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Changes in lifestyle and environmental exposure, rapid urbanisation, altered diet and antibiotic use have had profound effects on the human microbiome, leading to failure of immunotolerance and increased risk of allergic disease. Although evidence supports the concept of immune regulation driven by microbe\u2013host interactions, the term \u2018hygiene hypothesis\u2019 is a misleading misnomer. There is no good evidence that hygiene, as the public understands, is responsible for the clinically relevant changes to microbial exposures. <\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion:<\/jats:title><jats:p> Evidence suggests a combination of strategies, including natural childbirth, breast feeding, increased social exposure through sport, other outdoor activities, less time spent indoors, diet and appropriate antibiotic use, may help restore the microbiome and perhaps reduce risks of allergic disease. Preventive efforts must focus on early life. The term \u2018hygiene hypothesis\u2019 must be abandoned. Promotion of a risk assessment approach (targeted hygiene) provides a framework for maximising protection against pathogen exposure while allowing spread of essential microbes between family members. To build on these findings, we must change public, public health and professional perceptions about the microbiome and about hygiene. We need to restore public understanding of hygiene as a means to prevent infectious disease. <\/jats:p><\/jats:sec>","DOI":"10.1177\/1757913916650225","type":"journal-article","created":{"date-parts":[[2016,6,27]],"date-time":"2016-06-27T15:02:40Z","timestamp":1467039760000},"page":"213-224","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":229,"title":["Time to abandon the hygiene hypothesis: new perspectives on allergic disease, the human microbiome, infectious disease prevention and the role of targeted hygiene"],"prefix":"10.1177","volume":"136","author":[{"given":"Sally F","family":"Bloomfield","sequence":"first","affiliation":[{"name":"London School of Hygiene & Tropical Medicine and International Scientific Forum on Home Hygiene, The Old Dairy Cottage, Montacute, Somerset TA15 6XL, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Graham AW","family":"Rook","sequence":"additional","affiliation":[{"name":"Centre for Clinical Microbiology, Department of Infection, University College London (UCL), London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth A","family":"Scott","sequence":"additional","affiliation":[{"name":"Center for Hygiene and Health, Department of Biology, Simmons College, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fergus","family":"Shanahan","sequence":"additional","affiliation":[{"name":"APC Microbiome Institute, University College Cork \u2013 National University of Ireland, Cork, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosalind","family":"Stanwell-Smith","sequence":"additional","affiliation":[{"name":"London School of Hygiene & Tropical Medicine, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Turner","sequence":"additional","affiliation":[{"name":"Section of Paediatrics (Allergy & Infectious Diseases) and MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, Imperial College London, London, UK; Discipline of Paediatrics and Child Health, The University of Sydney, Sydney, NSW, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2016,6,27]]},"reference":[{"key":"bibr1-1757913916650225","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.299.6710.1259"},{"key":"bibr2-1757913916650225","doi-asserted-by":"publisher","DOI":"10.1136\/thorax.55.suppl_1.S2"},{"key":"bibr3-1757913916650225","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.g5267"},{"key":"bibr4-1757913916650225","doi-asserted-by":"publisher","DOI":"10.1016\/S0195-6701(13)60007-9"},{"key":"bibr5-1757913916650225","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.1218525110"},{"key":"bibr6-1757913916650225","doi-asserted-by":"publisher","DOI":"10.1016\/S0169-2070(99)00013-8"},{"key":"bibr7-1757913916650225","doi-asserted-by":"publisher","DOI":"10.1079\/9780851999968.0085"},{"key":"bibr8-1757913916650225","doi-asserted-by":"publisher","DOI":"10.1783\/147118906778586598"},{"key":"bibr9-1757913916650225","first-page":"598","volume":"22","author":"Iqbal S","year":"2009","journal-title":"The Psychologist"},{"key":"bibr10-1757913916650225","unstructured":"Bloomfield SF, Exner M, Fara GM, Nath KJ, Scott EA, Van der Voorden C. 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