Hughes, A-M, Lucas, R M, McMichael, A J et al. · Clinical and experimental immunology · 2013 · DOI
This study looked at whether early childhood experiences—like having siblings and attending childcare—affect the risk of developing central nervous system demyelination (a condition where the protective coating around nerve fibers becomes damaged). Researchers compared adults with demyelination to healthy controls and found that having younger siblings appeared to protect against demyelination, while the number of older siblings affected asthma risk differently. Interestingly, people with demyelination were more likely to also have chronic fatigue syndrome.
This study is relevant to ME/CFS patients because it identifies a strong association between central nervous system demyelination and chronic fatigue syndrome, suggesting shared or overlapping disease mechanisms. Understanding how early-life microbial exposures influence immune-mediated neurological conditions may inform future prevention or treatment strategies for both demyelinating diseases and ME/CFS.
This study does not prove that sibship structure directly causes or prevents demyelination or asthma—it only shows associations. The mechanism behind the 'sibling effect' remains speculative and based on the hygiene hypothesis, and the study cannot establish causality or determine whether the relationship applies to all populations or just those in these specific regions.
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
The first block is for the primary paper and is the citation you should use in research work. The atlas-snapshot line only applies if you are specifically referring to this atlas’s reading of the paper on the date shown.
Primary citation
Hughes, A-M, Lucas, R M, McMichael, A J, Dwyer, T, Pender, M P, van der Mei, I, et al. (2013). Early-life hygiene-related factors affect risk of central nervous system demyelination and asthma differentially.. Clinical and experimental immunology. https://doi.org/10.1111/cei.12077
BibTeX
@article{mecfsatlas-hughes-2013-early-life,
author = {Hughes, A-M and Lucas, R M and McMichael, A J and Dwyer, T and Pender, M P and van der Mei, I and Taylor, B V and Valery, P and Chapman, C and Coulthard, A and Dear, K and Kilpatrick, T J and Williams, D and Ponsonby, A-L},
title = {Early-life hygiene-related factors affect risk of central nervous system demyelination and asthma differentially.},
journal = {Clinical and experimental immunology},
year = {2013},
doi = {10.1111/cei.12077},
note = {PubMed: 23600835},
url = {https://www.mecfsatlas.com/evidence/hughes-2013-early-life},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-30. https://www.mecfsatlas.com/evidence/hughes-2013-early-life
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