Clinical Application of the Biodiversity Hypothesis in the Management of Allergic Disorders

Advances in understanding the environmental and lifestyle factors explaining the rise of allergic disorders in modern, urban societies have paved the way for change of management and disease prevention. The biodiversity hypothesis states that contact with the natural environment enriches the human microbiome, promotes immune balance, and protects from disease. The evidence is still mainly associative, but prevention practices are changing. Based on the new ideas, Finland is the first country to implement a nationwide, systematic programme (the Finnish Allergy Programme 2008–2018) to mitigate the overall allergy burden. The prevention strategy was turned from avoidance of allergens to promotion of immunological and psychological resilience. Allergy health and nature relatedness were emphasized. Medicalization, especially in food allergy was reduced and allergy diagnostics certified. The 10-year results are promising; patients are less disabled, attitudes have changed, and major cost savings have been obtained. In asthma, the first-line anti-inflammatory treatment was a paradigm shift in the 1990s and resulted in a major change for the better. The second paradigm shift, in the 2000s, was the Nature Step from treatment to prevention for all allergic disorders. The Finnish experience shows the power of implementing new knowledge and the utility of real-world data in outcome evaluation.