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Prevention of allergy and allergic asthma: World Allergy Organization project report and guidelines
  1. I Pollock

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Edited by S G O Johnsson, T Haahtela. Karger, 2004, €127.00 (hardback), pp 211. ISBN 3 8055 7810 5

Edited by two Scandinavian experts in the field, this book is the result of a working group of the World Allergy Organization (WAO) and the WHO. With contributions by authors from 21 countries it presents a contemporary international overview and consensus of what is known and not known about prevention (primary, secondary, and tertiary) of allergic disorders.

The introduction includes clear definitions of some terms such as allergy and hypersensitivity. It also sets out the useful instruction to all the authors to include an evidence base category with all references—and this book cannot be criticised for a lack of references!

The genetics of allergy are then reviewed in detail that is moderately technical but highlights some of the problems with the results from research to date, such as the varying definitions of atopy (that is, phenotype definition) used in different studies. Despite much effort and the advance of molecular biology, there are still few new certainties about the inheritance of allergy, but strategies for future work are described.

Unsurprisingly, the longest chapter in the book analyses proposed environmental influences causing asthma and allergy. Various dietary factors from fish oils to food additives are discussed. Topical issues such as the hygiene hypothesis, the influence of immunisations, antibiotics, and probiotics (live microbial food components) are all examined and the data presented concisely. What is known about the benefits of breast feeding and weaning is also summarised. The clearest conclusion is that environmental tobacco smoke is bad for allergic airways disease and more governmental action is required.

Another chapter reviews the fascinating issue of immunological influences on the fetus and neonate, showing that significant immune responses occur in utero, influenced by passage of allergen from mother to fetus.

Subsequently, the interventions in infants at high risk of developing allergy are concisely analysed with regard to altering maternal diet during pregnancy and lactation and reducing household aeroallergens. Of clinical relevance is the conclusion that there is no evidence of a preventative benefit of soy based compared with cows’ milk formulae.

“Can I do anything to stop my child getting asthma and/or eczema” is a concern of an increasing number of parents. Paediatricians, who are often faced with this question, do not have easy access to specialist allergy opinion at present, because allergy as a medical specialty in the UK could itself be considered to suffer from “failure to thrive”. Any paediatrician or clinician with an interest in asthma, eczema, or food allergy (are there any who don’t?) will find this book helpful. For anyone drafting local ward and/or community guidelines for nutrition, weaning, and allergy, it provides an evidence base and also some suggested information sheets and guidelines.

A minor criticism is that the subject index suffers from restricted development.

In conclusion, this book would be a useful resource for those interested in allergy within specialist departments and also for reference to the general paediatrician with an interest.

Book reviews in Fetal and Neonatal edition

The following book reviews are published in this month’s Fetal and Neonatal edition:

  • Managing newborn problems: a guide for doctors, nurses and midwives

  • Neonatal respiratory disorders, 2nd edn

Pre-published book reviews

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