledge comes to an end, the opinion begins
. Hypotheses of why the frequency of both types of immune violations so quickly grows and why this growth happens in the developed countries, big cities, among safe segments of the population, was stated much. The unexpected pandemic was tried to be explained with industrial environmental pollution, adverse social conditions, overconsumption of medicines, chemicalixation of agriculture, change of structure and structure of food, nervous overloads and a stress, distribution of an unknown infection and a set of other real or estimated factors. In the materials extended by opponents of use of genetically changed products, growth of allergies is steadily given as a result of distribution of “Frankenstein`s food“.
However, the last hypothesis disappeared at once. Growth of allergic diseases was recorded in
A little business was helped also by search of genetic bases of an illness. Communication of an allergy in itself with heredity was not subject to doubt. Long ago it was known that if one of parents has an allergy, then the risk of development it at the child makes 15 - 20%, and for the offspring of two allergic persons the risk increases up to 60 - 70%. (At the same time not those substances to which parents so not the illness, but predisposition to it is inherited are sensitive can appear allergens for the child at all.) In researches of the last years by the scientist it was succeeded to identify about 20 concrete genes in one way or another associated with allergy mechanisms. But all these, certainly, valuable researches gave nothing for understanding captured the developed countries of epidemic of allergies. What was a role of genes in development of this illness, the genetics of big populations did not undergo for the last 30 years of any changes which could be connected with allergies.
of the Statement about “undoubted“ communication of allergies with these or those new chemical agents (pollutants, pesticides, drugs etc.) wander from one publication in another, but often are not followed by any concrete figures or even estimates at all. In other cases in confirmation of them it is reported how many people have an allergy to antibiotics or pesticides and at what rates the number of such patients grows. These figures really impress if not to know that approximately with the same speed also incidence of allergies to “old“, well-known substances grows: pollen of plants, hair of animals, eggs, milk, fish etc. Especially “new“ substances cannot explain the parallel growth of autoimmune diseases: fabrics of a human body and their anti-genes definitely did not change for the last decades.
In the same cases when the role of factors of external environment becomes a subject of correct scientific research, their connection with distribution of allergies or does not manage to be revealed at all (so, for example, the growth rate of incidence was identical to the smoker and non-smoking part of the population), or the frequency of cases of an allergy in the compared groups differs at an insignificant size.“ Epidemiological data on this question are very inconsistent, and sometimes and are paradoxical“, - the famous Russian allergist Natalya Ilyina summarizes.
meanwhile at a dawn of a present pandemic the British epidemiologist David Strechen paid attention to strange regularity: the risk of development of such typically allergic diseases as asthma, eczema and hay fever, considerably decreased with growth of “serial number“ of the child in a family. For the second children it was lower, than for firstborns, for the third - below, than for the second, etc. At first Strechen assumed that each pregnancy makes some changes in mother`s organism affecting then on development of the following fruit. However soon it was necessary to refuse this hypothesis: if the first twins were born, the risk for each of them was a little, but is reliable below, than for the firstborn - the single though to prepare for them protection against future allergies there was nobody.
Trying to explain mysterious communication between number of children in a family and risk of an allergy, Strechen paid attention that at the heart of asthma and hay fever the excess immune answer in which a key role is played by lymphocytes of a certain type - so-called Th2 - cages lies. It is only one of possible versions of the immune answer: at the disposal of an organism there are also other protective reactions with participation of other cages. Many bacteria and viruses cause the immune answer mediated by other type of lymphocytes - Th1. As well as in all security services, the relations between different “departments“ of one “department“ in our immune system quite intense: development of Th1 - the answer is followed by suppression of synthesis of the alarm substances starting Th2 - the answer.
But as it was already told, the modern city dwelling represents almost sterile environment. And the child, especially so far it one and absolutely small appears the center of this cult of purity, object of continued hygienic efforts of all family, of course. To immediately clean any shadow of dirt, not to pass to the kid of any mote, to provide sterility of all the baby adjoins or can adjoin to, - the ideas of modern parents of the debt created by almost sesquicentennial efforts sanitarno - hygienic promotion are that.
A that if in it all and business? Almost without meeting microorganisms against which it is aimed at fight, Th1 - the system does not receive necessary stimulation and therefore develops insufficiently.“ The balance of forces“ in immune system is displaced towards Th2 - system, as gives it that hyperreactivity (excess sensitivity and power) which pours out then in any allergy.
Then becomes clear why younger children are less subject to this misfortune. It is much more difficult to maintain sterile purity in the house with two children even if it is twins. Even more difficultly it with children of different age: at the senior own microflora was already created and on the street he goes own legs, so, despite all efforts of adults, something will drag from there. Besides mother, the charter and having gained experience of the treatment of children, treats small violations of requirements of hygiene already more quietly, without rushing to wash the kid with bactericidal soap after each contact with a floor. So the formed immune system of the younger child is given much more opportunities for training.
is the assumption of doctor Strechen published by it in 1989 and which received the name of “a hygienic hypothesis“ first the assumption of doctor Zemmelveys seemed to the physicians who are as shocking as in due time. However, as often happens in such cases, Strechen`s guess gave sense and coherence to a set of the facts and empirical generalizations looking so mysterious and illogical. First of all there was clear a paradoxical communication between the frequency of allergic diseases and a standard of living: what this or that social group or society in general is richer with, that hygienic standards are higher in them. Received an explanation and long ago the noticed distinctions on this indicator between urban and country people: even if the farmer family lives in the well-planned house and uses all benefits of modern hygiene, she does not manage to reduce the maintenance of microorganisms to city standards, as a rule, everything-.But, of course, much more accurate and unambiguous results brought to
the researches which are specially undertaken for check of a hygienic hypothesis - the benefit of such works is executed in recent years much. So, for example, in 2002 the staff of University of Bristol revealed direct correlation between hygienic standards of a family and risk of asthma and eczema for children
Milk and a shed
Opponents, of course, specified that any of these facts can be treated and in a different way. For example, it is possible to assume that in the families paying much attention to hygiene, children have more chances to grow allergic persons because often contact to strong allergens - the chemicals which are a part of detergents. And rural children have no allergies because they grow in the fresh air, eat natural food and their city peers move much more, than. However, from this point of view it is difficult to explain, for example, the results received by the American and German scientists: the children growing in society of a cat or dog differ in high resistance to allergies, and not only on hair of animals, but also on other allergens. Here it is pertinent to remember that very many families, expecting the child, especially the first, try to get rid of pets, and to the main or one of the main occasions for this purpose serve just fears that at the kid the allergy will develop.
Even more paradoxically. Inhabitants of these heavenly spots have both a natural food, and the fresh, blown by ocean winds air; they are not familiar neither with industrial pollution, nor with pesticides, nor with transgenes. On economic development and features of life they belong more likely to that part of mankind to which “wellbeing diseases“ should not threaten at all. And nevertheless on both archipelagoes it was found very much high level of distribution of asthma and other allergic diseases. It is impossible to explain it from pollution positions and “a high allergenic background“. From the point of view of a hygienic hypothesis the situation on islands was that exception which confirms the rule: in the small closed communities of islanders the infections which are especially caused by respiratory viruses are rare (it was directly confirmed with the low level of antibodies to these viruses in blood of inhabitants of islands). It appeared enough to make them vulnerable for allergies.the Large-scale ALEX project organized by the European epidemiologists was specially devoted by
to studying of the reasons of resistance of rural children to allergic and autoimmune diseases. The large number of participants (research captured over 900 children from the adjacent regions of Switzerland, Austria and Bavaria) and sophisticated methods of statistical processing allowed to separate action of various factors from each other and to estimate a contribution of everyone. It is enough to tell that rural children were compared on indicators of incidence not only to radical citizens, but also with the children of peasants living mainly in the city (in modern farmer families it is not a rarity). As a result it turned out that two factors give the greatest protection against allergies: consumption of milk from own economy (not boiled and even not pasteurized) and regular stay in rooms for animals, simply telling - in a shed. During research even concrete substance, contact with which most of all promoted the correct development of immune system, was revealed. Endotoxin - a characteristic anti-gene of an external cover of gramotritsatelny bacteria was it. The content of endotoxin in the environment where the child grew was higher, the probability of development was lower than an allergy at it.
By the way, the same research showed that vulnerability to allergies cannot be explained with only one violation of balance of the Th1 and Th2 systems as it was assumed by Strechen. In particular, contrary to expectations of scientists, the “endotoksinovy experience“ of this or that child was richer, the less it was found in his Th1 blood - cages and their characteristic products. On the other hand, many autoimmune diseases - such as rheumatoid arthritis, an illness Krone or the same diabetes of the I type - are connected just with excessive Th1 - the answer. And as we remember, among the people who grew up in the low-microbic environment, the frequency of these diseases grows too. These and other new data forced to alter an initial hygienic hypothesis: now it says that early contact with pathogenic agents is necessary for normal development of special regulatory cages of immune system.
Protection against protection
In general it was to be expected. It is known that any excessively developed security service at shortage of spies and saboteurs begins to think out them, appointing to these roles of peace foreigners or too independent own citizens. Also also the immune system of the person calculated on much bigger anti-gene loadings than what it tests nowadays behaves. Besides viruses and bacteria fight against helminths whom nowadays many residents of the developed countries do not face in general also belonged to its duties. Meanwhile, as showed the researches conducted in 2001 in Ethiopia by the English physicians, infection of an ankilostomama or ascarids three times reduces risk of developing of asthma. Moreover, unlike the above described mechanisms which are working (or not working) in the first two years after the birth, ankilostoma are capable to cure - more precisely, to suppress - asthma at adults. At the same Nottingham university which staff studied this problem in Ethiopia the small group of volunteers - asthmatics was infected by ankilostomam that relieved them of painful attacks. Similar results were received in Iowa State University (USA). However, this method will hardly be widely used in clinic: if the patient, having recovered from asthma, peremorit then the deliverers (or those will die - life term ankilosty in a human body is limited, and in civilized conditions spontaneous reinfection is almost excluded), asthma will soon return. To create the hands in own country the helminthosis centers, with considerable work won
A really if the hygienic hypothesis is right, what to do to modern people to relieve itself of the accruing threat of allergies and autoimmune diseases? To refuse disinfection and sanitation, to reduce hygienic standards? To feed children with dirty vegetables and fruit, not to prevent them to select from the earth and to pull everything that they find in a mouth?Is not present
, of course. Eventually, how made the life of the person miserable asthma, insulin-dependent diabetes or system red a wolf cub, with these diseases it is possible to live decades while cholera, diphtheria or a typhoid mean real and considerable threat for the child`s life. On the other hand, we do not need to choose between Stsilla and Haribda at all. Eventually, for “training“ of immune system live and pathogenic activators are not obligatory. It is enough to show it their anti-genes, and quite nonspecific, characteristic of big groups of microorganisms. Means, in principle it is possible to develop certain vaktsinopodobny preparations which would stimulate the correct development of immune system of the child, without causing diseases. The first steps in this direction are already taken: the Swiss biotechnological center Cytos Biotechnology developed the preparation CYT003 - QbG10 on the basis of soil mikobakteriya - relatives of the causative agent of tuberculosis. The piece of synthetic DNA imitating characteristic nucleotide sequence of a mikobakteriya consists in an artificial cover like virus and is entered into a human body. Limited tests on small groups of patients showed high efficiency of a drug against an allergy to dust ticks, dog wool and pollen of plants. Last fall full-scale clinical tests of new means in the allergic centers of the different countries began. Meanwhile the researchers connected with the ALEX project experiment with preparations on the basis of endotoxin.
A we can adopt several simple rules and the receptions allowing to reduce risk of immune pathologies at our children already now. For example, not to be conducted on advertizing of new detergents which “kill all known microbes“. Not to use needlessly bactericidal soap: full sterility is necessary in the operating room, but not in the apartment. Not to be afraid to open window leaves and windows including in the room where there is a baby (if, of course, weather behind a window it allows). From the earliest age to walk more with the kid. When he begins to move itself, not to be frightened and not to abuse it if he barehanded rummages in the earth or will stroke a domestic cat. (Own dog or a cat especially are useful to the child, and not only in sense of prevention of an allergy.) In the village or at the dacha to allow it to drink fresh milk and curdled milk (if it has no problems with assimilation of these products) and there are berries directly from a bush. And the most important to remember that the reasonable measure is necessary in everything, including aspiration to purity.
By the way, all this will remain fair and in case the medicine sometime finds a radical solution of the problem of allergies.