Allergic airway diseases in childhood – marching from epidemiology to novel concepts of prevention

In the past years, a wide range of epidemiological, clinical, and experimental studies have produced remarkable advances in the field of respiratory allergies in childhood. By the recent investigations on epidemiological trends, risk factors, and prevention of asthma and allergic rhinitis, various exiting concepts have been challenged, and novel innovative approaches have been developed. Pediatric Allergy and Immunology (PAI), with a number of highly relevant contributions between 2010 and 2012, has become an important forum in this area. The prevalence of asthma in some developed countries may have reached a plateau, while in developing countries, where the prevalence was previously low, allergic diseases are still on the increase. A wide array of risk and protective factors, including hygiene, infections, outdoor and indoor air pollution, allergen exposure, breast‐feeding practices, nutrition, and obesity, play a multifaceted role in shaping the observed worldwide trends of respiratory allergies. Under the guidance of recent research, prediction and prevention strategies in the clinical practice are progressively changing, the focus moving away from avoidance of allergen exposure and toward tolerance induction.     

The microbiome and atopic eczema: More than skin deep

Discoveries in the defective molecular composition of the epidermal barrier, such as the epidermal protein filaggrin, in those with atopic eczema (or atopic dermatitis [AD]) have proved crucial in understanding this disease, but its aetiology remains to be fully elucidated. The epidermal barrier is just one interface between the microbial world and our immune system. Recent advances in molecular technology have demonstrated for the first time the true scale of the normal human microbiome and changes seen in disease states. In this review article we discuss the role of the human microbiome in the aetiology and maintenance of AD. The role of Staphylococcus aureus within the skin microbiome is examined, in addition to the role of other bacteria and fungi, identified using novel culture‐independent methods. The significant contribution of the gut microbiome and its manipulation via probiotic use is also reviewed. We emphasise that the microbiome of separate systems, including the gut, has a significant role to play in the manifestation of this cutaneous disorder. To date, there has been a lack of studies investigating whether changes to the lung microbiome may play a role in AD. An early interaction between the microbiome and immune system via multiple routes (skin–gut–lung) could feasibly affect the risk of a subsequent development of atopic diseases. When making management decisions for AD patients, clinicians must be mindful of the role of the microbiome.     

In utero exposure to the Korean War and its long-term effects on socioeconomic and health outcomes

Prenatal exposure to the disruptions caused by the Korean War (1950–1953) negatively affected the individual socioeconomic and health outcomes at older ages. The educational attainment, labor market performance, and other socioeconomic outcomes of the subjects of the 1951 birth cohort, who were in utero during the worst time of the war, were significantly lower in 1990 and in 2000. The results of difference-in-difference estimations suggest that the magnitude of the negative cohort effect is significantly larger for individuals who were more seriously traumatized by the war. Whereas the 1950 male birth cohort exhibited significantly higher disability and mortality rates at older age, the health outcomes of females are unaffected by the war. Different aspects of human capital (e.g., health and cognitive skills) were impaired by in utero exposure to the war, depending on the stage of pregnancy when the negative shocks were experienced.     

The Agar Diffusion Cytolysis Method: An Alternative In Vitro Screen for the Prediction of a Severe Ocular Response

Manufacturing intermediates and formulation components constitute the bulk of compounds evaluated in ocular irritation protocols. A cost-effective in vitro screen for predicting severe ocular reactions, which reduces the chance of exposing animals to caustic chemicals, was a logical first step in a tiered approach to the reduction, refinement, and eventual replacement of animals in ocular irritation test protocols. Our laboratory has validated the agar diffusion cytolysis method, which employs a monolayered SIRC cell culture as an initial biological ocular screen. Twenty-four hours after plating 100-mm dishes, the culture medium was replaced with a 0.01% neutral red/1% agar overlay and incubated for a minimum of 16 h. Solid or liquid compounds were applied atop the agar diffusion matrix in glass cylinders or on paper discs, respectively, at doses of 2, 5, 10, and 25 mg or μ1 and incubated at 37°C for 24 h. Clear zones resulting from the loss of the neutral red dye following compound-induced cytolysis were measured, and the response was compared to the responses of the positive and negative controls. Results from the in vitro cytolysis assays conducted with 24 formulation components and chemically complex manufacturing intermediates have correlated well with in vivo data. Thus far the assay has demonstrated the following performance characteristics: sensitivity of 100%, specificity of 93%, overall predictive value of 96%.