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Recent papers on allergy

Dr Sangeeta Dhami and Professor Aziz Sheikh review recent papers that could change the way you practice

Dr Sangeeta Dhami and Professor Aziz Sheikh review recent papers that could change the way you practice

Does allergen avoidance in early life work?

The paper: Arshad SH, Bateman B, Sadeghnejad A et al. Prevention of allergic disease during childhood by allergen avoidance: the Isle of Wight prevention study. Journal of Allergy and Clinical Immunology 2007; 119; 307-13.

Method Researchers randomised 120 high-risk infants to a combination of food allergen and house dust mite avoidance measures or control. The food allergen avoidance measures included being breast-fed by mothers while on a low-allergen diet or infants being given hydrolysed formula milk.

Results After adjusting the data for all relevant confounding variables, researchers found allergen avoidance was associated with a 76% reduction in the risk of developing asthma, 77% for atopic dermatitis and 58% for rhinitis.

Conclusion Allergic diseases can be reduced, for at least the first eight years of life, by combined food and house dust mite allergen avoidance in infancy.

What next Based on the findings of this well-conducted trial, multi-faceted early life allergen avoidance measures should be routinely recommended when infants are born into families in which one or more family members have a history of allergic disorders.

Do at-risk registers cut asthma deaths?

The paper: Watson L, Turk F, James P, Holgate ST. Factors associated with mortality after an asthma admission: a national United Kingdom database analysis. Respiratory Medicine 2007; 101:1659-64.

Method: The decline in UK asthma mortality rates noted over recent decades now appears to have reached a plateau. This study involved an analysis of asthma admissions between the years 2000 and 2005, with the aim of establishing whether it was possible to identify which patients are at greatest risk of dying after an asthma admission.

Results: The authors found that women, older people and those with co-morbid conditions – particularly cardiovascular disease and diabetes – were at greatest risk of death from asthma.

Conclusion: Comorbid conditions in older patients may contribute to mortality after an asthma admission and a greater understanding of risk factors is needed.

What next: There is ongoing work evaluating the effectiveness of compiling ‘at risk' asthma registers in prioritising care. Given the findings of this important study, formal risk assessment is something that practices should consider undertaking.

Should teenagers be screened for hay fever?

The paper: Walker S, Khan-Wasti S, Fletcher M et al. Seasonal allergic rhinitis is associated with a detrimental effect on examination performance in UK teenagers: case-control study, Journal of Allergy and Clinical Immunology 2007; 120:81-87.

Method: In the first real attempt to investigate this relationship, researchers enrolled 1,834 students aged 15 to 17 to a case control study.

Results: They found children suffering from hay fever were at significantly increased risk of dropping a grade between their winter mock and summer final exams compared with children without hay fever. The effect was compounded by sedating antihistamines – which an astonishing 28% of students took.

Conclusion: This is the first time the relationship between symptomatic allergic rhinitis and poor examination performance has been demonstrated.

What next: It's important that students with hay fever studying for exams are proactively identified and optimally managed. They especially need to be advised to avoid first-generation sedating antihistamines.

Does BCG cut the risk of developing asthma?

The paper: Linehan MF, Frank TL et al. Is the prevalence of wheeze altered in children by neonatal BCG vaccination? Journal of Allergy and Clinical Immunology 2007; 119:1079-85.

Method: The possible protective effect of BCG vaccination – a potent immune modulator – has attracted interest for more than a decade. This carefully conducted historical study – one of the largest to date – looked at the relationship between neonatal BCG vaccination in 2,414 children and the effect this had on risk of developing atopy and asthma.

Results: Neonatal BCG vaccination was associated with a 31% lower prevalence of wheeze, a statistically significant effect that remained after adjusting for potential confounders. Overall, the authors report a 27% reduced risk of children developing asthma-like symptoms.

Conclusion: These results demonstrate an association between asthma symptom prevalence and neonatal BCG vaccination and are therefore of considerable public health importance.

What next: If these results are confirmed in subsequent experimental studies, this could represent a very important primary prevention strategy.

Dr Sangeeta Dhami is a GP in Edinburgh and Professor Aziz Sheikh is professor of primary care research and development at the University of Edinburgh

Competing interests None declared

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