how you remove wastes from your body excretory system
TRANSCRIPT
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How you remove
wastes from your body
EXCRETORY SYSTEM
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Excretion: waste removal from body
Kidneys: Unique Problem
Keep Good Get Rid of
Things Bad Things
in blood
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How the kidneys do this:
1. Filtering- everything except blood cells & protein (big)
2. Bad things out with urine
3. Recycling (reclaiming):
Good things back to blood
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Bad things (waste): your kidneys remove
Example: urea from breakdown of protein
Good things: reclaimed
Example: H2O, glucose, amino acids
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50 gallons
of blood:
pumped
through
kidneys/day
½ gallon:
waste + H2O
leaves body as urine
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Damage to kidneys (failure): poor filter
Dialysis machine: filter/remove wastes
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Kidney Dialysis • Kidney disease > 60% caused by
hypertension & diabetes
• Toxic wastes build up
• Dialysis (separation): 3X/week
each 4-6 hr
• Patient blood artery tubes
selectively permeable
membrane
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Kidney
Dialysis
• Good
things
added:
bicarbonate
ions
(blood pH)
• Wastes:
discarded
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Kidney Transplantation
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2009: 78,000 people- waiting list
1. Best donor (kidneys last longer): living, matching (family) donor
2. Unrelated living donor
3. Deceased donor
Newer technique: “preconditioning” transplant recipient’s blood before operation: cleanse of antibodies (cause of rejection)
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Newer surgery
on donor:
Laparoscopic
Nephrectomy
(small cut in
abdomen)
Remove kidney recipient
“New” kidney starts working immediately
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• Many donated
kidneys still working
> 25 years
• Donor: normal
life span
• Remaining kidney
“compensates” for
loss of donated kidney
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“KIDNEY SWAP”
New England people- Kidney Disease:
3-5 year wait for cadaver kidney
• Second problem: incompatible donor
• Alternative: NE Kidney Exchange Program (Newton)
• Computerized data pool
• Likelihood match, Donation time
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Other things your kidneys do:
1. Control your blood volume:
+/- H2O
2. Control ion balance in your body
(sodium, potassium)
3. Help keep blood pH normal
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Urinary system: 2 kidneys: filter blood, produce urine
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Right Kidney Left Kidney
Ureters
Urinary Bladder
(Muscles contract)
Urine Urethra Outside Body
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Male
Urinary
System
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How the kidney filters: big picture
1. Blood into
kidneys:
renal artery
from aorta
2. Blood
filtered
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3. Blood out
of kidneys:
renal vein
4. Cleaned
blood
returned
to heart
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How kidneys filter blood: the little picture
Little filtering units: nephrons
1.25 million = each kidney
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Nephron Parts: 1. Bowman’s capsule Collects Filtered Blood Plasma: Good + Bad Things
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2. Complex,
twisted tubes
3. Collecting
duct: final
urine collected
4. Many
collecting ducts
Send urine to
renal pelvis
(cavity)
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5. Renal pelvis urine ureter
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6. Blood into
nephron from
renal artery
(arteriole)
7. Blood forms
ball of
capillaries:
Glomerulus
(porous)
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Close up view: glomerulus
Blood under pressure
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Glomerulus blood under pressure:
1. Small molecules leak out: H2O, glucose, sodium, potassium, vitamins
2. Also leaking out: metabolic wastes:
A) Urea- from protein breakdown
B) Creatinine: waste product from muscle contraction
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3. Big things: proteins, blood cells: don’t leak out- stay in blood
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4. Glomerulus
(capillaries)
form arteriole:
exits Bowman’s
capsule
5. 2d capillary
network formed
around nephron
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6. Finally,
capillaries
form
small vein:
blood
returned
to heart
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This was filtration by nephron: filtering blood: 1st thing kidney does
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2d thing kidney
does: Reabsorption: save good
things
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1. Cells in tubes actively pump sodium to outside of tube 2. Sodium moves into capillaries 3. H2O follows the sodium (osmosis): into capillaries
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H2O lost during filtration + glucose + nutrients: reclaimed back into blood
This is REABSORPTION
Wastes: most urea in tube not reabsorbed: pass out urine
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3rd thing kidney does: Secretion
(to release) H+ (balances blood pH), Potassium, Drugs, Poisons:
Move: capillaries tubes urine
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4th thing kidney does: concentration
More sodium
Pumped out-
end tube
moves into
capillaries-
H2O follows:
moves into blood
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Concentration: you save 99% of H2O filtered
You produce concentrated urine: wastes + some water
Very important for land animals: H2O conservation- prevents us from drying out
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Summary 4 things your kidneys do:
#1 Filter everything except protein & blood cells
#2 Reabsorb: H2O, sodium, glucose, vitamins
#3 Secrete: H+ & potassium from blood tubule
#4 Concentrate: save H2O, concentrate wastes urine (Excretion)
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Summary
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• Our kidneys evolved: conserve sodium & excrete potassium (homeostasis)
• Prehistoric diet
Kidneys & sodium/potassium balance
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Today’s diet: overloads kidney’s with salt
Our kidney’s have not adapted
“modern” diet: result- hypertension
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Natural way to control blood pressure
• Return to caveman diet
• Dietary Approaches to Stop Hypertension (DASH) Eating Plan
• National Heart, Lung & Blood Institute
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DASH
• Fruits & veggies
• Low fat milk (calcium) products
• Eat more: poultry, fish, nuts
• Eat less: red meat, sugar in
processed foods/drink
If all Americans ate DASH: dramatic drop in heart attacks/stroke
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DASH DIET
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What controls how much H2O you lose in your urine?
Walking- desert Drinking
many glasses
H2O
Your body adjusts
Concentrated Dilute yellow
yellow urine urine
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In Nevada Desert:
1. Lose H2O- breath, sweat
2. Blood volume (concentrated)
3. Brain (hypothalamus) detects change blood volume
4. Signals pituitary gland
Antidiuretic Hormone (ADH)
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Diuretic = urine secretion
Antidiuretic Hormone
• Makes tubules/collecting ducts more permeable to water
• Water moves into blood
• Result: more H2O in blood, urine- concentrated
• Important: saves body water- desert
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You arrive at Las Vegas Hotel- thirsty
• Drink several bottles H2O
• Blood volume
• H2O comes in from intestine
• Pituitary ADH
• Nephron tubules/collecting duct less permeable
• More H2O leaves urine
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Drink 12 ounces
Beer or Water
• Beer- more urination
• Alcohol: ADH production
• Alcohol = diuretic
• Urine secretion
• Dehydrating effect part of hangover
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To the outside…….
Urine ureters urinary bladder holds 27 ounces
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Urethra: from bladder to outside
Men: 7-8 inches- through penis
Women: ~ 1 inch
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Prostate gland: produces fluid for semen
Prostate: below
bladder,
surrounds
urethra-
Enlarged
Prostate
Urine Stream
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Urination
• Urethra: has sphincter muscle around it: voluntary control
• When bladder has 7 ounces urine:
• Stretch receptors- wall of bladder
“urge to urinate” brain
• Sphincter muscle relaxes, bladder muscle contracts: urine passes out of body (1/2 gallon/day)
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Kidney Stones: detected 7000 year old mummies
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Kidney stones: more common men
• Concentrated urine: crystal formation: calcium, uric acid stones
• Small pebble
• Very painful
• Occur in tubules, collecting ducts, ureters
• Can block urine flow if big
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Treatment:
1. Drink fluids- pass stone
2. Surgery
3. Medicine: to relax smooth muscles: pass stone
4. Shock waves: you sit in tub of water: machine- high energy shock waves: pulverize stones
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Kidney Stones (calcium oxalate)
Risk Factors
• Men 2X risk
• Overweight
• Diabetes
• “Stone belt”: people in Southeastern US: 20% risk: related-sweating, more concentrated urine?
• Grapefruit juice, stones
• Megadoses of Vitamin C
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After the stone has passed into urine
• Drink enough fluids
• Salt in diet
• Children animal protein & salt
stones
• Coffee drinkers: risk
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Good Bacteria
Many kidney stones: calcium oxalate
Oxalate: spinach, beets, nuts
Oxalobacter formigenes in intestine
Digests oxalate
People Oxalobacter Kidney stones
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Urinary Tract Infections
More common women
90% due to E. Coli (colon bacteria)
Anus close to urethra: bacteria multiply
Result: bladder infection (cystitis) & urethra infection (urethritis)
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Urinary Tract Infections
Other causes- bacteria infections
1. Sexual intercourse
2. Pregnancy
3. Urinary obstruction
Cranberries/cranberry juice
10 ounces/day: protection
Prevent growth E. Coli and
attachment to urinary bladder
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DIABETES
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What is diabetes?
• Diabetes mellitus
• Diabainein (Greek)= “to pass through”
• Mellitus (Latin)= “sweetened with honey”
• Glucose spills into urine
• Sweet urine- ants
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Diabetes
• Consistently blood glucose
• Result of:
1) insulin from pancreas
and/or
2) insulin sensitivity (responsiveness) by body cells
“insulin resistance”
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“Starvation in the midst of plenty”
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Symptoms (warning signs): diabetes
1. Frequent urination
2. Excessive thirst
3. Extreme hunger
4. Unusual weight loss
5. Increased fatigue
6. Irritability
7. Blurry vision
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Normal Blood Glucose: 80-100 mg
Renal Threshold Glucose : 160-180 mg
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At renal threshold:
Glucose filtered > Glucose reabsorbed
Spillover urine (wasted energy)
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Diabetes
• Without glucose, body breaks down (partially) fat- energy
ketones (acids)
• Brain, other tissues- adapt to use ketones for energy
• Excessive ketones urine
(test kit)
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Diabetes
• Ketones: acidity of blood (ketoacidosis)
• Rapid/deep breathing, very thirsty, urination, loss appetite
• Fruity breath odor
• Weakness, fatigue, confusion
• Severe dehydration, coma, death
• Requires immediate treatment
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YOUR IMMUNE SYSTEM
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Microbes are all around us
Babies: “bacteria-free”-
sterile womb environment
After birth: baby
“colonized”
by bacteria: mom’s
breasts, clothing, air
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Globe 2/08
“Your body:
a colony
of creatures”
Humans:
20,000 genes
Microbes living
on/in us:
3 million
genes
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“Microbes & their attached Humans” Symbiosis: “good germs” Concern: some bacteria disappearing American emphasis: anti-bacterial Kleenix, soaps, etc.
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Skin pore
with
Staphylococcus
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Macrophage
Ingesting
Staphylococci
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MRSA
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Our immune system: under
constant attack: viruses, bacteria, fungi
David Venter: born 1971 with severe combined immune deficiency
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“BOY IN A BUBBLE”
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David lived 12
years: isolation
chambers
• Baptized- sterile
water
• Breathed
filtered
air
• Clothes-
disinfected
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• Parents/doctors
handled him with
gloves attached-
bubble
• Died- 1984 after
bone marrow
transplant from
sister
• Marrow contained
virus- not detected
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Immune System: cells & proteins in your body
Kills invading microorganisms: bacteria, viruses, fungi
Antigen: any foreign substance- triggers immune response
Usually protein- on microorganism surface
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Protozoan
Parasites:
Infected &
Ruptured
Human Cell
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If you are invaded by bacteria: immune system kills them
1. Next time you are invaded: rapid response- kill bacteria
2. Immune system “remembers” 1st invasion
3. Immunity: long-lasting protection against microorganisms
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Macrophages attacking E. Coli bacteria
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Another example: vaccinations
1. Inject you with harmless “part”
of invader (vaccine)
2. Ex. Poliovirus (killed)
3. You have full immune response
4. Produce: antibodies: immune system proteins- attack 1 specific antigen
5. Immune system ready if real, live poliovirus invades you
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Polio-
not eradicated
in world
WHO global
Initiative
2009: Nigeria
“a runaway polio
epidemic”
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Vaccinations: diphtheria, tetanus, pertussis, polio, hepatitis, chicken pox, measles, mumps, rubella
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Another example:
1. You get chicken pox
2. Immune response- you produce antibodies- get well
3. Immune system “memory” protects you against getting chicken pox again
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Active immunity: you develop protection in response to invasion- microorganism
Passive (temporary) immunity examples:
1. Pregnant women antibodies through placenta baby
2. Breast milk antibodies baby
3. Gamma globulin shots- overseas travel
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1st line defense: prevents pathogens from entering body
Pathogen: disease causing organism
1. Epithelium: covers body surface (skin, intestine lining)- barrier to invasion
2. Glands: tears & saliva release enzymes- kill bacteria
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3. Lung surfaces: cilia sweep away microorganisms
4. Stomach juice/acid: kills pathogens
5. Urine: low pH: kills bacteria- protects against urinary tract infections
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2d Line of defense: if pathogen gets past barriers:
White blood cells= phagocytes Gobble up bacteria with pseudopods (false feet) 1. Large eaters (macrophages) 2. Small eaters (microphages)
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Phagocytes in lymph node attack bacteria
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General Immune Response: inflammatory response: you step on nail with bare foot
Bacteria invade puncture
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1st immune cells near injury
histamine
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Histamine:
• Blood vessels become leaky (permeable)
• Vasodilation
• More blood injury site
• Redness/swelling/warmth near surface
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2d: small & large eaters squeeze out of blood attack & kill bacteria
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3rd Complement proteins in blood near injury: “complement” this attack: cut holes in bacteria cell membranes
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4th Fibrin- blood protein forms network of fibers: “seals” off injury
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More specific immune response
Antibody Cell
Immune Immune
Response Response
“B” Cells “T” Cells
interaction
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Antibody immune response
• Carried out by
“B” cells (white
blood cells)
• Start out in
Bone marrow
• Migrate to spleen
& lymph nodes (filters)
• Ready to protect you
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Swollen neck:
“B” cells in lymph
node fighting
infection
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B cells’ membrane
surface:
• “Y” shaped
Antibodies
(receptors)
• Bind to 1
specific antigen
(bacterium)
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Some B cells make
“clones”: exact
genetic copies
• Kill bacteria as
it spreads
• Clones stay
in body: “memory”
• Ready: future
attacks
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Other “B” cells:
Release antibodies
from surface:
move into blood-
attack bacteria
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Cell Immune Response
Carried out by
“T” cells
(white blood
cells)
• Start out: bone
marrow
• Move to Thymus
(become specialized)
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Thymus gland: above heart
“T” cells later migrate: spleen & lymph nodes
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Cell Immune Response
• Especially good for viruses hiding inside your cells
• Viruses inside cells not attacked by antibodies
• One type T cell destroys your “virus infected” cells
• Virus attack coordinated by “helper T cells” (CD4 cells)
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AIDS: acquired immune deficiency syndrome
Caused by HIV: human immunodeficiency virus
Dangerous: attacks our immune system (helper T cells)
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AIDS weakens immune system
• Body can’t fight off:
other viruses
bacteria
fungi
susceptible: pneumonia, cancer
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HIV= RNA virus
(single strand)
also called a
Retrovirus
Retro=
Backwards
RNA makes DNA
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How HIV damages your immune system
1. HIV attaches to receptor on helper T cell membrane
2. Enters cell
3. Uses special enzyme & RNA to make DNA (“retro”)
4. New “virus” DNA becomes part of cell DNA (Invasion Body Snatchers)
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HIV Infection
5. Cell tricked into making new RNA viruses (replication)
6. Viruses burst out of helper T cell (killing it)
7. Released viruses infect new cells
8. 10 billion new viruses made/day
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HIV Infection
9. Body immune system starts to fail: “immune deficiency”
10.Finally: other infections set in: bacteria, viruses, fungi, parasites
11.Low CD4 count (200/microliter or less): sign HIV infection
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AIDS viruses attacking immune cell
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Problem in developing HIV vaccine:
1. HIV multiplies- great numbers
2. Mutates rapidly- makes different versions of self
3. Difficult to make antibodies against different virus surface proteins
4. HIV adapting rapidly to immune system: human populations
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AIDS Treatment
• “Cocktail” of drugs (3+)
• Antiretroviral therapy
• Reduce amount HIV in blood
• Never disappears
• Drugs: growth & replication virus
• Allow people: longer life, less serious complications
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AIDS patients living longer but immune system damaged before “cocktail” used and antiretroviral drugs themselves further damage
Result: AIDS survivors- many medical conditions as they age
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John Holloway: 59- AIDS survivor more health problems than 85 year old father
• COPD
• Diabetes
• Kidney failure
• Bleeding ulcer
• Depression
• Rectal cancer
• Prolonged effects- broken hip
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How you get AIDS
• Vaginal, anal, oral sex with infected person
• Virus in: blood, semen, vaginal secretions
• Virus enters body- small tears in tissue
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Other ways to get AIDS
• Virus “transmitted”- infected blood: transfusions
• Needles/syringes- HIV contaminated
• Pregnant women- AIDS baby
• Organ transplants
• Unsterilized dental/surgical equipment
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HIV not transmitted
• Sweat or tears from AIDS person
• Kissing AIDS person
• Sharing towels, telephone, toilet with infected person
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Autoimmune Diseases
Normally your immune system
distinguishes between
“self” “non-self”
your normal infection/foreign
cells cells
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Autoimmune Diseases
• Immune system attacks healthy tissue (as if foreign)
• T cells developing in thymus never learn difference: self vs. non-self
• Antibodies: attack normal tissues
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Autoimmune Diseases
1. Rheumatoid arthritis: attack connective tissue (joints)
2. Multiple sclerosis: attack of nerve cell covering
3. Type 1 diabetes: destroy cells in pancreas: insulin
4. Lupus: joint inflammation, pain, rash
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• Disfigurement: rheumatoid arthritis- difficulty signing greeting card
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Lupus
Erythematosus
“The Red Wolf”
Face rash: people
with “wolflike”
appearance
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Multiple Sclerosis
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ALLERGIES
Common
allergens
(antigens)
• Tree, grass,
weed pollen
• Spores
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Dust Mites
• Live in
Pillows,
Mattresses,
Blankets,
Carpets
• Like: darkness, high humidity,
your dead skin flakes
• Dust mite droppings airborne
allergy inhaled
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Cockroach
Droppings
(proteins)
Trigger
Asthma
Attacks
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Animal Dander Allergy
• Protein: in saliva,
dander (dead skin),
urine of cats, dogs,
other mammals
• Airborne
Allergic reaction
• Hair- not allergen
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MOLD
• Microscopic fungi
• Release enzymes:
break down organic
matter on which
mold lives
• Protein secretions & mold spores: airborne allergies
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Allergies
• Hypersensitivity reactions
• Genetic predisposition
• Overreaction- immune system to environmental antigens (allergens)
• Overproduction of certain type of antibody (IgE)
• Example: reaction to pollen grain= hay fever
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Hay fever
• Pollen grain enters body: stimulates antibody production
• Subsequent exposure: antibody attaches to mast cells (in connective tissue)
• Antibodies “grab” allergens
• Mast cells release histamine: inflammation response
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Inflammation Response • Vasodilation- blood vessels • Capillaries: leaky- release fluid • Sniffles/runny nose • Coughing/sneezing/tearing eyes • Difficulty breathing • Histamine contraction smooth
muscle: airways • Antihistamines: block receptors
(blood vessels)- that bind to histamine
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Allergy Testing
• Scratch specific
allergens into skin
• Trigger IgE (antibody)
histamine mast cells
• See redness &
swelling if allergic
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Allergy Shots
• Immunotherapy
• Decrease your sensitivity to allergens
• Inject increasing amount of specific allergens (Build-up Phase)
• Maintenance Phase: therapeutic dose reached to reduce allergic symptoms
• Like vaccine: your body develops “immunity” or tolerance to allergens
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Allergy Free Bedroom
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Anaphylactic Shock
• Dangerous allergic reaction
• Some people very sensitive to allergens:
venom of
bee sting,
peanuts,
shellfish
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Anaphylactic Shock
• Sudden inflammatory chemicals
• Blood vessels dilate quickly
• Dramatic Blood pressure= shock
• Counteract: epinephrine injection
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Peanut Allergies
• 3.3 million Americans allergic to peanuts or tree nuts
• Reactions: range- mild stomach/skin reactions airway constriction
death
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2009 Research
• Children: sprinkle
Peanut Powder
on
food
• Increase doses
• After 10 months:
Children eat 15 peanuts
without symptoms
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Organ Transplants
• Each body cell has distinct proteins on cell surface (“self” proteins)
• Makes you unique- anyone else
• Impossible: any 2 people- same proteins on cell surface
• Exception: ID twins
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Organ Transplants
• Problem: skin grafts & organ transplants: one person another
• Rejection: your body “sees” new tissue/organ as foreign: immune rejection
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To minimize rejection
• Doctors “match” donor and recipient (cell surface proteins) as closely as possible
• Tissue typing: worldwide data base
• ID twins: exact same tissue type
• Brothers/sisters: close match
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To minimize rejection
• Administer: immunosuppressant drugs
• Suppress immune/rejection response
• Problem: person more susceptible: infections & cancer
• Autografts (autotransplantation): graft tissue one place another in same person
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Bone Marrow Donor Programs: cancer
• Worldwide volunteers
• Look for “good” matches
• Recipient bone marrow: radiation
• Eliminates person’s bone marrow
• Kills cancer cells & inactivates immune system
• Donated bone marrow contains white blood cells: replaces eliminated marrow without rejection
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Pigs for Spare Parts
Animal to Human Organ Transplants
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The “Perfect” Pig
1. Pig with human genes
2. Organs can be transplanted into humans without rejection
Xenotransplantation
• Transfer: organs, cells, tissues from 1 species another
• “Xeno”= strange or foreign
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Organ Transplants
The Need:
• 80,000 people in U.S. on waiting lists for organ transplants
• 16,000 people die/year while waiting
• “Not enough organs to go around”
• Some countries: “Black Market” for organs
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Why Pigs?
• Physiologically similar to humans
• Plentiful, easy to breed
• Carry fewer deadly diseases vs. primates
• Organs similar in size to humans
• “Miniature swine” used: inbred strain
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The Concern
• Pigs born with viruses
• Concern: spread pig viruses to general human population
• Ex. Malaysia: 1997 “new” pig virus killed 100 people
• Ex. Bird Flu Epidemic
• AIDS epidemic: HIV “jumped” from chimp humans
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2002: Charlestown, MA company
• Cloned first pigs:
“knocked out”
1 of 2 genes that
trigger violent
immune response in
humans (single knockout)
• Worcester company: developing “double knockout”: pig organs that are “human friendly”
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Nextran Company, New Jersey
• Developing: “transgenic pigs”
• 300 pound pregnant pig under anesthesia
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Technician: flushes fertilized eggs out of uterus • Microinject: under microscope: single human gene into each egg • Implant eggs in another sow (in heat) • Create baby “transgenic” piglets • A little bit “human” • Do “tail snip”: check if pigs have human
DNA • Goal: allow human immune system to
accept pig organs
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Superbug War
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Superbugs • Hospital acquired infections
• Become infected during stay in hospital
• Kills 900,000 Americans/year
• Bacteria spread:
Person to person
On hands
On bedrails, sheets, IV poles
While inserting vein catheters
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Superbugs • Overuse antibiotics: bacteria become
drug resistant
• Clostridium difficile (C. diff)
• Intestinal bug: severe diarrhea
• Attacks people- weakened immune systems
• Attacks people using catheters, IV lines, ventilators
• MRSA: “Staph Infection”- spread: person to person
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Superbugs
• Cost of treating “hospital infections”: $20 billion/year
• Survey: health care workers clean hands effectively: only ½ of times
• New emphasis: sanitizing rooms, equipment, washing hands, sterile conditions: inserting catheters, precautions with infected people
• Result: dramatic in infections
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2008: EPA approved health claim: copper alloys (brass & bronze) are antimicrobial
Copper ions: kill bacteria
99.9% MRSA kill rate
Uses in hospitals:
door knobs, arm rests,
bed rails, other fixtures
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Hygiene Hypothesis
Should babies eat dirt?
Mothers know: “Instinctive” baby behavior: pick things up from floor/ground: put in mouth
?
Evolutionary
Advantage
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New born baby’s immune system: like an “unprogrammed computer”
• Needs to be programmed
• GI tract needs to be “colonized”
• Early exposure to bacteria, viruses, worms in “dirt” triggers development of “healthy immune response”
• GI tract: important part of immune system: “point of entry”
• Microbes GI epithelium Immune Response
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“Dirt” may help baby’s immune system
distinguish
Strong immune “ignore” some
Response: antigens (dust mites,
Protect against (dander, pollen)
Dangerous (harmless)
Pathogens
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Recent evidence: U.S. and developed countries: increase in immune system disorders
• Multiple sclerosis
• Type 1 diabetes
• Inflammatory
Bowel Disease
• Asthma
• Allergies
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Are we too clean?
• Overuse of antibacterial products may increase antibiotic resistant, disease causing bacteria
• Children raised: “ultraclean” environment: not exposed to organisms that “help” their immune systems to develop
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Evidence:
1. Children raised in large families
2. Children raised on farms- exposed to worms and other farm animal organisms
3. Children sent to day care centers at early age
Allergies Autoimmune Diseases
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Some Doctors recommending:
• Use plain
soap & H2O
• Let children
play in dirt
• Go barefoot
in dirt
• Have dogs &
cats (exposure
to GI worms)
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2008 Study: Asthma rate of Africa
Americans born in
Dorchester
3X higher than
black people
born outside U.S.
Reason: hygiene hypothesis?
Children- developing countries strong immune response to life-threatening diseases
Immune system “ignores” dust mites/mold (allergy/asthma triggers)