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In Reply: As Dr Ente points out, the hygiene hypothesis provides a tantalizing framework to explain the increase in incidence of allergic disease and asthma. At a simple level the observation that the presence of domestic animals in the house is associated with a decreased prevalence of sensitization could be seen as evidence supporting the hypothesis. Indeed, the observations by Ownby et al that the effect requires more than 1 animal, and that it has an effect on allergens in general, could fit with a nonspecific effect due to endotoxin.¹ However, other studies show that the effect of cats is allergen specific when compared with that of dust mites, and that the presence of a cat can decrease the onset of asthma in preteenage children.^2-3 This evidence argues against a parallel with the early childhood effects of endotoxin. Furthermore, direct measurements do not show that the presence of a cat . . . [Full Text of this Article]

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