In this issue

Three years ago, we published three consecutive papers on the dietary prevention of allergic diseases in infants and small children. This covered a very comprehensive and systematic review of the literature on this topic. It concluded with recommendations carrying the weight of the section of pediatrics of the European Academy of Allergy and Clinical Immunology (1–3). As there has been a revision of the Cochrane review on the use of modified milk formulae, the section of pediatrics felt it was appropriate to re-evaluate the literature and produce further recommendations which in some respects are at variance with the conclusions of the Cochrane review. The ultimate consistent message, however, is that more research is required. There are a number of wheezing phenotypes in early life. Studies from Aberdeen over the last 40 years have helped to clarify these and we have another excellent paper from the Aberdeen team outlining the demographic associations for what they describe as wheezy bronchitis which is effectively virus-associated wheeze compared with multi-trigger wheezing which most of us would label as asthma. Many factors interact to contribute to the severity of each of these two phenotypes. It is interesting to note from the Aberdeen observations that while asthma has increased in prevalence, virus associated wheeze has not. These observations are very much in accord with those from a study we published from Spain (4). We then have a paper on hospital admissions for asthma in Taiwan demonstrating continued increases in children but not in adults. This is perhaps somewhat at variance with a study from Greece which showed increases in admissions during the 1970s and 1980s, but a subsequent leveling out in admission rates which may have been due to improved long term management strategies (5). Many genetic polymorphisms have been associated with increased risks of asthma and allergic rhinitis. A study from Turkey has focused on polymorphisms and IgG receptor gene (Fc-cRIIIa). This polymorphism appears to primarily affect risk of atopy which has been the subject of many previous publications (6, 7). We have three papers on defective immunity. One is focused on the leukocyte adhesion deficiency, which we normally associate with delayed cord separation and a very interesting paper on the association between IgA deficiency and oral and dental problems. Staphylococcal skin colonization and infection is a major problem in atopic eczema. Whether or not this is a consequence of impaired immune responses as suggested in a study from Poland or more to do with defects in skin barrier function still requires further investigation. We have published many papers on the effects of immunization programs on the development of allergic disease (8–10). Our latest paper focuses on pertussis infection in children who either were or were not previously immunized against this organism. While there is a positive association between infection and immunization in relation to atopic outcome, it is not clear whether this is cause or effect. Poor response to the immunization will be associated with a greater risk of both allergic disease and pertussis. My own feeling from publications so far is that immunizations have no impact on allergy outcomes and if anything some may have a small protective effect. There are now numerous studies of probiotics in the management of allergic conditions with variable and predominantly disappointing results. At least such interventions do not adversely affect responses to immunization and might even enhance them as shown in a paper from Sweden, which very much matches another study we published from Finland (11). Does rhino-sinusitis affect asthma? This has been discussed in a recent supplement (12). We now have a paper indicating that nasal corticosteroids to treat persistent allergic rhinitis can improve lower airway function. Allergen immunotherapy is clearly an important component of allergy management strategies though asthma guidelines tend to exclude this from the therapeutic algorithm. We have two papers on a very carefully conducted double blind Pediatr Allergy Immunol 2008: 19: 5–6