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Background: Environmental tobacco smoke (ETS) exposure in children is linked with the development of allergic asthma. However, its influence on allergic sensitisation in children has not been conclusively determined. Objective: To systematically review existing evidence of ETS exposure's impact on markers of allergic sensitisation in children. Methods: CENTRAL, MEDLINE and EMBASE databases were searched. Included studies assessed following markers of atopic sensitisation: total immunoglobulin E (tIgE) concentrations, at least one specific IgE (sIgE+), and positive skin-prick tests (SPTs+) in ETS-exposed and non-exposed children. Results: 8 studies on the influence of ETS on tIgE concentration (2603 patients), 6 studies on ETS and sIgE+ (9230 participants) and 14 papers on ETS and SPT (14 150 patients) met our inclusion criteria. ETS was shown to raise tIgE concentrations by 27.7 IU/mL (95% CI 7.8 to 47.7; I²=58%; results based on 3 studies) and to increase the risk of atopic sensitisation, as assessed by sIgE+ (OR=1.12, 95% CI 1.00 to 1.25; I²=54%; results based on 4 studies) and SPT+ (OR=1.15; 95% CI 1.04 to 1.28; I²=0%; results based on 10 studies). In a subgroup analysis, this effect was most pronounced in children <7 years (preschoolers) by 0R=1.20; (95% CI 1.05 to 1.38) and 0R=1.30 (95% CI 1.05 to 1.61), (for sIgE+ and SPT+, respectively). Conclusions: Current analysis supports an association between ETS exposure in early childhood and the increased risk of allergic sensitisation. Subgroup meta-analyses demonstrate that younger children suffer the most from detrimental immunomodulating effects of ETS exposure. This study underscores ETS as an important but avoidable risk factor for the development of allergic disease in children. [ABSTRACT FROM AUTHOR]

Shortly after bacteriologist Paul de Kruif had been dismissed from a research position at the Rockefeller Institute for Medical Research, he started contributing to a novel in collaboration with the future Nobel laureate Sinclair Lewis. The novel, Arrowsmith, would become one of the most famous satires on medicine and science. Using de Kruif's correspondence with his idol Jacques Loeb, this paper describes the many ways in which medical science is depicted in Arrowsmith. This article compares the novel with de Kruif's and Loeb's biographies, and (1) focuses on the struggles of the main character, Martin Arrowsmith, as an allegory of the institutionalisation of medical research in the US, (2) shows that (influenced by de Kruif) Sinclair's purpose is to caricaturise scientific work in modern medical research institutions anywhere and (3) shows that the novel depicts a reductionist philosophy of research that seems to contradict the "messiness" of medical practice. [ABSTRACT FROM AUTHOR]

The paper presents articles related to allergy, immunity and infection. The first article aims to determine whether an anti inflammatory cytokine profile in meningoccal disease (MCD) was associated with increased risk of severe disease or death. In MCD there is early activation of both pro and anti inflammatory cytokines triggered by the release of endotoxin. Some studies of MCD have claimed that an anti inflammatory cytokine profile is associated with a fatal outcome, so contra indicating pro inflammatory cytokine inhibition therapies.

The article discusses various papers discussed in this issue including one by Malik et al. on a consultation with a child with a facial paralysis, one by Ian Wacogne and Kate Skone on problem solving in clinical practice and one on the development of allergy.

STUDY QUESTION: Does dietary n-3 long chain polyunsaturated fatty acid (LCPUFA) supplementation of pregnant women with a fetus at high risk of allergic disease reduce immunoglobulin E associated eczema or food allergy at 1 year of age? SUMMARY ANSWER: n-3 LCPUFA supplementation in pregnancy did not reduce the overall incidence of immunoglobulin E associated allergies in the first year of life, although immunoglobulin E associated eczema was lower. WHAT IS KNOWN AND WHAT THIS PAPER ADDS: Several mechanistic studies have suggested that higher intakes of n-3 LCPUFA during pregnancy modulate the neonatal immune response towards a less allergenic phenotype. n-3 LCPUFA supplementation in pregnancy did not reduce the incidence of immunoglobulin E associated food allergies in the first year of life, but the incidence of atopic eczema was lower. [ABSTRACT FROM AUTHOR]

The "hygiene hypothesis" suggests that decreasing exposure to micro-organisms during infancy is responsible for the increasing prevalence of atopy. However, while a decreased risk of atopic disease is associated with various surrogate markers of microbial exposure including early attendance at day care, a greater number of siblings and living on a farm, specific associations between clinical episodes of infection and atopy remain ill defined and the possible mechanisms obscure. Two recent research papers have sought to characterize further the links between infection and atopy.

Presents a case study of a patient with a persistent rash. Report that the patient, an amateur photographer, took photographs of his skin condition intended to aid his doctor's diagnosis of the rash; Diagnosis of a lichenoid reaction in a skin biopsy; Discovery that the patient was allergic to hydroquinone, a chemical used in the development of color photographs.