The implications of cleanliness

Asian boy got dairy or milk allergy, got red skin rash around his month, keep scratching, blue background

I was surprised to hear that we now do not recommend sterilising babies bottles. The hours of fun I had with boiling water and being ever so clean with our second baby: All a waste of time and just goes to show how advice changes.

Another interesting spin off of our current Covid-19 precautions is the potential to test the Hygiene Hypothesis.

Allergies have become a lot more common over recent years and cause great concern. The hypothesis says that keeping ourselves too clean does not test our immunity, which when redundant, turns bandit and attacks ourselves.

Children growing up on farms and those from bigger families seem to have fewer allergies; examples being, eczema, asthma, hay fever and drug and food allergies. 

We now have had a whole eighteen months of scrupulous attention to hygiene issues and one might expect the ‘knock-on’ effect to be even more allergies if the hygiene hypothesis is correct. This research is going on and no conclusions have been reached but I will keep you posted.

I ran this hypothesis by a Consultant Haematologist friend of mine. There are some interesting hygiene issues in his field. Childhood leukaemia is more common in affluent families. Does this have something to do with an over-sterile germ-free home? Possibly. Children who attend a nursery from a young age are also less likely to develop leukaemia. A child with no siblings is another risk factor for leukaemia.

If we look at the animal kingdom, domesticated cats are much more likely to get leukaemia than the feral moggies.

So once again, giving our immunity something to do, within limitations, has massive implications!

This is all very interesting and confusing I know. Once again it is all about taking the middle road and using common sense.

Let’s look at antibiotics. It drives me mad when a patient says they are allergic to most antibiotics but cannot remember which ones or who diagnosed their allergy. No bracelet worn either! This is a huge problem if you have sepsis and the antibiotic has to be given more or less immediately to save your life. Penicillin derivatives are still widely used and life saving in sepsis. 

I met a patient recently who said he was allergic to every local anaesthetic, which is amazingly rare, and a huge problem if it was just his personal hunch without any real proof, particularly as he had a wound needing to be sutured. 

We know how to treat allergic reactions. The serious one is anaphylaxis, when the throat closes, the tongue swells, a rash appears and circulation collapses. It is truly life-threatening. You’ll have read about the nut allergy – when someone with that allergy unknowingly ingests a nut product and dies. It usually hits the headlines.

I can honestly say that in my long career in A&E and as a GP, I have only seen true anaphylaxis once or twice. I see patients every day who have ‘allergies’.

On the subject of antibiotics there is a general reluctance to give antibiotics for colds and flu. In our bowel we have two kg of good bacteria. The microbiota. This adds up to ten thousand billion bacteria and we know very little about them. They work with our immunity to keep us well. Bump them all off with powerful antibiotics and big trouble can ensue. It may take months for normal service to resume. Rather like spraying your garden with non-selective weed killer and wondering why your roses have died!

How can you help your immunity over the coming winter months? A good mixed diet, plenty of sleep and exercise and avoiding toxins like alcohol and smoking. Stress is hugely damaging to our immunity and being aware of your stressors and dealing with them is important. I like a good walk, a day fishing, looking forward to new challenges and being proud of what I have done, and accepting I am not perfect by any means.  

The hygiene hypothesis makes medicine very interesting and we are learning all the while. Take home message? Life is all about balance, not too much or too little. If you have an allergy talk to your GP about it. For a serious one get an EpiPen and learn how to use it. For tricky cases there is an excellent allergy clinic at CUH to investigate and confirm the more serious reactions.

It goes without saying that I believe firmly in vaccination. Touch wood, it has kept me safe during some tricky times in A&E. 

I respect that people may decline vaccination but I had a patient of 78 who had significant health issues and refused not only the Covid vaccination but would not even let us do a Covid swab test! This was tantamount to refusing medical treatment and it presented us with a huge dilemma, which took hours to resolve and put staff and other patients at risk. Bizarre! 

Dr Jeff Featherstone

Dr Jeff Featherstone is a West Cork GP and A&E doctor at Mercy University Hospital and Cork University Hospital.

Next Post

Inside Out Beauty with Suzie O’Neill AYU

Tue Oct 5 , 2021
The beauty industry is booming! Yes, despite the economic magnitude of the COVID-19 pandemic the beauty industry has proven relatively resilient, especially in terms of online sales. In fact, a research report by McKinsey found that online revenue for beauty-industry players rose 20 to 30 per cent during the outbreak. […]