In This Issue

Despite medical scepticism about the use of herbal therapy in the management of any diseases, it has remained popular as a component of complementary treatment of allergy and particularly asthma. Indeed, a significant percentage of British asthma sufferers have resorted to various forms of complementary medicine. The evidence base is limited with perhaps only atopic eczema having been shown to be benefited by Chinese herbal decoctions in convincing controlled trials. However, we now publish a paper on a Chinese herbal decoction tested in a double-blind clinical trial which achieves significant improvements in airway hyper-responsiveness in association with reduced medication requirements in children with mild to moderate persistent asthma. I am sure this study will generate considerable interest in the media and amongst sufferers who are desperate to find alternatives to inhaled steroids and beta agonists. However, it will be very important to establish whether this therapy is safe. Many more studies are required before it can be considered as part of any conventional therapeutic schedule. However, no doubt we will all be faced by parents demanding this therapy and we will need to carefully explain that natural does not necessarily mean safe. In the last issue of the journal, we published a paper from Japan on structure and transcriptional regulation of the cysteinyl leukotriene 1 receptor in an association study with asthma and rhinitis which failed to show any associations (1). In this issue, we publish a paper from Spain investigating a particular polymorphism in the gene which was foundmore commonly in patients with combined asthma and atopic eczema compared with those with asthma alone but only in male and not female subjects. As the gene is on the X chromosome, it is perhaps not surprising that it has a greater impact on males. Gender differences clearly are important in assessing the impact of genetic polymorphisms as other studies we have published have shown (2). Allergen avoidance in the primary prevention of allergic sensitization and allergic disease have been the focus of many studies. There is no consensus as to whether this approach has any benefit. We publish the 4-yr outcomes from the very large and well-known PIAMA study from the Netherlands. Comparison of avoidance with non-avoidance, the former having been achieved primarily by the use of bed covering systems, showed no effect on sensitization or allergic symptoms by 4 yrs of age. This is in keeping with more recent studies of dietary allergen avoidance in pregnancy as a means to prevent allergic disease. A recent review published on this topic came to the conclusion that currently there was no indication to recommend any form of avoidance and that a normal diversified diet in pregnancy is more appropriate (3). Psychological factors clearly can affect severity of disease. However, relatively less attention has been focused on the effects of stress on therapeutic responses. It is perhaps not surprising that stress will impact adversely and we publish a paper on its effects on sublingual immunotherapy with non-stressed patients having the greatest clinical benefit. Atopy patch tests have been recommended particularly to diagnose food allergy in atopic eczema and gastrointestinal disease. However, results are conflicting perhaps predominantly because of lack of standardization of the procedures. We have published a number of papers on this in the past (4, 5). We have two papers on the use of atopy patch tests, the first in asthma and rhinitis as a means to diagnose house mite allergy. However, only a relatively low percentage of asthmatic children with positive skin prick test to house dustmite had positive atopy patch tests. Whether those with positive tests would have greater benefits from avoidance will only be established by further study. At this stage, it is not possible to recommend this technique for diagnosing inhalant allergy. However, the second paper provides more convincing evidence in its use for the diagnosis of food protein-induced enterocolitis. Maintaining the theme of food hypersensitivity, we have another paper on prevalence from the Isle of Wight. As with many Pediatr Allergy Immunol 2006: 17: 314–315