J. O. Warner

The control of allergens of dust mites and domestic pets: a position paper.

*Department of Zoology, University of Glasgow, Glasgow G12 8QQ, U.K.; ^Regional Department of Respiratory Medicine, East Birmingham Hospital, Bordesley Green East, Birmingham B9 5ST, U.K.; % Respiratory Research Group, Department of Child Health, Royal Hospital for Sick Children, Bristol BS2 8BJ, U.K.; ^Medicine I, Level D, Centre Block, Southampton General Hospital, Southampton SO9 4XY, U.K.; ^Allergy Analysis Centre, 31 Station Lane, Witney, Oxfordshire OX8 6AN, U.K.; **The Blackrock Clinic, Blackrock, Co. Dublin, Republic of Ireland. ^•Cardiothoracic Centre, Broadgreen Hospital, Liverpool L14 3LB, U.K.; ^Department of Child Health, Southampton General Hospital, Southampton S09 4XY, U.K.; ^Regional Department of Respiratory Physiology, Wythenshawe Hospital, Manchester M23 9LT, U.K.

Dietary prevention of allergic diseases in infants and small children.

Because of scientific fraud four trials have been excluded from the original Cochrane meta‐analysis on formulas containing hydrolyzed protein for prevention of allergy and food intolerance in infants. Unlike the conclusions of the revised Cochrane review the export group set up by the Section on Paediatrics, European Academy of Allergology and Clinical Immunology (SP‐EAACI) do not find that the exclusion of the four trials demands a change of the previous recommendations regarding primary dietary prevention of allergic diseases. Ideally, recommendations on primary dietary prevention should be based only on the results of randomized and quasi‐randomized trials (selection criteria in the Cochrane review). However, regarding breastfeeding randomization is unethical, Therefore, in the development of recommendations on dietary primary prevention, high‐quality systematic reviews of high‐quality cohort studies should be included in the evidence base. The study type combined with assessment of the methodological quality determines the level of evidence. In view of some methodological concerns in the Cochrane meta‐analysis, particularly regarding definitions and diagnostic criteria for outcome measures and inclusion of non peer‐reviewed studies/reports, a revision of the Cochrane analysis may seem warranted. Based on analysis of published peer‐reviewed observational and interventional studies the results still indicate that breastfeeding is highly recommended for all infants irrespective of atopic heredity. A dietary regimen is effective in the prevention of allergic diseases in high‐risk infants, particularly in early infancy regarding food allergy and eczema. The most effective dietary regimen is exclusively breastfeeding for at least 4–6u2003months or, in absence of breast milk, formulas with documented reduced allergenicity for at least the first 4u2003months, combined with avoidance of solid food and cows milk for the first 4u2003months.The role of primary prevention of allergic diseases has been a matter of debate for the last 40 years. In order to shed some light on this issue, a group of experts of the Section of Pediatrics EAACI reviewed critically the existing literature on the subject. An analysis of published peer-reviewed observational and interventional studies was performed following the statements of evidence as defined by WHO. The results of the analysis indicate that breastfeeding is highly recommended for all infants irrespective of atopic heredity. A dietary regimen is unequivocally effective in the prevention of allergic diseases in high-risk children. In these patients breastfeeding combined with avoidance of solid food and cows milk for at least 4-6 months is the most effective preventive regimen. In the absence of breast milk, formulas with documented reduced allergenicity for at least 4-6 months should be used.

Clinical characteristics of peanut allergy

Background Current clinical advice regarding peanut allergy is based on small series of patients.

The effects of a double blind, placebo controlled, artificial food colourings and benzoate preservative challenge on hyperactivity in a general population sample of preschool children

Aims: To determine whether artificial food colourings and a preservative in the diet of 3 year old children in the general population influence hyperactive behaviour. Methods: A sample of 1873 children were screened in their fourth year for the presence of hyperactivity at baseline (HA), of whom 1246 had skin prick tests to identify atopy (AT). Children were selected to form the following groups: HA/AT, not-HA/AT, HA/not-AT, and not-HA/not-AT (nu200a=u200a277). After baseline assessment, children were subjected to a diet eliminating artificial colourings and benzoate preservatives for one week; in the subsequent three week within subject double blind crossover study they received, in random order, periods of dietary challenge with a drink containing artificial colourings (20 mg daily) and sodium benzoate (45 mg daily) (active period), or a placebo mixture, supplementary to their diet. Behaviour was assessed by a tester blind to dietary status and by parents’ ratings. Results: There were significant reductions in hyperactive behaviour during the withdrawal phase. Furthermore, there were significantly greater increases in hyperactive behaviour during the active than the placebo period based on parental reports. These effects were not influenced by the presence or absence of hyperactivity, nor by the presence or absence of atopy. There were no significant differences detected based on objective testing in the clinic. Conclusions: There is a general adverse effect of artificial food colouring and benzoate preservatives on the behaviour of 3 year old children which is detectable by parents but not by a simple clinic assessment. Subgroups are not made more vulnerable to this effect by their prior levels of hyperactivity or by atopy.

Markers of eosinophilic inflammation and tissue re-modelling in children before clinically diagnosed bronchial asthma.

Chronic inflammatory changes in the bronchial mucosa have been well documented in patients with established asthma. Much less is known of the changes, which occur in the airways of children early in the evolution of their disease with most of the information based on indirect markers of inflammation only. We evaluated markers of inflammation and tissue re‐modelling in bronchial biopsies from children with early respiratory symptoms before a clear clinical diagnosis of bronchial asthma could be made. We examined bronchial biopsies performed in 27 children between the ages of 1.2 and 11.7u2003yr who were bronchoscoped for a clinical indication because of recurrent or chronic respiratory symptoms. The patients were re‐evaluated 22–80u2003months after the original bronchoscopy to determine whether or not they had subsequently developed bronchial asthma. There were more eosinophils in the bronchial mucosa (129.4 vs. 19.1u2003cells/mm2 of lamina propria, pu2003<u20030.001) and the thickness of the subepithelial lamina reticularis was greater (4.65 vs. 3.72u2003μm, pu2003=u20030.044) in children with bronchial asthma diagnosed at follow‐up, compared with the children who did not progress to asthma. Eosinophilic inflammation and airway re‐modelling occur early in the natural history of bronchial asthma and are present even before asthma would be diagnosed based on clinical symptoms. Recognition of these changes and their significance for clinical disease should emphasize the need for timely detection and diagnosis of asthma in children to facilitate the early introduction of anti‐asthma therapy.

HLA class II DRB1, DQB1 and DPB1 genotypic associations with peanut allergy : evidence from a family-based and case-control study

Peanut is one of the most common foods provoking allergic reactions and is the most frequent cause of fatal and near‐fatal food‐induced anaphylaxis. However, as yet, little is known of the genetic and immunological mechanisms which underly peanut allergy.

Allergy Practice Worldwide: A Report by the World Allergy Organization Specialty and Training Council

In 2004 the World Allergy Organization’s Specialty and Training Council conducted a survey of World Allergy Organization (WAO) member societies to obtain information about the status of the specialty of allergy worldwide. Responses were received from 33 countries, representing a population of 1.39 billion people, of whom it was estimated that 22% may suffer from some form of allergic disease. Allergy was reported by 23 respondents to be a certified or accredited specialty in their country, and the number of certified allergists per head of population ranged from 1:25 million to 1:16,000. Allergists were ranked as the fifth most likely clinicians to see cases of allergic asthma, third most likely to see allergic rhinitis, and fourth most likely to see eczema or sinusitis. Nine countries only reported that children with allergic diseases would be seen by a pediatrician with appropriate training. The survey results highlight a pressing need for the development of allergy services worldwide.

News and commentaries. Requirements for medications commonly used in the treatment of allergic rhinitis - European Academy of Allergy and Clinical Immunology (EAACI) allergic rhinitis and its impact on asthma (ARIA)

It has been shown that several medications are effective in the treatment of allergic rhinitis (1–3). Among them, oral H1-antihistamines and intra-nasal corticosteroids are the most widely used. A large number of studies have been carried out with these drugs but they use various end points which make these studies difficult to be compared. Moreover, the pharmacological properties of these drugs are well known but recently, new data have focussed on the mechanisms of action of H1-antihistamines and their so-called antiallergic properties. Guidelines for the development of drugs used in allergic rhinitis are pending. It seemed therefore important before proposing recommendations for such guidelines to define the properties of oral H1-antihistamines, anti-allergic effects of H1-antihistamines and intra-nasal corticosteroids. There is therefore an urgent need to make internationally valid definitions. These will be of importance for physicians and scientists but also for drug companies developing new drugs and registration authorities.

Serological characteristics of peanut allergy

Peanut is the most common cause of severe or fatal food‐associated anaphylaxis. Studies indicate that peanut extracts contain many allergenic proteins. The identification of major and minor allergenic components is necessary for standardization of experimental and diagnostic extracts.

Airway function correlates with circulating eosinophil, but not mast cell, markers of inflammation in childhood asthma

Background Lung function tests, including forced expiratory volume in one second (FEV1), forced expiratory flow at 25–75% of vital capacity (FEF25–75%) and provocation concentrations of histamine which reduce FEV] by 20% (PC20), are used as indicators of airway form and function in bronchial asthma. Recently, markers of eosinophil activation in bronchial lavage and serum have been suggested as a measure of eosinophil mediated inflammation in the airways. These include eosinophil cationic protein (ECP), eosinophil protein X (EPX) (also known as eosinophil derived neuro‐toxin) and eosinophil peroxidase (EPO). Similarly, serum tryptase has been used as a marker of mast cell activation in systemic anaphylaxis.