A. J. Newman Taylor

Early prescriptions of antibiotics and the risk of allergic disease in adults: a cohort study

Background: For many years it has been assumed that the risk of childhood respiratory allergies is related to allergen exposures in early life. There are, however, few prospective data in support. We aimed to examine this relationship in a representative cohort of children born in Ashford, Kent (UK). Methods: 625 children (94% of those eligible) were followed from birth to the age of 5.5 years at which time 552 underwent skin prick testing to extracts of house dust mite and cat fur allergens. Maternal reports of wheeze in the last year were collected by interview. These outcomes were related to individual domestic concentrations of Der p 1 and Fel d I allergens estimated from dust collection at the age of 8 weeks. Results: 10% of children were sensitised to house dust mite or cat at age 5.5 years; 7% had atopic wheeze. No significant relationships between allergen exposure and either sensitisation or wheeze were found but, on examination, the exposure-response relationships for both allergens and for each outcome rose steeply at low levels of exposure and were attenuated at high levels of exposure. These patterns were modified by paternal atopy and by birth order. Conclusions: There are no linear relationships between early allergen exposure and the induction of childhood respiratory allergy; rather, the risks of IgE sensitisation and asthma rise at very low levels of exposure and are attenuated thereafter. These patterns are influenced by parental atopy and birth order. These findings suggest important gene-environment interactions in the development of atopy and asthma and imply that reductions in domestic allergen exposure alone are unlikely to have a major impact in decreasing the incidence of these diseases in childhood.

An outbreak of asthma in a modern detergent factory

The striking decrease in the occurrence of protease-induced occupational asthma in the detergent Industry has been attributed to enzyme encapsulation. We report an outbreak of asthma, at least equal in size to those reported in the 1960s, in a modem European factory which has exclusively used encapsulated enzymes. A survey revealed that enzyme sensitisation and work-related respiratory symptoms were positively correlated with airborne enzyme exposure. We suggest that encapsulation alone is insufficient to prevent enzyme-Induced allergy and asthma.

Identification of the major water/salt insoluble wheat proteins involved in cereal hypersensitivity

Background Several studies have investigated water/salt soluble proteins which comprise 50% of the proteins in wheat. The remaining 50% of wheat proteins, are water/salt insoluble proteins of which there is limited information on their role in cereal hypersensitivity.

Environmental associations with eczema in early life

Backgroundu2003Although atopic eczema (AE) is a common disease, little is known about its causes.

Crete: does farming explain urban and rural differences in atopy?

Background Urban‐rural differences in the prevalence of atopy and associated allergic diseases have been reported in several non‐European countries. Within Europe, where such variations are less striking, a farm childhood has been postulated to be protective.

Early allergen exposure and atopic eczema.

Backgroundu2002 The relationship between exposure to indoor aeroallergens in early life and subsequent eczema is unclear. We have previously failed to show any significant associations between early life exposure to house dust mite and cat fur allergens and either sensitization to these allergens or wheeze. We have also previously reported a lower prevalence of parent‐reported, doctor‐diagnosed eczema by age 2u2003years for children exposed to higher concentrations of house dust mite, but no other associations with other definitions of eczema or for exposure to cat allergen.

BOHRF guidelines for occupational asthma

Publication of the first evidence based guidelines for occupational asthmannNew guidelines for the identification, management, and prevention of occupational asthma are published this month in Occupational and Environmental Medicine .1 The first evidence based guidelines for occupational asthma, they were prepared by a working group that included clinicians, patients, occupational hygienists, and representatives of the Health and Safety Executive. The work was supported by a grant from the British Occupational Health Research Foundation (BOHRF). The guidelines will be supplemented by an abbreviated version for primary care practitioners, occupational health practitioners, employers, employees, and workplace safety representatives.nnThese guidelines are intended to increase awareness and improve the management of occupational asthma by all practitioners who encounter such patients, and to stimulate the means to reduce its incidence by those able to effect this.nnThe important issues in occupational asthma concern its aetiology, diagnosis, outcome and prevention. Questions about these are not readily answered by randomised controlled trials (RCTs) and, arguably, conventional hierarchies with the RCT at the apex are not appropriate for assessing the strength of evidence used in the generation of guidelines.2 Although not having the high internal validity of the RCT, strong inferences can be drawn from observational studies (whose external validity can be greater than that of an RCT) when these are well designed and their findings consistent and plausible.nnThe guidelines address several questions that are of key importance to respiratory physicians:nnnnnnAsthma can be …

Comparison of a radioallergosorbent (RAST) inhibition method and a monoclonal enzyme linked immunosorbent assay (ELISA) for aeroallergen measurement

Background Mouse and rat urinary proteins are potent occupational allergens for exposed personnel. Methods of measuring airborne allergens differ greatly, and reported levels of allergens vary considerably between laboratories.

Reduction of exposure to laboratory animal allergens in the workplace

Objectives Evidence is now accumulating that the prevalence of allergy to laboratory animals is related to the intensity of exposure to animal allergens. Whilst airborne animal allergen concentrations may be influenced by the litter type, cage design and stock density, the effectiveness of methods to reduce personal exposure has not been objectively assessed. Methods Air samples were collected at 2 L/min and 180L/min onto polytetrafluoroethylene (PTFE) filters and the rat urinary aeroallergen (RUA) and mouse urinary aeroallergen (MUA) concentrations were measured by radioallergosorbent test (RAST) inhibition.

New pregnancies and loss of allergy

Background Inverse associations between allergic disease and sibship have been consistently described and are frequently explained by purported lower rates of early infection among children from small families. Alternative explanations include the possibility that pregnancy itself determines maternal atopic status.