In these pages you will find reports of advances and key observations that will affect the care of children with allergic and immunologic diseases now and in the near future. The pediatrician is poised to identify infants and children at risk for disease and to intervene. Along the themes of preventing and predicting allergy, several articles present clinical and laboratory evidence that respiratory allergy, asthma, and allergic diseases may be predicted on the grounds of early lung mechanics, atopic disposition, and exposure to allergen. Potential interventions such as the use of probiotics and allergen avoidance are highlighted by several articles, but the area is complex, and additional articles emphasize the role of exposure to tobacco, pollutants, and respiratory infections in determining outcomes. Avoiding a progression of allergic disease and preventing allergies remain a key focus of research; however, as indicated by several articles, a perplexing controversy remains regarding the impact of reduced infection (the so-called hygiene hypothesis) on increasing rates of allergic disease. Notions about allergen avoidance are being refined; for example, the role of food avoidance in prevention of atopic dermatitis and food allergy is becoming less clear as studies reviewed herein show that delayed introduction of certain allergenic solids may not prevent allergy and may increase risks. Several selected articles focus on the importance of, and methods for, reducing exposure to environmental tobacco smoke, focusing on genetic risks, and identifying tobacco-smoke–related inflammation and modalities to improve intervention. Key observations in the area of food allergy present a potential for improved diagnosis and management. In particular, several articles present practical lessons regarding instructing patients on self-injection of epinephrine and pitfalls in avoiding allergens (eg, exposure during kissing). Major advances in atopic dermatitis include the clinical relevance of skin infection and the identification of loss-of-function mutations in the filaggrin gene, which result in skin-barrier dysfunction. Several articles paint a story of a disrupted skin barrier that may predispose to allergen sensitization, which in turn leads to further allergic disease. A variety of articles on asthma diagnosis and management were published just before the new National Heart, Lung, and Blood Institute Expert Panel 3 guidelines for the diagnosis and management of asthma and address evolving paradigms. For example, studies included here address issues of asthma classification, monitoring, and treatment. Practical implications to improve monitoring (eg, the use of spirometry), treatment (eg, practical tips for the use of metered-dose inhalers), and prevention are highlighted. Articles about the use of inhaled steroids continue to address chronic compared with intermittent use, impact on adrenal function, and whether these medications alter the course of asthma (an area of continued controversy). There is increasing interest in, and evidence for efficacy of, immunotherapy and immunomodulators. Reviewers selected a dozen articles on these themes that reveal the promise of allergen immunotherapy to prevent and effectively treat allergic disease; modalities of treatment that may be more child-friendly (eg, oral administration rather than injection); modifications of allergens that may allow fewer adverse effects, better efficacy, and faster onset; and the mechanism of these therapies. Several articles on primary and secondary immunodeficiency provide insights into disease pathogenesis, diagnosis, and emerging therapies. Our reviewers were asked to identify original research articles of interest, but several of them felt obliged to point out that the pediatrician should be aware of a number of superb review articles, practice articles, and guidelines on various aspects of pediatric allergy, asthma, and immunology. In the coming year, we will post such identified articles on the Section on Allergy and Immunology Web site (www.aap.org/sections/allergy).
- Copyright © 2007 by the American Academy of Pediatrics