The management of paediatric allergy: not everybody's cup of tea – 10–11th February 2012

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Omnia non pariter rerum sunt omnibus aptaPropertius, Elegies III,9,7PART 1 – NOT EVERY ALLERGY HAS THE SAME ROOTSIntroduction – not everybody's cup of teaOver decades, noncommunicable diseases (NCDs) have become an emergency problem for the developed world. Obesity, cardiovascular diseases, chronic nephropathies, psychiatric disorders and neoplastic diseases top the list of the major global threats and are also increasing in the developing world [1]. These include metabolic diseases, neurodegenerative conditions, autoimmune disorders (type 1 diabetes, chronic inflammatory bowel diseases, thyroiditis, rheumatoid disease) as well as allergic conditions and asthma [2]. Inflammation and immune dysregulation are common features of all these different conditions and they highlight the central multisystem role of the immune system [3].The increase of respiratory allergy in westernized countries, started 50 years ago, seems to have plateaued at the beginning of this century [4], but a new wave of food allergies has emerged in the last 10–15 years [5,6], in particular in preschool children [7–10]. This ‘second wave’ is particularly evident in countries where respiratory allergy had increased, for example United Kingdom, Australia and United States [5,7,11]. Peanut allergy has more than doubled in the last 15 years and has recently been recorded in 1–2% of children in Australia, Canada, United Kingdom and United States [9]. The reasons for the differences in temporal presentation of various allergic conditions and the intergenerational dissimilarities in the disease profile have not been elucidated; however, as the increase in allergic disease has occurred too rapidly (within one to two generations) to be attributed to genetic changes in the population, it is likely related to environment.The search for environmental causes of allergies and epidemiological trends is a good opportunity to explain the complexity of allergic disease. Whatever the cause(s) of this increase are, they do not act in the same way in different populations, socioeconomic environments and cultural habits; this reflects the situation at the individual level, in which the paediatric allergist knows perfectly that every child has his/her specific allergic condition. Thus, preventive interventions, diagnostic pathways and therapeutic proposals may not be identical in different populations, nor in individuals in the same population. And in an age in which a spate of cutting-edge technology and clinical breakthroughs has substantially altered our vision and practice regarding allergy medicine, it is increasingly clear that all these improvements have their specific applications and, in plain language, may not be everybody's cup of tea.Role of innate immunity in allergy inceptionInnate immunity is one of the areas of the immunologic research that have substantially modified our understanding of allergic diseases. Cells of the innate immune system have been referred to as ‘the unsung heroes’ by Parham [12] as, with the accruing knowledge in this area, it has become clear that if ‘most people are not perpetually sick, this is tribute to innate immunity squelching most of the infections that we contract’.

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