Hay fever and asthma in relation to markers of infection in the United States

J Allergy Clin Immunol. 2002 Sep;110(3):381-7. doi: 10.1067/mai.2002.126658.


Background: The hygiene hypothesis proposes that declining exposure to infections is implicated in the rising trend of allergy and asthma.

Objective: We sought to test this hypothesis by examining the relationship of hay fever, asthma, and atopic sensitization with markers of infection in a large general population sample of the United States.

Methods: We analyzed the data of 33,994 US residents recorded in a public database of a nationally representative cross-sectional survey (Third National Health and Nutrition Examination Survey, 1988-1994). The variables examined were sociodemographic information, lifetime diagnosis and age at first diagnosis of hay fever or asthma, current skin sensitization to 9 airborne allergens and peanut, and current serology for Toxoplasma gondii, herpes simplex viruses type 1 and 2, and hepatitis A, B, and C viruses.

Results: Hay fever (adjusted odds ratio, 0.27; 95% CI, 0.18-0.41; P <.001) and asthma (adjusted odds ratio, 0.45; 95% CI, 0.31-0.66; P <.001) were less frequent in subjects seropositive for hepatitis A virus (HAV), T gondii, and herpes simplex virus 1 versus seronegative subjects after adjusting for age, sex, race, urban residence, census region, family size, income, and education. Skin sensitization to peanut and to all the airborne allergens examined, except for cockroach, was less frequent among HAV-seropositive versus HAV-seronegative subjects younger than 40 years of age. The prevalence of hay fever and asthma diagnosed at or before 18 years of age in HAV-seronegative subjects increased progressively from 2.7% (95% CI, 0.7%-4.7%) and 0.4% (95% CI, 0.1%-1.6%), respectively, in cohorts born before 1920 to 8.5% (95% CI, 7.3%-9.7%) and 5.8% (95% CI, 4.8%-6.8%), respectively, in cohorts born in the 1960s, whereas they remained constant at around 2% in all cohorts of HAV-seropositive subjects.

Conclusion: In the United States serologic evidence of acquisition of certain infections, mainly food-borne and orofecal infection, is associated with a lower probability of having hay fever and asthma. Third National Health and Nutrition Examination Survey data support the hypothesis that hygiene is a major factor contributing to the increase in hay fever, asthma, and atopic sensitization in westernized countries.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Antibodies, Protozoan / blood
  • Antibodies, Viral / blood
  • Asthma / complications
  • Asthma / diagnosis
  • Asthma / epidemiology*
  • Biomarkers / blood
  • Child
  • Child, Preschool
  • Hepatitis A / complications
  • Hepatitis A / diagnosis
  • Herpes Simplex / complications
  • Herpes Simplex / diagnosis
  • Humans
  • Hypersensitivity, Immediate / complications
  • Hypersensitivity, Immediate / diagnosis
  • Hypersensitivity, Immediate / epidemiology
  • Infant
  • Middle Aged
  • Prevalence
  • Rhinitis, Allergic, Seasonal / complications
  • Rhinitis, Allergic, Seasonal / diagnosis
  • Rhinitis, Allergic, Seasonal / epidemiology*
  • Skin Tests
  • Toxoplasmosis / complications
  • Toxoplasmosis / diagnosis
  • United States / epidemiology


  • Antibodies, Protozoan
  • Antibodies, Viral
  • Biomarkers