A Synopsis of the Synopses

Abstract

This synopsis book reports advances and key observations that will affect the care of children with allergic and immunologic diseases now and in the near future. Reviewers for this synopsis book selected many articles that have clinical “pearls” and provide insights that are applicable for daily practice, as well as ones that challenge our previous notions and provide data that might lead to new approaches for diagnosis and treatment. The apparent increase in atopic disease demands attention toward environmental and genetic factors and their interaction and an eye toward identifying prevention strategies. Barrier defects of the skin, reflected by genetic variants in filaggrin, are not only associated with atopic dermatitis but also with additional atopic diseases. This raises the possibility that a defective skin barrier, or immunologic changes associated with this defect, might predispose to allergen sensitization. Results of several studies support the notion that prematurity or lower birth weights might be protective against atopy, but the reason remains elusive. There are theories that obesity creates an inflammatory state that promotes atopy, as evidenced by a study from the National Health and Nutrition Survey reviewed in this supplement. An interesting novel observation was that even among lean adolescents, decreased sleep time was associated with a greater risk for atopy; fatigue is possibly being another stress on immune function. Our reviewers found a large number of studies with findings that suggest that vitamin D deficiency is related to increased atopy. Relationships were described among various studies to indicate that lower vitamin D levels or lower dietary intake is associated with more infections, more wheeze, a higher risk of atopy, and worse atopic dermatitis. Less outdoor activity, with its resulting decrease in sun exposure, …