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	Since this article does not have an abstract, we have provided the first 121 words of the full text and any section headings.

To the Editor: In his Editorial accompanying the article of Dr Ownby and colleagues, Dr Platts-Mills¹ did not discuss the hygiene hypothesis² as an explanation for their results.

The hygiene hypothesis posits an inverse relationship between the incidence of infectious diseases in early infancy and the subsequent development of allergies, asthma, and atopic disease. It is possible that this relationship may include not only specific infectious diseases in childhood, but also more general microbial burdens in early life. These may interact with genetic susceptibility to determine the extent of later atopic disease. The hypothesis has widespread implications for the increasing number of antibacterial products on the market, which may paradoxically increase the prevalence of atopic disease.

Gerald Ente, MD
Westbury, NY

1. Platts-Mills TA. Paradoxical effect of domestic animals on asthma and allergic sensitization. JAMA. 2002;288:1012-1014. FREE FULL TEXT 2. Weiss ST. Eat dirt—the hygiene hypothesis and allergic disease. N Engl J Med. 2002;347:930-931. FREE FULL TEXT

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2003;289:842.

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