In this issue

Our educational series this month focuses on latex allergy. It is appropriately included as part of the series on food allergy because of the common association with allergic reactions to a wide range of fruits and vegetables. As has been emphasized in numerous papers published in the journal a window of opportunity exists in early life where there is the greatest possibility of modifying asthma and allergy risk (1). We have a paper from a very influential prospective controlled study of a multi-faceted intervention programme from Canada giving the risk factors for asthma at 7 yr of age. The intervention has continued to have a beneficial impact, however one or two of the outputs from logistic regression are somewhat disturbing including the suggestion that maternal smoking is protective. This observation conflicts with other recent publications suggesting a higher prevalence of asthma, wheezing and allergic rhinitis associated with household smoke exposure (2). There is considerable contention over the relative protective effect of breastfeeding in relation to later allergic disease with some studies supporting the concept (3) and others rejecting it (4). The current paper from Japan following a birth cohort of 763 infants could find no statistically significant effect of duration of breastfeeding on the risk of asthma. Maybe we now need to study the quality of the breast milk in order to establish whether it is likely to have any protective qualities. Thus previous studies have shown differences in breast milk between healthy and allergic mothers (5). Our current paper from the founding editor of the journal has demonstrated that administering a probiotic to the mother will modify some breast milk immune mediators with a particular impact in reducing transforming growth factor b2 levels which in turn was subsequently associated with a lower rate of allergic sensitization and eczema. While most studies have focused on the use of probiotics in the treatment of allergic disease (6) we should perhaps focus on the effects of administration of the probiotic to mothers during pregnancy and lactation which could have a far greater impact on outcomes. The German multicentre allergy study has generated an enormous amount of data highlighting risk factors for allergic disease. It has also offered the opportunity to understand the frequency of illness in early life and a paper in this issue highlights the frequency of respiratory infections in early life. Based on two standard deviations from the mean up to 11 respiratory infections per year in infancy, eight in pre-school children and four in school age children could be regarded as normal and provide an upper limit below which further investigation for immune deficiency is unnecessary. It will be interesting to hear the impact of frequence of infection on allergy outcomes. However, it will be necessary to incorporate into this an understanding of whether antibiotics were employed during the infections (7). Cord blood studies have repeatedly highlighted inefficient Th1 lymphocyte responses as potentially accounting for increased susceptibility to infection (8). The current study focuses on a very recent cytokine interleukin 27 whose induced expression is higher in the neonates than in adults. As this promotes a Th1 response it may in part compensate for the deficiency of other pathways. Its effect on later allergy outcome will clearly be of interest. The old concept of the allergic march suggests that allergic rhinitis is the last manifestation coming significantly after the onset of asthma. However, clinical impressions suggest that the two conditions probably have a similar age of onset as part of the unified airway. This has now been highlighted in a study from Japan. The key issue in this study was to be able to discriminate between allergic and infective causes of rhinitis which was achieved by detailed examination including rhinoscopy, nasal cytology, nasal challenge and allergy phenotyping. Remaining in the upper respiratory tract we then have a paper on defective c-interferon production in cells within the adenoids from children with recurrent otitis. Studying the lymphoid tissue in the upper respiratory tract can be very rewarding and given the easy availability of such tissue should have perhaps been the focus of rather more studies (9). Pediatr Allergy Immunol 2008: 19: 475–476