Hygiene and balance · Strachan 1989
David Strachan noted less hay fever in larger families and coined the hygiene hypothesis in the BMJ. Graham Rook argued we need microbes we co-evolved with — not street dirt or a skipped vaccine.

David Strachan noted less hay fever in larger families and coined the hygiene hypothesis in the BMJ. Graham Rook argued we need microbes we co-evolved with — not street dirt or a skipped vaccine.
European farm-child studies linked livestock exposure and raw-milk contexts to lower atopy — correlation with caveats. As worms and some infections fell in rich countries, some immune-mediated diseases rose — a pattern, not a prescription to seek worms.
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David Strachan noted less hay fever in larger families and coined the hygiene hypothesis in the BMJ. Graham Rook argued we need microbes we co-evolved with — not street dirt or a skipped vaccine.
European farm-child studies linked livestock exposure and raw-milk contexts to lower atopy — correlation with caveats. As worms and some infections fell in rich countries, some immune-mediated diseases rose — a pattern, not a prescription to seek worms.
Clean water, sewers and vaccines saved more lives than any romantic idea of a muddy childhood. Balance means keeping those wins while asking why some immune diseases rose. Hay fever was rare in early clinic notes and common in late-20th-century cities. That contrast invited theories.
Immune systems calibrate on what they meet. Too little diversity may leave regulation twitchy; too much sewage kills. Needed courses save lives and also thin early-life diversity — a trade-off, not a ban.
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Next question: Influenza · Open the topic: Hygiene and balance
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