In This Issue

We have published many articles on genetic polymorphisms and their association with various allergic diseases. This has included a study identifying genetic polymorphisms in interleukin 13 associated with raised cord serum IgE (1). Alongside these papers there are also numerous studies of environmental risk factors for the development of disease. However, relatively few have linked the two together. This was highlighted in our recent supplement on initiatives for future research in paediatric allergy, asthma and immunology. This emphasized the importance of studies investigating gene by gene and gene by environment interactions to generate gene profiling which might allow focused environmental modification (2). We have a paper presenting data from a huge Danish cohort study which has identified some gene by environment interactions, between polymorphisms in the IL13 gene and an interaction with tobacco smoking during pregnancy as well as polymorphisms in the IL8 gene affecting the association with pet keeping and subsequent wheeze. Perhaps the divergent results identified from the impact of household smoking exposure on atopic outcomes may be explained by differences in genetic polymorphisms in different communities (3, 4). We have published numerous papers on the characteristics of cord blood mononuclear cells in relation to many outcomes. However as umbilical cord blood is being used as a source of stem cells to treat malignancies it is important to understand why they are associated with a relatively low rate of acute graft versus host disease (GVHD). A study from Taiwan suggests that high percentages of regulatory T cells in umbilical cord blood by comparison with adult blood may result in down-regulation the immune responses associated with GVHD. Many studies have investigated serum markers of severity of disease in atopic conditions.Wehave previously published on serum levels of various chemokines in association with severity of atopic dermatitis (5). We now have another paper confirming that CCL17 reflects severity in atopic dermatitis and also responses to treatment. We have two papers employing questionnaire surveys to parents of food allergic children. The first, from Japan, suggests that food avoidance in infancy no doubt predominantly as a consequence of food allergy is associated with a higher risk of several allergic diseases including more food allergies. This would match with clinical experience that early food allergy is associated with a more aggressive subsequent allergic march. The second paper highlights the value of a formal food challenge in egg allergic children. This was followed by greater reductions in parental anxiety by comparison with egg allergic children who had not undergone challenge. Emotional stress can have pervasive effects on immune responsiveness as highlighted in the (Life style Immune System Allergy) LISA study where stressful life events increased concentrations of Th2 cytokines in children (6). Appropriate education is also important in allaying anxieties and for children with asthma it is an integral part of recommended management as outlined in guidelines (7). We have a well-conducted randomized controlled trial of an outpatient education programme showing the benefits in terms of frequency of asthma attacks and associated improved parental knowledge. There is a burgeoning literature on sublingual immunotherapy demonstrating efficacy in rhinitis and asthma (8). In this issue, we have a large multi-centre case controlled study again demonstrating efficacy and interestingly also a reduction in the rate of new allergen sensitizations. Exhaled nitric oxide measurements are becoming ever more valuable in monitoring asthma. Despite the wide acceptance of guidelines to standardize measurements there are some methodological issues to be resolved. We have a paper from Rotterdam, where a great deal of work has been performed to evaluate non-invasive markers of asthma which outlines the effect of ambient nitric oxide on the measurement of exhaled and nasal nitric oxide. The groups have highlighted an effect of the ambient levels on nasal measurements. A study from Finland has shown a correlation between the levels of exhaled nitric Pediatr Allergy Immunol 2009: 20: 612–613