This Week in BMJ | Editor's Choice | Press releases | Advertisement details

Press releases Saturday 5 April 1997
Embargoed: 00.01 HRS 4 April 1997 UK time

New light on the causes of allergic reaction

The prevalence of allergic rhinitis (hayfever), asthma and atopic dermatitis (eczema) has increased greatly over the last 30 years, both in the UK and worldwide. Two papers and an editorial in this week's BMJ take a further look at atopy (a predisposition to develop hypersensitivity to common allergens such as pollen and house dust mite).

Children with older brothers and sisters, who are therefore exposed to common childhood infections at a younger age, are believed to be less likely to develop atopic conditions such as hayfever or eczema. A study of 1659 military students at an air force school in Caserta, Italy, examined this hypothesis, and found that young men with antibodies to the hepatitis A virus had a lower prevalence of atopy and atopic diseases, and this was independent of the number of older siblings.

The authors found that the prevalence of atopy was as low in those without hepatitis A antibodies as in those with, when they had three of more older siblings. Common infections acquired early in life, they conclude, whether because of the presence of older siblings (among those without hepatitis A antibodies} or because of unhygienic living conditions which favoured the spread of disease (among those with antibodies) may have reduced the risk of atopy. 'These findings are probably not restricted solely to hepatitis A infection, but may well be relevant to other common childhood infections, they say.

In another paper, researchers from Denmark examined the birth records of 7682 babies and looked for links between factors such as birth weight and age of the mother and the development of atopic dermatitis (a chronic skin disease most prevalent in early childhood). They found that 18.7% of the children had been diagnosed as having atopic dermatitis at the age of 7, and that children who were born heavier than average and postmaturely had a higher risk of developing the condition.

The prevalence of atopic dermatitis has increased in the last few decades and the increase has been linked with a number of factors, such as pollution and changes in diet. But there has been little evidence to support these suggestions, say the authors, who suggest that their findings indicate that the predisposition to developing atopic dermatitis is determined before birth.

In an editorial, Dr Seif Shaheen, of the Department of Public Health Medicine, United Medical, and Dental Schools of Guy's and St. Thomas's Hospitals, calls for greater collaboration between virologists, immunologists and epidemiologists, if the role of infections in the development of atopy is to be unravelled. Recently instituted studies, which have recruited women early in pregnancy, are likely to increase our understanding of the relations of prenatal nutrition and growth to atopy and atopic disease in children, he says, and this will bring us nearer to the goal of primary prevention.

Contact: Dr Paolo Matricardi
Laboratorio di Immunologla ed Allergologla
Pomezia (Rome)
Italy

Tel: 00 39 69 108 464
Fax: 00 39 69 1601 079
e-mail: MD2767@mcLink.it

Dr Anne Braae Olesen
Aarhus University Hospital Aaarhus
Denmark

Tel: 00 45 89 49 18 52
Fax: 00 45 89 49 18 50

Dr Seif Shaheen
Department of Public Health Medicine
UMDS
London

Tel: 0171 928 9292 x 3138
Fax: 0171 928 1468
e-mail: S.Shaheen@UMDS.ac.uk

Traders want government action on cigarette sales to children

Traders' views on cigarette sales to children and the legislation surrounding this are reported in a letter in this week's BMJ. Ninety four (94%) of those surveyed said that they would like the government to introduce identity cards with photographs, and 31% did not know of the health risks involved in starting smoking young.

Two public health workers surveyed thirty two traders selling cigarettes in northeast Wales, and found general disagreement on how difficult it was to know the age of children attempting to buy from them. Although thirty respondents said that health was the main reason for the Children and Young Person's (Protection from Tobacco) Act 1991, three thought that smoking had no effect on children's health, and ten did not know that becomiong a smoker before age 15 carries a higher risk of lung cancer than does starting smoking at the age of 25. The authors suggest that traders would benefit from education about the reasons for the age limits for the sales of tobacco as well as the Act itself.

Contact: Delyth Wyn Jones
Mold Health Promotion Service

Tel: 01352 755 543
Fax: 01352 754353

Gulf war illness - why did it take so long to decide to invetigate?

Two letters in this week's BMJ look at the problems associated with investigating Gulf War Illness. In the first, former Surgeon General Sir Peter Beale, now Chief Medical Adviser to the British Red Cross, says that the problem was finding sufficientnt people who were affected to be able to make a decision.

Casualties in the Gulf War conflict itself were mercifully few, he says, and sickness rates unremarkable. It was only some 18 to 24 months later that he became aware of a campaign by lawyers to recognlse Gulf illness. Up to 200 people were on their books, but despite widespread appeals only 15 came forward. Unsurprisingly, with such a small number, no pattern of illness emerged.

A single consultant physician was appointed to see all such patients, but by June 1994 he had seen only 30. It was not until January 1997 that 1100 had been registered, and 920 seen and fully investigated. Now it has been agreed that full epidemiological studies are to be undertaken into the Incidence of ill health among UK Gulf War veterans, he says: "In answering the criticism that these expensive studies should have been undertaken earlier, I have tried to show how difficult it has been to decide exactly when this decision could have been made". The United States embarked on their studies earlier than the UK as they were dealing with greater numbers, he says.

In a second letter on the subject, Peter Hear, medical consultant to the Royal British Legion, encourages Gulf War veterans who have health problems to attend for assessment by the Ministry of Defence.

Contact: Sir Peter Beale
British Red Cross

Tel: 0171 201 5273
Fax: 0171 235 5194

Dr Peter Hear
Royal British Legion

Tel: 0171 973 7200
Fax: 0171 973 7399

Hepatitis B - should vaccination be universal or selective?

Hepatitis B is a major public health problem even though safe and effective vaccines have been available for over 10 years, says a paper in this week's BMJ. Researchers from the Viral Hepatitis Prevention Board say that despite WHO's recommendation in 1992 that all countries should integrate hepatitisB vaccination into their national immunisation programmes by 1997, many, including Britain, have not.

More than one third of the world's population have been infected with hepatitis B virus, say the authors, and about 5% (350 million) are chronic carriers. About a quarter of these carriers will develop serious liver disease, including chronic hepatitis, cirrhosis, and primary liver cancer. The WHO estimates that hepatitis B infection results in more than one million deaths every year worldwide.

In most European countries notification of hepatitis B infection is mandatory, but wide differences exist between case definitions and methods of reporting, and the number notified each year is below the true incidence of infection. It is therefore difficult to make comparisons between countries, says the authors, but the Regional Office for Europe of the WHO estimates that a million people are infected in Europe every year. The incidence of new infections in western Europe, North America, and Australia, and the burden of acute and chronic disease place hepatitis B among the most important communicable diseases, they say. For instance, in the United States mortality from hepatitis B was 10 times that from measles before routine vaccination of children was introduced.

Economic evaluations cannot be used to delay the implementation of universal hepatitis B vaccination in countries with low endemicity, say the authors. Cost effectivemess studies of the vaccination compare favourably with prevention and vaccination studies for other diseases. Countries should not wait for the arrival of combination vaccines containing hepatitis B, but should implement universal immunisation now in order to control the infection.

In a commentary, Philip Mortimer and Elizabeth Miller, from the Public Health Laboratory Service, Colindale, London, say that the most important step for the UK population is to stop the maternal transmission of hepatitis B. Unfortunately, they say, only a minority of pregnant women in Britain are currently screened for hepatitis B, despite government advice. "Moreover, the proportion of infants thereby identified who complete the three dose vaccine schedule is disappointingly low." In Britain, these authors favour a phased approach towards the goal of eliminating the hepatitis B virus; detect and protect all babies born to infected mothers; redouble efforts to immunise fully those who have identifiable risk of exposure; and only then, if new surveillance data indicate a clear need for it, or if a more attractive vaccine formulation becomes available, immunise adolescents or possibly infants.

"Our current reservations about universal immunisation should certainly not be taken to imply that prevention of hepatitis B is not a priority and that the halfhearted implamentation of the preventive strategy already in place is therefore acceptable", they conclude.

Contact: Dr Pierre Van Damme
Centre for the Evaluatlon of Vaccination
University of Antwerp Netherlands

Tel: 00 32 3 8202538
Fax: 00 32 3 820 2640

Dr Philip Mortimer
Public Health Laboratory Service
London

Tel: 0181 200 4400
Fax: 0181 200 1569

Embargo: 00.01 HRS Friday 4 April 1997

Journalists: For further information, please contact:

Linda Millington on 0171 383 6473
Public Affairs Division,
BMA House,
Tavistock Square,
London,
WC1H 9JP

Telephone (8.30am - 6.00pm): 0171 383 6254
After 6pm & at weekends: 0181 651 5130, 01895 239687, 0181 674 6294, 0171 727 2897, 0181 769 4949.
Fax: 0171 383 6403.

If you currently receive your British Medical Journal press release by mail and you would like it faxed to you please telephone (00 44) 171 383 6123 (08.30hrs to 18.00 UK hours) or fax (00 44) 171 383 6403 (24 hours).

When dialling the UK from abroad, remember to delete the first zero from the local area code, eg, (00 44) 171...

BMA on Internet page: http://www.bma.org.uk

If you intend to use any article publicised in this press release, ensure you quote the British Medical Journal as source.