Although immunotherapy has been in use for over 100 years, innovations continue to be investigated to optimize this therapy.1 Examples are peptide immunotherapy, recombinant allergens, epicutaneous immunotherapy and oral immunotherapy. All of these novel approaches have been found to have shortcomings in terms of efficacy or safety. So, we continue to use subcutaneous and sublingual immunotherapy. Novel approaches are required but these should be focused on where there is a therapeutic gap, for example IgE-mediated food allergy.2 Recurrent wheeze is a major issue in the pre-school age group.3 We only have a rudimentary understanding of the pathophysiology of this presentation, based on pre-schoolers with severe pre-school wheeze. Malmström et al have assessed airway hyper-responsiveness, remodelling and inflammation in pre-school children (median age 1.1 years) with persistent wheeze and troublesome breathing.4 Half had impaired lung function often in association with airway hyper-responsiveness. However, this was not associated with increased bronchial airway smooth muscle, bronchial mast cells, reticular basement membrane thickness nor level of eosinophilic inflammation. They conclude that eosinophilic inflammation or remodelling do not underlie recurrent wheeze in young pre-schoolers although there are structural changes in older pre-school children.5 Cleaning is associated with the asthma symptoms. Brooks et al have looked at symptoms and lung function in 425 professional cleaners to understand how to predict poor outcomes.6 Compared with 281 controls, cleaners had more current asthma symptoms or medication and had lower lung function but were less likely to have a diagnosis of asthma nor to be atopic. The authors suggest that cleaners may have a distinct phenotype of asthma. Finally, I would like to say farewell to Dr Frankland, the grandfather of allergy, who sadly died in April. I remember Bill fondly from my first BSACI meetings in the mid ‘90s and then from his visit to the David Hide Centre on the Isle of Wight just after he turned 90. Dr Glenis Scadding has written an obituary which is published in this issue. G. Roberts1,2,3

中文翻译：

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免疫疗法、学龄前喘息和哮喘

尽管免疫疗法已经使用了 100 多年，但仍在不断研究创新以优化这种疗法。1 例如肽免疫疗法、重组过敏原、表皮免疫疗法和口服免疫疗法。已发现所有这些新方法在功效或安全性方面都存在缺陷。因此，我们继续使用皮下和舌下免疫疗法。需要新的方法，但这些方法应侧重于存在治疗差距的地方，例如 IgE 介导的食物过敏。2 反复发作的喘息是学龄前儿童的主要问题。3 我们对病理生理学只有初步了解本演示文稿基于患有严重学龄前喘息的学龄前儿童。Malmström 等人评估了气道高反应性，学龄前儿童（中位年龄 1.1 岁）的重塑和炎症，伴有持续的喘息和呼吸困难。4 一半的人肺功能受损，通常与气道高反应性相关。然而，这与支气管气道平滑肌、支气管肥大细胞、网状基底膜厚度和嗜酸性炎症水平无关。他们得出结论，尽管年龄较大的学龄前儿童存在结构性变化，但嗜酸性粒细胞炎症或重塑并不是学龄前儿童反复喘息的基础。5 清洁与哮喘症状有关。Brooks 等人研究了 425 名专业清洁工的症状和肺功能，以了解如何预测不良结果。 6 与 281 名对照相比，清洁工目前有更多的哮喘症状或药物治疗，肺功能较低，但被诊断为哮喘或特应性的可能性较小。作者认为清洁工可能具有独特的哮喘表型。最后，我要告别过敏症的祖父弗兰克兰博士，他于四月悲痛地去世了。我在 90 年代中期第一次参加 BSACI 会议时深情地记得比尔，然后在他刚满 90 岁时访问怀特岛的大卫·海德中心。Glenis Scadding 博士写了一篇讣告，发表在本期杂志上。G. 罗伯茨1,2,3 我在 90 年代中期第一次参加 BSACI 会议时深情地记得比尔，然后在他刚满 90 岁时访问怀特岛的大卫·海德中心。Glenis Scadding 博士写了一篇讣告，发表在本期杂志上。G. 罗伯茨1,2,3 我在 90 年代中期第一次参加 BSACI 会议时深情地记得比尔，然后是他刚满 90 岁时访问怀特岛的大卫·海德中心。格莱尼斯·斯卡丁博士写了一篇讣告，发表在本期杂志上。G. 罗伯茨1,2,3