For a number of years I have written, lectured, discussed and treated people with the emerging confidence that the application of benign, but signalling specific human derived bacteria would have benefits in terms of mucosal tolerance. One of the areas I have been most interested in has been the use of lactic acid bacteria as an immune modifying organism. As the first 1,000 days of a human’s life represent the ones in which immune activity is most responsive, the implication is that early stage supplementation – even in utero supplementation will have a modifying effect on some risk factors associated with a loss of mucosal tolerance.

One in 10 schoolchildren in the western world suffers from eczema and even developing nations have also seen an increasing trend in the last few decades. There are many proposals to explain the increased incidence, one area of relevance is the environmental impact. Falling under the often misused ‘hygeine hypothesis’ title it has been proposed that there is a reflective difference in the gradient between rural and urban children. Implying the environmental impact on the developing immune system of children is different and therefore less protective in the urban setting.

This concept has now been studied in a recent article in the British Journal of Dermatology.[1] By conducting a Medline and Embase data base review studies that compared the incidence between the two environments were reviewed. Some 26 papers were assessed with 19 demonstrating a higher risk for eczema in an urbanised area, of these 11 were regarded as being statistically significant. A further 6 studies showed a lower risk of eczema in an urbanised area, of which just 1 was statistically significant.