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James E. Gern, MD; Scott T. Weiss, MD, MS

JAMA. 2000;283:394-395.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

A major question facing modern medicine is why atopic diseases such as asthma, allergic rhinitis, and atopic dermatitis, which have in common the overproduction of allergen-specific or total IgE, are increasing in prevalence. Atopic diseases are influenced by genetic predisposition and environmental exposures. However, since the spontaneous genetic mutation rate is quite slow, it is clear that changes in the environment are responsible for the increased prevalence of atopic diseases. But which environmental factor(s) is the culprit?

Many theories, based on epidemiologic or experimental data, have been advanced, including improved hygiene^1-2; changes in diet^3-4; changes in intestinal flora due to increased use of antibiotics⁵ and altered patterns of infant feeding⁶; greater exposure to allergens⁷; obesity and reduced physical activity⁸; and changes in the prenatal environment.⁹ One interesting theory is that the reduction of early childhood infectious . . . [Full Text of this Article]

Author Affiliations: University of Wisconsin Medical School, Madison (Dr Gern), and Channing Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (Dr Weiss).

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