In these pages you will find reports of advances and key observations that will impact 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 atopic disease and to intervene. A recent clinical report from the AAP Committee on Nutrition and the Section on Allergy and Immunology presented an update on the role of maternal and infant diet on atopy prevention (Greer FR, Sicherer SH, Burks AW; American Academy of Pediatrics, Committee on Nutrition and Section on Allergy and Immunology. Pediatrics. 2008;121:183–191) highlighting the utility of breastfeeding and delaying whole proteins until 4 to 6 months of life. Presenting additional fuel to a growing appreciation of the nuances of dietary influence on atopy are articles reviewed here showing that infants do not develop allergen sensitization in utero, that breastfeeding may delay or prevent atopy (although this effect is modified by maternal atopic status and additional factors), and that delaying introduction of solid foods beyond 4 to 6 months does not necessarily provide additional protection from atopy. Factors apart from allergen exposure, whether in the diet or by inhalation, seem to play a role in the development of atopic disease, because studies have shown only a modest risk for developing new pet allergies when acquiring a new pet, and several studies support the “hygiene hypothesis,” indicating protection from atopy for those in less hygienic conditions and increased risks for those who received antibiotics in the neonatal period. However, several interesting articles have presented conflicting results regarding allergen exposures and the role of hygiene. One area that is not controversial is the adverse effect of tobacco smoke and air pollution on atopic disease. Articles reviewed here indicate increased respiratory allergy risks for children in homes with smokers and for those living near traffic and include data to elucidate possible mechanisms. Also reviewed are articles indicating that food allergy is common and significantly impacts quality of life, and unfortunately, data are showing a greater persistence of egg and milk allergies well beyond the first years of life. Therefore, pediatricians are increasingly required to diagnose and manage food allergy; several articles present pearls and pitfalls to avoid regarding testing. Exciting studies are showing interventions that may treat food allergy in the future. Treatments for anaphylaxis, however, have not changed in decades and are based on avoidance of the trigger, prompt use of injected epinephrine for symptoms, or the use of immunotherapy for insect-venom allergy. However, the identification of platelet-activating factor as a significant mediator in severe anaphylaxis presents a novel target for future therapies. Advances in atopic dermatitis include the recognition of important triggers and cofactors such as allergens and infection, and a key role of the skin barrier; several articles have presented potential therapeutic options to consider today. A variety of articles on asthma pathophysiology, diagnosis, and management were published shortly after the new National Heart, Lung, and Blood Institute Expert Panel 3 guidelines for the diagnosis and management of asthma and addressed evolving paradigms. For example, studies selected by our reviewers addressed the role of infection, social environment, and obesity, suggest aids in diagnosis, including pearls about testing and history-taking, and review global issues about adherence to asthma management plans, including special issues regarding adolescents. A milestone article revealed that a single dose of dexamethasone did not alter hospital admission rates for 2- to 12-month-olds presenting with a first episode of moderate-to-severe bronchiolitis. Articles about medication use for asthma explored outcomes of various approaches to using inhaled corticosteroids and/or a leukotriene antagonist and identified differential effects of β agonists depending on a child's β-2 adrenoreceptor genotype. There is increasing interest in, and evidence for efficacy of, immunotherapy and immunomodulators for treatment of allergies; future modalities of treatment may be more child-friendly (eg, oral administration rather than injection). Several articles on primary and secondary immunodeficiency have provided insight on disease pathogenesis, diagnosis, and emerging therapies, including a breakthrough report that identified the genetic basis of hyper-immunoglobulin E syndrome. On behalf of myself and our reviewers, we hope that this supplement stimulates and informs, giving you practical information to improve the care of children with allergic and immunologic diseases now and an exciting peek out of a window toward understanding therapies on the horizon. For additional information about our Section, please visit www.aap.org/sections/allergy.
- Copyright © 2008 by the American Academy of Pediatrics