The AAIR Charity



	A Grown Up Approach for Teenage Asthma and Allergy Sufferers AAIR trustee Dr Graham Roberts could radically change the approach to consultations with teenagers suffering from asthma or allergies after his research shows traditional consultations could be alienating them. The Consultant Paediatrician at Southampton University Hospital NHS Trust has introduced teenage-only clinics which aim to empower teenagers to take over ownership of their asthma and allergies. The move comes in response to research at Dr Robert’s large Southampton clinic he inherited 5 years ago. Dr Roberts felt the clinic failed to provide optimum care for this age-group. Teenagers were caught between nursery-like or adult clinics which Dr Roberts suspected were both unsuitable. Dr Roberts said: “Adolescence is a challenging time for teenagers. They need to develop into independent adults able to take responsibility for themselves. For teenagers with food allergy or asthma, gaining this independence can be more challenging as their parents are likely to have been managing their medical problems since they were small children.
We often see teenagers starting to experiment and take risks, which may be why this age-group is particularly at risk of adverse health events. This is a major issue because we know that teenagers are at particular risk from severe food allergy reactions or life-threatening asthma.” To understand what his teenager patients wanted Dr Roberst set up two research studies with senior medical students, Kate Edgecombe and Hannah Monks. They asked the teens how their medical problems affected their life, their experience of being a patient in clinic and what they would like to change. The researchers found a number of common themes. Teenagers said that their parents dominated the consultation with the doctor although teenagers also seemed to be rather dependent on their parents’ involvement. A number of teenagers were just not interested in attending the clinic, perhaps because they didn’t feel involved. A number were concerned about issues of confidentiality. Others just didn’t want to be seen in a “baby clinic”. For teenagers with food allergy a few specific issues came up. They often inaccurately assessed the risk of specific situations and weren’t clear how to manage allergic reactions. The teenage patients with asthma had issues with forgetting their preventer inhalers and they were often not clear why they were taking their medication. This has led to Dr Roberts setting up a specific teenage clinic where patients are initially seen on their own, to allow them to be more active patients, and parents are invited to join later. Dr Roberts’ team is now evaluating this approach to see whether it addresses the issues that teenagers have with the usual way that clinics run in the NHS. Teenagers attend paediatric clinics although these environments are more akin to a nursery than the typical haunts of the average teenager. When they move to the adult clinic, these are often also not ideal for them. This poor service is a major issue because we know that teenagers are at particular risk from severe food allergy reactions or life-threatening asthma. Adolescence is a challenging time for teenagers, their parents and their doctors. Teenagers need to develop in independent adults able to take responsibility for themselves. For teenagers with food allergy or asthma, gaining this independence can be more challenging as their parents are likely to have been managing their medical problems since they were small children. We often see teenagers starting to experiment and take risks, which may be why this age-group is particularly at risk of adverse health events. Dr Graham Roberts, Consultant Paediatrician at Southampton University Hospital NHS Trust and Trustee of the AAIR charity, moved down to Southampton some five years ago. He inherited a large clinic with many teenage patients. It became apparent to him that the clinic wasn’t providing the optimum care for this age-group. To understand what his teenager patients wanted, he set up two research studies. Two of his senior medical students, Kate Edgecombe and Hannah Monks, interviewed his teenage patients with asthma and food allergy. Teenagers were encouraged to talk about how their medical problems affected their life, their experience of being a patient in clinic and what they would like to change. The researchers found that there were a number of common themes. Teenagers said that their parents dominated the consultation with the doctor although teenagers also seemed to be rather dependent on their parents’ involvement. A number of teenagers were just not interested in attending the clinic, perhaps because they didn’t feel involved. A number were concerned about issues of confidentiality. Others just didn’t want to be seen in a “baby clinic”. For teenagers with food allergy a few specific issues came up. They often inaccurately assessed the risk of specific situations and weren’t clear how to manage allergic reactions. The teenage patients with asthma had issues with forgetting their preventer inhalers and they were often not clear why they were taking their medication. This research has recently been published in two papers in Archives of Diseases in Childhood and Clinical Experimental Allergy. It has led to Dr Roberts altering the way he sees his teenager patients. He now has a specific teenage clinic. Teenage patients are initially seen on their own to allow them to be more active patients. The staff aim to empower the teenagers to take over ownership of their asthma and allergies. At the end of the consultation, the parents are invited to join so they can hear the plan and can comment. Dr Roberts’ team is now evaluating this approach to see whether it addresses the issues that teenagers have with the usual way that clinics run in the NHS.

	PROFESSOR STEPHEN HOLGATE BECOMES A CBE AAIR's chairman Stephen Holgate, professor of immunopharmacology has been recognised in the Queen's New Year Honours list. The world-leading expert in respiratory disease from the University of Southampton has been awarded a CBE for services to clinical science. Prof. Holgate said he was 'delighted' and wanted to pay tribute to his colleagues."Although the award is in my name, in reality it recognises the dedication of so many colleagues both from this country and overseas who have contributed so much to our research effort." Prof Holgate's research, which is leading to the development of new treatments, focuses on improving our understanding of and finding new treatments for asthma - specifically the lung's susceptibility to asthma and how the inhaled environment such as allergens, viruses and pollutants cause and exacerbate the disease. His research is leading to new treatments. In a distinguished career that has spanned 30 years, he has published more than 900 peer-reviewed papers and scientific contributions to journals and edited 50 books on asthma. As well as jointly founding The AAIR Charity, Prof. Holgate is a key member and spokesperson of the Medical Research Council, advises the government on a range of issues including air pollution and an honorary consultant of Southampton University Hospitals NHS Trust. He was also recently appointed by the Higher Education Funding Council (HEFCE) to be a main panel chair for the Research Excellence Framework (2013-14), a prestigious role assessing the quality of research in UK universities.

Young Scientist Award Gemma Campbell, one of 4 PHD students supported by AAIR has scooped a top award following an impressive presentation at the British Association for Lung Research national conference. Gemma won the BLAR Young Scientist Award after giving a presentation and answering questions about her word. Gemma said: I was only given two weeks notice to give my first presentation in front of many internationally renowned scientists in my field so I was very nervous but I managed to keep my anxiety at bay. Fortunately it went well and I was able to relax and listen to the other presentations and find out about many new advances in the asthma field. I was so surprised at winning the award I couldn't believe it especially as it was my first presentation. I am very grateful to the people and organisations that have supported me with this work, expecially my supervisors Dr Lyn Andrews and Professor Donna Davies, the fellow researchers and those who have funded my research.

Research into New Asthma Treatment By Dr Paddy Dennison, Clinical Research Fellow at the Respiratory Biomedical Research Unit. A substantial proportion of asthma patients remain ‘uncontrolled’ despite advances in asthma treatment and maximal therapy: that is, their asthma disturbs their sleep/day-to-day life or they require frequent doses of their ‘reliever’ medication (salbutamol or Ventolin). Research is ongoing therefore to find new ways of treating asthma by targeting different aspects of the disease. One of the aspects of asthma which has not really been looked at in great detail concerns the permeability or ‘leakiness’ of the lining of the airways in the lung. The inner lining of the airway’s cells is known as the ‘epithelium’, and several studies have shown that this lining is disrupted or leaky in asthma (though it is not known how much is cause and how much effect). Increased leakiness might allow increased exposure to substances which can worsen people’s asthma such as house dust mite, viruses and other allergic substances. AAIR has awarded a grant supporting this research which is headed by AAIR Trustee Dr Peter Howarth, while Dr Paddy Dennison is the main co-investigator: Dr Dennison said: ”We are conducting an exciting new study looking into whether a treatment can decrease the leakiness of this epithelium which may then improve people’s asthma symptoms. The study is using a growth factor to try to improve the airway lining. Growth factors are natural substances produced by the body that stimulate activity of specific cells, and keratinocyte growth factor, or ‘KGF’, is a type of growth factor that stimulates the activity of epithelial cells – these are found lining not only the lung but also the mouth and gut. ‘Palifermin’ is a synthetic form of KGF which has been produced in a laboratory and licensed for use as a medicine in humans. At the moment, palifermin is only used in certain cancer patients to decrease the amount of mouth ulceration they get after treatment with chemotherapy or radiotherapy, where it is thought to act by repairing the epithelium in the mouth. However studies have shown that KGF can also have a protective effect in the lung, and most interestingly one study showed that KGF protected against allergen exposure. Dr Dennison is looking for people with moderate uncontrolled asthma – people who despite a steroid inhaler are still using their ventolin more than 3 times a week (which can be a marker of poor control although often people accept this as ‘normal’) - to take part in studies to help with this research. For more information please contact Dr Dennison on pd1d08@soton.ac.uk to discuss things further.

COMBINING WORLD CLASS RESEARCH UNDER ONE ROOF Pioneering Research supported by AAIR is set to transform more lives thanks to a new state of the art £5m unit which opens in December. The Respiratory Biomedical Research Unit (BRU) at Southampton General Hospital is at the forefront of a drive to develop new ways of preventing, diagnosing and treating disorders such as asthma and COPD. Funded byThe National Institute of Health Research the BRU is one of just 3 country-wide. Professor Ratko Djukanovic, MD, FRCP and Director of Southampton NIHR Respiratory BRU said: “The BRU provides a world class facility that will result in a step-change in the way we conduct our translational research. It will add both quality and speed to drug discovery, both using the research conducted by our own scientists and that undertaken in collaboration with other BRUs and the pharmaceutical industry.” As the regional centre for difficult asthma and allergic diseases, Southampton was chosen to house the new unit because of the strength of research collaboration and already taking place between the Southampton University Hospital Trust and The University of Southampton.
	AAIR will support work within the BRU via studentships, by pump priming various projects and buying or contributing to key items of equipment. The charity has awarded some £400,000 to adult respiratory projects during the past three years. Communications manager for the BRU Jane Smythson said: “We are all thrilled. Respiratory research is already a major area of strength in Southampton. The BRU will build on our reputation as a centre of excellence and help transform the lives of millions of patients. The unit will provide a vibrant environment to ensure collaborations, cross working, discussion and cooperation to bring together independent projects all under one roof. This will enable us to build on partnerships between scientists both in UK and internationally and also with small and large pharmaceutical companies so that practical research can by quickly translated into real treatments such as new drugs, therapies and new forms of prevention. By focusing on “Translational Research” or bench to bedside any discoveries can be quickly applied to other areas, for example where a discovery is made regarding allergies or asthma in adults this may be quickly applied to the paediatric population.” There will be 23 nurses employed by the beginning of 2011 to work in the BRU One of these nurses has already been funded by AAIR to undertake her asthma diploma. Nurse Team Leader, Sandy Pink, said: “This is a great incentive to ensure a high standard of care for the asthma patients who participates in research.”

	Unravelling The Causes of Asthma by Dr Timothy Hinks, Clinical Research Training Fellow in Respiratory Medicine For some people asthma is a mild condition, but for others living with asthma can be a daily battle. They suffer from the discomfort of wheeze, from a chronic cough which wakes them from sleep and from a tiring and often terrifying sensation of tightness in the chest. Asthma is the most common serious chronic lung disease. In UK there is a person with asthma in one in five households. It is a leading cause of time off school or work, and tragically causes a death every seven hours. Worldwide, asthma affects up to 300 million, a number predicted to rise by 100 million in the next two decades. There remains no cure for asthma, and 1 in 20 people with asthma have severe disease, which responds poorly to current treatments. What causes this type of asthma, and how to identify people at risk is not understood. Many exacerbations of asthma are triggered by infections. We believe this may be because their immune system responds abnormally to infection. As a respiratory doctor I’m delighted to be conducting research into these severe forms of asthma at Southampton. Our unit is undoubtedly a world-leading centre for asthma research with a wide variety of different projects going on at present from very early-stage research right through to advanced clinical trials of new medications. I’m excited to be involved with one such clinical trial testing a new medication which may help prevent viral “head colds” going on to cause exacerbations of asthma. At the other end of the spectrum I’m also chief investigator on my own project which aims to study a newly described component of the immune system called T helper-17 cells. With my research nurse Caroline Smith I’m examining the differences between the immune response in people with asthma and those who are healthy. We will also study how the body’s immune response progresses during exacerbations of asthma and during infection with the virus responsible for the common-cold. I work closely with another scientist Dr Karl Staples who is also conducting very early-stage research into another immune cell in asthma which goes by the catchy name of the “alternatively activated macrophage”. I’m always impressed by the motivation and generosity of a wide variety of people who volunteer to take part in our research. They come to the Wellcome Trust Research Facility to undergo various tests of asthma and allergy. They then give us samples of sputum and undergo a bronchoscopy which is a flexible camera examination of the airways. Such samples are an invaluable resource for research. Dr Staples and I are also very grateful to the AAIR Charity who have supported the research of our lab by providing us with essential equipment including a centrifuge and an incubator.
Our hope in achieving our goals will be to better understand the immune responses underlying asthma. Such knowledge may help lead to the development of new drugs, and to direct future research into tests and treatments for people who suffer from asthma.” Dr Timothy Hinks, Clinical Research Training Fellow in Respiratory Medicine.

	Drug for severely asthmatic children 'available in Scotland but not England' A drug which can dramatically reduce the number of attacks suffered by severely asthmatic children will not be available on the NHS in England after the Government’s drug rationing body ruled it was too expensive. The draft guidance by the National Institute for Health and Clinical Excellence (Nice) concluded that, at £256 per injection, Omalizumab is not cost-effective for under-12s, although it will be available to patients in Scotland. Omalizumab (also know as Xoliar) has been available to adults on the NHS since 2008, ‘transforming’ many lives. AAIR trustee and Consultant in Paediatric Allergy and Respiratory Medicine Dr Graham Roberts described the decision as disappointing: “The European Medicines Agency extended the licence for omalizumab in June 2009 on the basis of clinical study data. It is disappointing to see that NICE have not also extended their recommendations for the use of omalizumab down to this age group. NICE focus on clinical trial data. Unfortunately in this age group there are few studies and these do not focus on the very severe patients. omalizumab is not an appropriate treatment for most young children with asthma, but for those with severe uncontrolled symptoms it has the potential to be very beneficial. We have seen dramatic improvements in the quality of life of teenagers with went we have started omalizumab therapy.” Asthma affects around 1.1 million children in the UK with more than 30,000 aged 14 or younger being admitted to hospital between 2008 & ‘09 following an asthma attack. Xolair costs around £12,000 per patient a year although research shows that taking it for a year can cut in half the number of asthma attacks children suffer. While Nice accepted that the drug could reduce attacks, it said that the drug made no difference to the number of times that children were hospitalised and other key markers. Xoliar is the first in a generation of drugs for severe, allergic asthma, where patients have high levels of the antibody IgE in the blood, resulting in an oversensitive immune system. The drug prevents IgE from starting the reaction that leads to asthma symptoms, effectively blocking the allergic triggers responsible for attacks. It has been found to greatly help those for whom regular drugs - such as inhalers and oral steroids which suppress the symptoms rather than tackling the causes - are ineffective. Nice is not expected to publish its final guidance on the use of Xolair, which is made by Novartis, until October.

	ALLERGY CARE SHOULD BE TAKEN MORE SERIOUSLY Progress of allergy care has been slow or non-existent, while cost-effective solutions are still not being implemented, according to the report from the Royal College of Physicians and Royal College of Pathologists. The report follows recommendations from the House of Lords Science and Technology Committee inquiry into allergy in 2007, which urged practical steps to improve allergy services. GPs surveyed as part of the report said they believed there had been no improvement in access to specialist service provision. In 2003 the Royal College of Physicians, under the chairmanship of AAIR trustee Professor Holgate, issued a report concluding that Allergy services in the UK were totally inadequate. Prof Holgate was again involved in this new report and told AAIR: "It seems that the same situation exists despite at least 3 additional Government Reports. Allergy is being trivialised in the UK at a time when levels are at epidemic proportions and the complexity and severity continues to increase. Allergic diseases that include life-threatening anaphylaxis, food allergy, asthma, rhinitis, conjunctivitis, hives, eczema and drug and insect reactions often occurring together in different combinations requires specialist diagnosis and treatment as well as a greater awareness in primary care. It is time to treat allergy as a real public health problem and to drive forward its prevention and treatment. To do this requires the whole subject of allergy to be taken much more seriously and for a more joined-up approach to its management".

airAlert A pilot scheme run by local authorities– called airAlert – has been launched as new research reveals air quality in some areas exceeds Government limits. airAlert is a FREE service that sends text messages to your mobile or home telephone, informing you if poor air quality is predicted in your area. So far only Hertfordshire & Bedfordshire, Southampton & Sussex are offering the service. The scheme is targeted at people with respiratory problems who may be affected by air pollution and gives warnings the day before or on the day that elevated air pollution is expected (probably around 20 times per year). Dr Graham Roberts, a paediatric consultant and AAIR trustee, commenting on the scheme said: “Pollution is an important cause of exacerbations of asthma. We get many parents who feel that their child’s asthma is worse around pollution.” Southampton’s public health director Andrew Mortimore said: “We believe the airAlert service will make a real difference to those people in the city with conditions such as asthma.” Register for free at www.airalert.info.

Managing Asthma. AAIR Chairman and leading asthma expert Professor Stephen Holgate was interviewed on BBC Radio 4’s You & Yours programme discussing new treatments for asthma. This is now available to listen to on BBC iPlayer. To listen Click here and select ‘Chapter 5’.

Hay Fever Sufferers Wanted NOW. Volunteers are needed for a new multinational 4-year study investigating a new hay fever treatment. Allergen Immunotherapy involves the injection of allergens to which an individual is sensitized to induce a tolerance to these allergens, so reducing symptoms. The study, organised by AAIR trustee Dr Howarth, is directed against grass pollen allergens and thus aimed at helping those with troublesome hay fever. Hay fever symptoms will be recorded in Year 1 (rescue treatment will be provided for symptom relief during this year and subsequent years). Following this, injection immunotherapy will be given for Years 2 & 3 and the hay fever severity compared to Year 1. Not all injections will be the proper allergen immunotherapy, some will be placebos. None of the subjects or investigators will know which is which to allow comparison and ensure any benefit is due to the proper injections and not just changes due to alterations in the levels of grass pollen from year to year. Finally participants will be observed for one final hay fever season as the allergen immunotherapy would be anticipated to have a long-lasting benefit, acting even when injections have stopped. Potential participants should be aged 8 to 65, suffering symptoms predominantly in May, June, July and have a history of at least 2 years of seasonal symptoms such as itch eyes, runny nose and sneezing that have required therapy. Deadline for entry is mid-May. For more details & to check eligibility phone 02380795108.

Eczema and allergy Dr M Ardern-Jones Senior lecturer in Dermatology January 2010 Eczema is a disorder of inflammation in the skin and is strongly associated with other allergic conditions: asthma, hay fever and food allergy. Eczema incidence from 2001-5 has risen by 40% and now affects 20-30% of UK school age population and 3-10% of adults. Eczema has been found to impair quality of life as much as asthma and diabetes. It is well recognised that children frequently progress from one allergic condition to another: eczema usually arises first, most frequently in the absence of allergy, and is a major risk factor for the development of severe asthma and food allergy. The development of allergy to environmental allergens is thought to be due to the eczema and the severity of eczema has been shown to predict children with more severe forms of asthma. As well as inflammation in the skin and allergic responses, the characteristic features of eczema are reduced effectiveness of the skin as a barrier and impaired defence against infection. We propose that the leaky skin barrier and impaired defence against infection are responsible for the development of allergic responses in eczema.
	We propose to test this hypothesis by designing a model of human skin in the test tube. We will do this by using cells donated from the skin of those with eczema and those without. Using this system we will be able to control the exact environment in which the skin grows to prevent differences arising from factors other than the cells making up the skin barrier. We can then challenge the models with the same allergen and determine if the immune response generated in the model from eczema skin promotes allergic responses as we suspect. If so, this will stimulate further work to address which components of eczema skin are most important for the allergic drive and these findings will become ideal targets for new therapies. Investigation into the mechanisms responsible for eczema in humans has been limited to clinical tests (skin and blood tests) and laboratory examination of skin biopsies and blood samples. Although advances have been made with these limited approaches, investigators have sought to reproduce the more complex interactions in eczema by using models. Whilst gene manipulated models allow detailed analysis of single pathways, it is unclear whether these truly represent human eczema. Indeed, forty such models have been described for eczema, but none completely reproduce all the complex features of human eczema as described above. There is a clear unmet need for a human model system which encompasses both skin and immune system interactions to recreate the complexity of eczema. If successful, this model system will not only allow us to test our hypotheses but could also allow a platform for testing new therapies aimed at modifying the components of eczema. We are very grateful to AAIR charity for making a grant to fund the cost of undertaking this important research in the field of skin allergy.

	New study identifies genes that determine lung function The Respiratory Genetics Group and the MRC Environmental Resource Unit at the School of Medicine, working as part of a large international consortium of 96 scientists from 63 centres in Europe and Australia, have identified five common changes to DNA that appear to be associated with lung function. In a paper published in Nature Genetics, the scientists compared 2.5 million human versions of genes in over 20,000 individuals of European ancestry together with their lung function to look at genetic changes. In five different DNA locations people who inherited altered genes had worse lung function compared to those that didn’t. The scientists confirmed their findings by checking the effects of the same versions of the genes in over 33,000 additional individuals. They also compared their results to those of a second consortium, CHARGE. These genes identified make proteins which are important in cleaning toxins like cigarette smoke, regulating information and healing damaged tissue. A permanent reduction in lung function occurs in a number of respiratory diseases including severe asthma and chronic obstructive pulmonary disease (COPD), which affects around 1 in 10 adults above the age of 40 and is thought to be the fourth most common cause of death worldwide. Smoking is the major risk factor for development of COPD. So what dose this mean for patients with respiratory disease? Dr John Holloway, Reader in Genetics at the University of Southampton School of Medicine, said: “The results of this huge collaborative study give us a fascinating insight into the potential causes of chronic respiratory disease.
However many people may assume that we will now be able to use these findings to predict which people will go on to develop lung disease and conditions such as asthma and COPD. Unfortunately this is not the case as each gene identified has just a very small effect on lung function. So even if we assessed all people we couldn’t predict who would or wouldn’t go on to develop lung problems, so for now no case for developing the test. “However the study can still benefit patients. The large numbers of subjects that were included in this study means that we can be certain that the genes identified make proteins which play an important role in lung disease. So these proteins should be good targets for the development of new therapies. For example, one of the genes identified makes a protein called RAGE. This protein has already been shown to be important in a number of inflammatory conditions such as heart and arthritis. Several drug companies are currently developing drugs to target this molecule. The results of our study suggest that these new therapies may also benefit people with lung disease.” The research would not have been possible without the generous support of the both the participants of the contributing studies from the UK, Europe and Australia, and to all the funders of the different groups including AAIR, to whom we offer our thanks. The study was lead by Dr. Martin Tobin (University of Leicester) and Professor Ian Hall (University of Nottingham).

	Building a Better Future The Respiratory Biomedical Research Unit (BRU) are building on Southampton’s reputation as one of the world-in developing groundbreaking medicines, treatments and medical procedures — transforming the lives of millions of patients. Supporting this exciting new initiative are a new team of nurses just appointed to work along side the researchers and scientists on the individual projects. The BRU’s Nurse Team Leader Mal North said “This is a very exciting time for research in Southampton. We have recruited an excellent team of nurses all of whom are dedicated to ensure the wellbeing of our research volunteers is maintained during the time they spend on the study.” Respiratory research is already a major area of strength in Southampton. The new BRU is integrating existing research facilities at Southampton General Hospital with a new state of the art research unit being built on the hospital site. This is building on research into allergies, lung diseases, cystic fibrosis, asthma, and chronic obstructive pulmonary disease. The Respiratory BRU also serves as a platform for collaborations with other BRUs in the UK, other national and international academic groups and pharmaceutical companies. If you are interested in becoming a research volunteer you can contact us on 023 80 79 4597 or email us at iiinurses@soton.ac.uk.

	The Image Analysis System AAIR has recently awarded a grant to the Histochemistry Research Unit (HRU) to help with the upgrade of their Zeiss Image Analysis System. This grant has enabled the purchase of an additional light microscope with a camera and new analysis software. The HRU provides histopathology support to scientists in the School of Medicine at the University of Southampton to assist them with the study of cells and tissue samples to try and further understand the causes of asthma and other allergic diseases. These samples are stained by a variety of specialised techniques to identify features of interest that may contribute to the disease process. The Image Analysis System, which consists of a microscope with a high resolution digital video camera linked to a computer, enables the scientists to photograph the stained sample and then make measurements of the features of interest using specialised computer software. The software can present the generated data in a variety of formats including numeric lists which can then be statistically analysed. This allows comparisons to be made between samples collected from healthy subjects and those with disease, and the affects of new disease treatments to be investigated. Dr Susan Wilson, head of the HRU using the upgraded image analysis system ‘We are very thankful to AAIR for their support. This upgraded image analysis system will be of great benefit to us and our users and will facilitate our pioneering research into the mechanisms of asthma’. The photograph on the left shows a section of lung tissue stained for EGFR which is important in the epithelial repair process in asthma. Positive staining is brown. On the right the image analysis system has been used to digitally select all the positive staining which can then be quantified.

	New Awards to help train allergy specialists Southampton’s MSc Allergy course has won a £1,650 grant to help train specialists in their fight against allergic disease. The 1 – 3 year course is one of just two in the world, training student doctors, nurses, dieticians and other health care professionals to tackle allergies – a condition which now affects one in three people. The course is run by AAIR supporter Dr Judith Holloway, a lecturer at the Southampton University School of Medicine. Dr Holloway says: “As someone who suffers from life-threatening allergies, I am passionate about helping health care professionals get the best training we can give to help them train colleagues and treat patients more effectively.
I applied for the grant as I thought it was an excellent idea to enable me to offer support to talented students who are ambitious and want to dedicate their knowledge to improving allergy care.” The initiative has been set up by The Learning Curve scheme which launched a new Education and Research Grant Programme; a formal system of applying for educational grants. It is funded by Aptamil and Cow & Gate who are part of the Nutricia Group which is also under the Danone umbrella.. Presenting the cheque to Dr. Holloway Nutricia’s Caroline Brandi said: “On behalf of the whole company, we are delighted to encourage health care professionals to find out more about food allergy as it is so common these days. We hope our contributions will make a big difference.”

	Asthma and healthier home environment Asthma is one of the most common chronic diseases and causes considerable ill health. Exposures to allergen and pollutants play an important role is causing symptoms of asthma. Home is where we spend most of our time. Exposures at home are therefore important. Our home environment is favourable to proliferation of house dust mite and moulds, which are common allergens. Indoor allergen levels are high in certain types of home such as those with high indoor relative humidity, floor covered with carpets, with pets and visible mould growth. The energy efficient houses of today with high indoor temperatures and humidity may increase the allergenic burden. Therefore, modern living conditions may be associated with a higher risk of allergen exposure causing increase in symptoms of asthma and allergy. Indoor pollutants are also a source of worry. Indoor pollutants include smoke from cigarettes and wood, coal or gas fires, and chemical vapours and gases, which may come from sources including building products, cleaning agents, and paints. A combination of high level of indoor pollution and allergen may increase the severity of asthma.
Although, it is generally accepted that environmental exposures cause worsening of asthma, most patients and physician rely completely on drugs for treatment. Previous studies have shown some benefit of avoidance of specific allergens, such as house dust-mite when extensive measures have been taken. Other studies found it difficult to clearly show a benefit for the patients, when one measure such as mattress cover alone was applied. This implies that extensive measures need to be applied and this led to our quest for houses that were specifically designed and built for prevention of respiratory problems associated with indoor allergens and pollutants to improve indoor climate and reduce allergen load. We worked on the assumption that it should be possible to reduce indoor allergen and pollutant burden by greater attention to design, construction, and living conditions of our houses. The opportunity arose when Portsmouth City Council approved funds to build houses that aimed to provide a healthier environment for the asthmatic subjects as part of a government initiative to a healthier nation. We won a grant from the NHS Research and Development to support the scientific assessments. We recruited families where at least 2 members (parents or children) suffered from asthma. Following random selection, some (index) families were housed in these specially constructed houses, while other (control) families moved to houses built to the normal standard. Characteristics of these special houses included ; (i) an efficient ventilation system with increase air exchange and reduce humidity, (ii) Polished wooden floors and nominal upholstery, (iii) an effective vacuuming system to reduce the recirculation of dust, as dust is vacuumed into an outlet in each room to a reservoir outside the house, (iv) no gas or coal fires or gas cookers, (v) mattresses and bedding encased in special dust-mite protective covers. Thirty houses were built to the specification of healthier home environment. Thirty families with 60 asthmatics moved to these houses. We assessed asthma control by a variety of means before families moved into their respective houses. These included symptoms control, lung function, quality of life and requirement of medication. These assessment measures were repeated at 3 and 6 months after families had settled into their new homes to assess the effect of this environment. For comparison, 15 families with 30 asthmatics were randomly selected to move into standard houses and monitored in a similar way. All data had been collected over the last few years. We are in the process of analysing these data and hope that we can share these with you in the next 6-12 months. S. Hasan Arshad

Ciliated airway epithelium including mucus cells (EM by Patricia Goggin) Ciliated epithelial cells grown using specialist cell culture methods (EM Patricia Goggin, cell culture Claire Jackson)	Focus on Cilia - Dr Jane Lucas In 2006 the Department of Health funded three national centres to provide a diagnostic service for a lung disease called Primary Ciliary Dyskinesia (PCD). Dr Jane Lucas directs the service for the South & West of England, which is based at Southampton General Hospital. PCD is caused by a genetic abnormality of cilia (explained below). Although PCD is relatively rare, problems with the cilia in other lung diseases, including asthma, may be very common. Using state-of-the art technology and expertise within the PCD team, we are investigating abnormalities of the cilia in asthma. This research is in collaboration with Dr Peter Howarth, who heads a large asthma clinic and research programme in Southampton. This important research is possible because of the strong links between the adult and paediatric clinics in Southampton, the expertise of the Southampton scientists who study the airway cells and the unique opportunity to utilise the specialist equipment available through the PCD service. What are cilia and why may they be important in asthma? The airways, nose, sinuses and ears are lined with cells called epithelial cells that have microscopic hair-like structures (cilia) on the surface (Figure 1a). The cilia are surrounded by a thin layer of fluid called periciliary fluid, and on top of that is a film of thicker mucous in which foreign particles and bacteria get stuck. The cilia within the thin periciliary fluid make coordinated sweeping movements (Figure 1b) through the thick mucous, pushing it towards the throat where it is swallowed or coughed out, and thereby clearing the mucous containing particles. This is called mucociliary clearance (or MCC for short).
There is evidence that MCC is impaired in patients with asthma, not only during exacerbations when their disease worsens, but also when they are apparently well. Impaired MCC could exacerbate asthma by permitting bacterial infection or by failure to clear allergens. It may also contribute to the severe mucous build up resulting in ‘plugging’ in the airways of patients who die from asthma attacks. The reason for impaired MCC in asthma is unclear. Observations suggest that thicker mucous in some asthma patients may make it physically difficult for the cilia to move the mucous up the airway, or that the number of cilia to do this could be reduced. These theories have not been properly investigated. In the small number of asthma patients we have looked at we have seen uncoordinated, sluggish or static cilia, all of which could contribute to impaired clearance of the airways, potentially resulting in a build up of mucous and particles. Methods we are using to investigate the cilia Using a microscope linked to a special high speed video camera, we can record the movements of living cells, including the extremely fast beating cilia. By replaying the video at a much slower speed we can (i) determine whether movement of all the cilia is coordinated or random, (ii) determine how completely they sweep through the mucous and (iii) measure the frequency at which the cilia beat. We will also look in detail at the cilia using an electron microscope (EM) which allows us to look at structures within the cells (Figure 2). Epithelial cells for this study will be obtained by gently rubbing a cytology brush along the airways of volunteers. This will be done using a fibreoptic camera (bronchoscope) that is used to look inside the lungs during a procedure known as bronchoscopy. The bronchoscopies are being conducted on volunteers either for clinical reasons to help medical management, or because they have volunteered to have a bronchoscopy for other research studies that are underway in Southampton. All these investigations have ethical approval and the samples are given by patients who provide both their approval and their signed consent. The epithelial cells can continue to grow and live outside the body in an incubator for some months. New cells grow and produce cilia (Figure 3), and because we can nourish the cells and prevent infections we expect the cilia to grow healthily and function normally, even if the original cells had impaired cilia. By adding chemicals that are at high concentrations in asthmatic airways (eg. nitric oxide) to healthy new epithelial cells, we can investigate whether they affect ciliary function. Figure 1a: Diagrammatic representation of mucus granule secretion from goblet cells, and undirectional mucus flow by ciliary beating on ciliated columnar epithelial cells. Figure 1b: Diagrammatic representation of the ciliary beat pattern of a cilium, with a forward directional power stroke followed by a weaker reverse directional recovery stroke, which sweeps below the mucus layer in the periciliary fluid. What do we hope to find out? How common abnormal ciliary function is in people who have asthma? What factors are responsible for abnormal ciliary action in asthma? In particular the role of an inflammatory chemical called nitric oxide. Whether these studies into abnormal ciliary action may be used to develop treatments to improve mucociliary clearance in people with asthma.

An insight into living with asthma Are you an asthmatic? Would you like health experts to understand you condition better? Perhaps you can - by volunteering for the pioneering Expert Patients Programme based in Southampton. This in a mentoring scheme which pairs people with long-term health condition, such as asthma, with student Nurses. This presents a unique opportunity for trainee nurses in Southampton to gain an insight into how asthma sufferer managed their condition and the effects it has on their day-to-day lives. “We feel the mentoring project is an excellent opportunity for people with experience of a long-term condition to show what life is like from their point of view, rather than from a medical perspective and would welcome volunteer representation from people living with any long term condition,” said Cheryl Berry, Regional Manager for the Expert Patients Programme CIC. The project will recruit volunteers in mid-January and begin officially in February 2009. All volunteers must be aged 18 or over. Volunteers will need to attend a 2 hourly meeting approximately every fortnight for a period of 12 weeks across the 30 week academic year. Expenses will be paid. To register your interest, please contact Sue Littleford at the Expert Patients Programme on 01273 704955* or email sue.littleford@eppcic.co.uk* For the volunteer this is a unique opportunity to develop these skills with training and support provided by the EPP CIC. The certificate you will gain on successful completion of the training will greatly enhance your personal and professional development.

Experts urge change in asthma management The Brussels Declaration on Asthma, sponsored by AAIR, is leading calls for urgent changes in Europe-wide asthma management and pleas to follow the Finnish asthma programme. The declaration, recently published in the European Respiratory Journal (ERJ), is the culmination of two years work by respiratory specialists, patient representatives, GPs and paediatricians from across Europe and North America. The declaration urges European policy makers to recognize that asthma, which causes 180,000 deaths annually, is a major public health problem requiring complete shift in asthma management in the face of an increasingly unmet need. They want a concerted effort of all groups involved – policymakers, regulators, health professionals, industry and patients, to remedy the significant disparities in asthma management practices between and within European countries to ensure better outcomes for all asthma patients. Professor Stephen Holgate, a founding father of the of the declaration, said The Finnish programme demonstrates that early diagnosis, personalized treatment and guided-self-management, combined with patient education and reductions in tobacco smoking and exposure to environmental risk factors can improve patients’ asthma whilst reducing overall costs. “The Finnish Asthma Programme is a compelling example for what can be achieved when all parties involved cooperate. I can only hope it will find as many ‘copycats’ as possible.” The article identifies deficiencies in diagnosis, in the recognition of the disease nature, in asthma control, in the set-up of clinical trials, in the treatment of asthmatic children, in asthma research and in environmental conditions.

Breastfeeding could help children develop stronger lungs AAIR’s Dr Hasan Arshad has once again been in the news following research which shows the sheer physical effort involved in breastfeeding may leave babies with stronger lungs well into childhood. Many sections of the national media recently reported the latest results of research into the respiratory health of children born on the Isle of Wight between 1989 and 1990. Now in its 18th year, this is one of the world’s most well-known asthma studies, tracking the progress of 1500 British children from birth to adulthood. Studies of when the children were 10-years-old found that a third of the children who had been breastfed for at least four months could blow out more air after taking a deep breath, and could blow it out faster. This happened regardless of whether their mother was asthmatic or suffered from allergies. Dr Arshad , director of the David Hide Asthma and Allergy Research Centre on the Isle of Wight which is conducting the study, said that, on average babies needed to generate three times the sucking power compared to bottle-feeding and feeding sessions tended to last much longer. "What the babies are doing is very similar to the kind of exercises we suggest for pulmonary rehabilitation in older patients. We are very please to demonstrate that breastfeeding improves baby’s lung function,” he said.

	Why some teenagers can�t �be bothered� with asthma Asthma is the commonest chronic disease of adolescence affecting 800,000 teenagers in the UK. In spite of the major advances in asthma treatments over the last few decades, many teenagers still experience ongoing asthma symptoms and an impaired quality of life. AAIR�s Dr Graham Roberts (Consultant in Paediatrics ) was concerned that many of these ongoing problems were due to the way that teenagers manage their asthma. To investigate this problem, Dr Robert and his colleague Dr Kate Edgecombe interviewed 22 teenagers with asthma who are looked after in the children�s respiratory clinics at Southampton University Hospital NHS Trust, St Mary�s Hospital Portsmouth and St Mary�s Hospital on the Isle of Wight. From these interviews they collated their experience and views. Dr Roberts said: �Although the teenagers in general felt involved in clinic consultations with their doctor many did not take responsibility for interacting with the medical staff. They relied on their parents to report symptoms, translate medical terms and remember what the doctor had told them. Most teenagers needed their parents to remind them to take their medication. Unfortunately many simply forgot their medication, could not be bothered to take it or found that taking it conflicted with other teenage activities.�
�It was apparent that many did not understand why they were using the medicines while others were concerned about potential adverse effects. In particular, many could not be �bothered� to use the spacer device with their inhalers meaning that they were not experiencing the benefit of these devices. Lastly, about half of the teenagers lived with a pet that they were known to be allergic to or with a smoker.� �The results of this study have been very helpful in revealing what teenagers actually do in terms of managing their asthma and the reasons behind this. Furthermore, it also provides us with important strategies that have the potential to improve the way that teenagers manager their asthma. For example, we now attempt to assess teenagers� understanding and belief about their medication, correcting this where necessary and tailoring their asthma device to their lifestyle. �Adolescence is a crucial time. As paediatricians, we have to empower teenagers to gradually take a responsibility for their asthma to enable them to become expert patients before they graduate into the adult world and adult outpatient clinics.�

Studying rare disease to gain new insight into allergic disease
AAIR research Dr Xiaoying Zhou with a centrifuge purchased for the lab by the support group for mastocytosis sufferers (Mastro Group UK).	AAIR researcher Dr Andrew Walls and his team at Southampton have developed a new diagnostic test for a rare disease as part of their research into the role of mast cells in allergic disease. In asthma and other allergic diseases, a cell in the body called the mast cell can do a lot of harm, secreting histamine and various other chemicals that can cause many of the symptoms associated with these conditions. Believing useful insights can be obtained by carrying out research into another disease in which mast cells play a role, the team have been studying Mastocytosis. This is a very rare condition, affecting only a few hundred sufferers in the UK, which sees much higher numbers of mast cells in suffers than the norm. There are various forms of Mastocytosis but symptoms can include flushing, skin rashes and there may be a greater chance of suffering from a severe allergic reaction. It is during this research Dr Walls, working with Dr Xiaoying Zhou, has been successful in developing a new blood test for Mastocytosis. This is a major step forward for suffers as the disease can be extremely difficult to diagnose, and in some sufferers it can go unrecognized for many years, The new test involves measuring an enzyme released by mast cells called CPA. Levels of CPA can be particularly high in the blood of people with Mastocytosis. Dr Wall said: "We feel that our research into this condition will not only benefit those who suffer from Mastocytosis, but should lead to new insights into allergic disease."

Launch of new Research Unit
	Preparations have started to launch the Respiratory Biomedical Research Unit which was awarded to the partnership between the Southampton University Hospitals NHS Trust and the University of Southampton, as mentioned in the last newsletter. This unit is a real boost to respiratory research. It will focus on the major allergic diseases of the airways and a strong emphasis on testing new, exciting drugs which can prevent asthma and allergy in general from developing as well as new drugs to prevent exacerbations of adult asthma and improve control of chronic disease. The BRU will employ specialist nurses, statisticians, trials coordinators and scientists to work on nine projects in the first instance. Professor of Respiratory Medicine and BRU Director, Ratko Djukanovic said: "It is very much the intention of the BRU to bring in additional projects in collaboration with biotech companies and the pharmaceutical industry to test their new compounds."
The BRU will also be the regional centre for a network of regional hospitals and their respiratory themes. "So much depends on collaboration these days"; said Professor Djukanovic, "and we have excellent teams both in primary care and the district general hospitals who wanted to help". Because the BRU hopes to grow, additional funding will always be needed. Research into disease mechanisms and discovery of new drugs is expensive because of tight regulation and the complexity of the research methods that are needed. Furthermore, sophisticated equipment is needed and this is often expensive. AAIR will be launching a campaign later this year to help fund vital equipment. Patients with asthma and their families and friends are urged to help the BRU to deliver. Contact the AAIR Charity if you wish to have more information and think that you can contribute to this prestigious unit.

Allergic Rhinitis: a significant issue The clocks have gone forward announcing the start of summer. It doesn�t feel like it yet although we know this heralds a period of the year when those with pollen allergies start to experience symptoms. The lengthening days and the increase in temperature lead initially to tree pollination and then later grass pollination. The earliest trees to flower are hazel and alder, followed by others such as birch, oak and ash. As they flower pollen is disseminated in to the air and when it settles on the moist mucus membranes of the eyes, nose and throats or is breathed down into the airways of those with pollen allergy, symptoms arise. Typically these symptoms represent some or all of the following: itchy, watery red eyes (conjunctivitis), itchy nose, sneezing, runny nose and nasal stuffiness (rhinitis), itchy throat or itchy inside the ears and wheeze, breathlessness, chest tightness and cough (asthma). For those sensitised to tree, grass and weed pollens (weed pollination arises after the grasses in late summer and early autumn) the symptoms may last from February through to September/October. Thus although pollen allergies are often referred to as seasonal disease and thus not considered to last for more than 4-6 weeks at the most, those with many allergies experience problems for many months. The same symptoms can arise all year round in those sensitised to indoor allergens, typically those linked to house dust mites or pets (usually cats and dogs). With such all year round allergy, itching is less noticeable and, within the nose, blockage is often more problematic. In all instances allergic rhinitis impacts significantly on an individual�s quality of life and has more of an impact than those without rhinitis could appreciate. Although we often focus on the symptoms referable to the eyes, nose or chest, those with rhinitis feel generally unwell, often have headache, sleep poorly and have impaired concentration. Studies have shown that with untreated rhinitis school performance is impaired and allergic rhinitis (especially summer seasonal allergic rhinitis at times of high pollen counts) is recognised as an important cause of reduced productivity or absenteeism from work. Last summer we were involved in an international trial to see if four injections of a modified grass pollen extract, given before the grass pollen season, could protect against the development of symptoms. Intuitively this may seem strange. It is, however, recognised that the administration of high doses of an allergen to someone who is allergic can lead to immunological tolerance, such that the body ceases to respond to that allergen. Usually we build this up over many months to years, as the injections may themselves induce a very serious allergic reaction, and the standard treatment course is three years. The potential availability of just four injections that have the same effect would make this much simpler and more acceptable, providing it was both effective and safe. We are awaiting the results of this trial but the allergy and asthma clinical trials unit in Southampton was a major contributor to this study, having entered the most patients to this study from all the sites within the UK. We are about to start a trial of a new orally administered treatment for house dust mite sensitive allergic rhinitis. See Our Story for more details.

Biomedical Research Units Southampton University Hospitals NHS Trust and the University of Southampton are delighted to announce the award of a NIHR Biomedical Research Units worth over �4million. The unit will specialise in respiratory disease including asthma. The NHS/University partnership will foster growth, driving innovation in the prevention, diagnosis and treatment of ill health. The BRUs will focus on "translational research" that takes advances in basic medical research out of the laboratory and into the hospital clinic, delivering the maximum benefits to our patients. Research in the Respiratory BRU aims to help develop medicines that prevent onset of airways disease in adults and children and ameliorate control where disease is established. Five specific programmes of investigation are planned in immune response, novel therapies, epithelial repair mechanisms, antibiotic resistance, and imaging in lung disease. �This is the greatest vote of confidence that we could get as a centre of excellence in translational research and a sign of how we are perceived nationally and internationally�, said Professor of Respiratory Medicine and BRU Director, Ratko Djukanovic. �It is also recognition of what Southampton has achieved in respiratory medicine since the Medical School was established. The BRU will be a platform for more excellent work and an opportunity to develop new areas, such as adult intensive care and ILD, as well as to broaden our existing strengths.� The selection process took six months, ending with a rigorous panel interview for the applicants, and NHS and University senior management. Southampton is the only centre to have been awarded two BRUs � another ten will be established across the country. Second of which will focus on nutrition, diet and lifestyle �The awards are excellent news�, confirmed NHS Chief Executive, Mark Hackett, �helping us turn the 2020 vision into reality and achieving our objective of becoming a comprehensive Biomedical Research Centre within five years.� The AAIR Charity is delighted with this unit as the charity is based in the Southampton General Hospital and raises funds to support the world-acclaimed asthma and allergy research team based there. This team will be at the heart of this prestigious new bio medical research unit.

Is Asthma Preventable? AAIR�s Dr Hasan Arshad is currently studying a generation from birth through to adulthood hoping to help answer the question �Is asthma preventable?� This study is now in its 18th year and is probably the best known asthma prevention study in the world. �Asthma is the most common chronic disease in children. Asthma and allergic diseases affect millions of people in the UK and some reports suggest that their prevalence is still increasing. Asthma and rhinitis adversely affect quality of life and some people with severe asthma live in a constant fear of another attack. Although, a number of questions regarding the causes of asthma and allergy remain unanswered, this lack of knowledge should not deter us from the important task of investigating new and effective ways to prevent the development of asthma and allergy. It is well known that both genetic and environmental factors contribute to the development of asthma and allergy. Thus, children with a family history of allergy are at higher risk. Exposure to allergens in early childhood may be one of the most important environmental factors. Lack of infection in early childhood, exposure to pollution and dietary changes may be others. In 1990 we embarked on a study to test the effectiveness of strict dietary avoidance of food allergens combined with reduced exposure to house dust-mite allergen to prevent asthma. Infants, at higher risk of asthma and allergy, due to family predisposition, were recruited before birth and assigned to intervention (that is allergen avoidance) and control groups. This study was carried out in the Isle of Wight. The intervention group infants were either strictly breast-fed with mothers on a low allergen diet or they were given a special milk formula with reduced allergen content (hypoallergenic milk formula). We also cleaned infants� homes with special chemicals to kill house-dust mites. Control group children followed standard recommendation by midwives and health visitors. This reduction in exposure to allergens was only carried out during the first year. We followed up these children as they grew up to see how many from the intervention and how many from the control group would develop asthma and allergy. All 120 children have been seen at ages 1, 2, 4 and 8 years. Throughout this period, children who avoided high allergen exposure during infancy did develop less asthma (about 50%), and eczema (about 50%) and they were less often allergic to foods and house dust mite allergens on skin prick test.
	These children have now grown up in to young adults, age 18 years. The important question is to establish if the effect of allergen avoidance during infancy, which was seen up to 8 years of age, continues into adolescence and early adult life. We are delighted to have been awarded a 2 year funding from the National Institute of Health Research to do that. This is probably the best known asthma prevention study in the world and results up to the age of 8 years are very encouraging. If we can demonstrate that this type of intervention in children of parents (or sibling) with allergic disease is effective, we can then make appropriate recommendations.

Genes, Mums, Environment and Asthma
Matthew Rose-Zerilli using the robot to handle all the DNA samples from mothers and children in the study.	Researchers in the Asthma Genetics Group at the University of Southampton are working on a project to understand how the environment a mother is exposed to during pregnancy might increase the risk of her child developing asthma. We already know tobacco smoke exposure before and after birth is a risk factor for respiratory problems in children, and our collaborators at the University of Bristol and Imperial College recently found very frequent use of paracetamol in pregnancy may also increase the risk of asthma in the child. However, we still needed to understand several things. Firstly did exposure to these factors have the same effect in everyone, and secondly, by what mechanism might they be altering lung development to increase the risk of asthma?
The lungs are continually exposed to potential injury from some forms of oxygen found in pollutants and tobacco smoke. The lungs in early childhood, which are growing rapidly, may be particularly vulnerable. There are clues that consumption of antioxidants, such as vitamin E and selenium, may protect against such damage, and hence improve lung health. As genetic differences in the mother and her child might cause differences in the level of responses to oxidant injury, we looked at genetic variation in genes that encode proteins that help protect the body from this type of injury. Susceptibility to the detrimental effects of tobacco smoke and paracetamol, and the extent to which antioxidants may be beneficial, is likely to vary between individuals, depending which genetic variants are present in the mother and/or child. These genetic differences were measured in over 10,000 mothers and their children participating in the Avon Longitudinal Study of Parents And Children. The ALSPAC project began in 1991, with the recruitment of some 14 000 expectant mothers by a team led by Professor Jean Golding at the University of Bristol. The Children have been followed since then for a wide range of health related outcomes including allergy and asthma. We have now found several genetic variations in both the mothers and children that appear to modify the risk of exposure to tobacco smoke and paracetemol intake on asthma in the children. This tells us several things, firstly, if an individual is more susceptible to these exposures when they have gene variants which make these exposures more toxic, this would provide strong evidence to suggest that the exposures are really causing lung problems later in life. At present we cannot be sure that apparent effects of paracetamol on asthma risk are really causal or just a marker of some other environmental exposure. Secondly, identification of gene variants which influence susceptibility may help to clarify the mechanisms by which paracetamol and tobacco smoke cause damage to the developing lung. For example, at present we do not know whether nicotine is responsible for the harmful effects of tobacco smoke or some other component. In the same way, we hope to clarify whether exposure to antioxidants in the diet in early life is beneficial for lung growth and development. By gaining further understanding of the early life influences on lung development we hope to devise new strategies to prevent lung disease in children and improve their respiratory health. We are particularly grateful to the British Lung Foundation who funded this work and also to the AAIR charity that provided funding to purchase a multi-channel pipette that helped us handle the tens of thousands of DNA samples from the mothers and children in the laboratory.

ALLERGY EPEDEMIC AAIR�s allergy experts were once again in the public eye as a House of Lords Report highlighting the growing allergy epidemic in the UK featured heavily in all the national media. The investigation by the House of Lords Science and Technology committee, published September 26th, found that serious and immediate action were required to combat what has become known as the �modern epidemic� The Report identified the �severe shortage of allergy specialists in the UK� and that �clinical services lag far behind� most of Europe. The Report confirms the huge rise in allergy and inadequate provision across the NHS at all levels � including a lack of training in allergy in medical school undergraduate training programs, in primary care and in hospital-based secondary care resulting in inadequate patient care. As President of the NASG (National Allergy Strategy Group) and one of the world�s top allergy experts AAIR�s Prof Stephen Holgate, was in high demand to comment on the report from both the media and medical bodies including the Medical Research Council. Prof Holgate said: �The Report on allergy highlights Southampton as one of the lead hospitals in the UK for allergy and asthma research. Since we receive strong support for our work (including my professorship) from the Medical Research Council, the MRC wanted to seek our advice when the Report was published.� Prof Holgate welcomed the report and its key recommendations which included: The Department of Health to set up regional allergy centres nationwide through the ten Strategic Health Authorities. These should be headed by full-time specialists in allergy. They would act as �clusters� of expertise that include a partnership among allergists, paediatric allergists, clinical immunologists, chest physicians, dermatologists, ENT specialists, gastro-intestinal specialists and occupational health physicians. Each Allergy Centre should have facilities for diagnosis of complex cases and provide training in allergy for specialist trainees, organ-based specialists, GPs, nurses, pharmacists and school personnel. As Professor of Clinical Pharmacology at The University of Southampton Prof. Holgate went on to explain how Southampton�s world acclaimed allergy department, backed by AAIR, is leading the way. Professor Holgate said: �What is unique about our research and clinical allergy team is that they are fully engaged in tackling some of the difficult questions about allergy mechanisms and treatment that has also been so strongly supported by AAIR. Indeed it is the synergy between our AAIR charity and the MRC that has helped drive forward our new PhD research training programme that Professor Donna Davies now runs as well as supporting both the basic and clinical science that underpins our success. Without this fantastic local support we would not be in such a strong position to push forward the frontiers that will lead to new treatments. We are grateful to all those who continue to support us especially when the going gets tough.� This is the 4th national Report on allergy. All say much the same on services and patient need, despite this the Department of Health have not acted to bring about change. Professor Holgate urged Health Ministers to act now as failure to diagnose and treat allergy is resulting in continuing illness and cost to the NHS and patients. The facts behind the allergy epidemic. 1 in 5 of the UK population suffers from hayfever - Reduces quality of life and work performance - Impairs results in school examinations. 1 in 10 have asthma - That�s 3-4 children with a �blue� inhaler per classroom - Allergies are a major trigger factor for asthma - Asthma may be severe and even life threatening 1 in 50 children suffer from peanut allergy - That�s one child in every 2nd classroom - May cause life-threatening anaphylaxis Asthma accounts for 70,000 admissions and anaphylaxis for 30,000 admissions to hospital each year within UK Medications for allergies cost �0.9 billion/yr, 11% the total NHS drug budget There are only about 30 specialist allergists and GPs are poorly informed and most have received no formal training. There are only 8 trainee doctors in allergy for the whole country: not enough to replace consultants soon to retire. The recommendation to abandon the DH advice on �peanut avoidance in pregnancy /early childhood� identifies the lack of evidence. But the lack of research is in part a result of lack of allergy specialists. More clinical research is needed. Prevention of allergy will be important in the future.

Professors Stephen Holgate and Martin Church Book Award
	AAIR professors Stephen Holgate and Martin Church were recently awarded top prize in the most prestigious medical book competition in the United Kingdom. Their book Allergy, 3rd edition was named the British Medical Association (BMA) Book of the Year. This is made to the publication which is deemed to best fulfil the criteria of clinical accuracy and currency which maintains a high standard of design and production. It was also triumphant in the Respiratory Medicine category A record 632 titles competed for 20 top awards across a variety of categories in the competition, which has been held annually since 1994. The book, co-authored with Professor Lawrence Lichtenstein from Johns Hopkins University in Baltimore, USA, was praised by its reviewer as offering "a wealth of detailed information on the diagnosis, treatment, and management of allergic diseases - from asthma to urticaria."
Professor Martin Church, co-author of Allergy, said: 'All the authors are thrilled by the recognition that this BMA Award gives us for our book. The current book is the third edition and contains more clinical information than previous editions. We have always endeavoured to use illustrations to replace rather than repeat information in the text and this latest update contains a CD Rom with slides suitable for presentation. 'We are indebted to our publishers who have been brilliant in helping us achieve our objective of producing a really accessible book at a time when allergic disease has reached epidemic proportions.'

A Bright Future For Research at Southampton Southampton�s reputation as one of the leading respiratory centres in the UK with a bright future has again being recognised The department has won 4 MRC-funded Capacity Building Studentships in Respiratory Medicine from 21 awarded nationwide � more than any other UK academic institution. The research awards address the need to increase the number of researchers in respiratory medicine and were created in response to the growing number of people in the UK who suffer from respiratory disease. Various medical research charities joined forces with the Medical Research Council to fund the studentships. They hope that by encouraging young scientists to study conditions affecting the respiratory system, there will be a greater capacity to develop treatments and knowledge of these illnesses in the future. The four talented young scientists will begin their 4yr PhD research projects is Southampton in October 2007 . Southampton�s Professor Donna Davies, who led the team applying for the awards, explained that Southampton was likely to have been so favourably received not just because of its world-class reputation. �We applied for four studentships and were awarded all four for several reasons. For these four-year MRC awards, we designed a specific �Respiratory Pathway� to fit into the School of Medicine�s Four Year PhD Programme in Biomedical Sciences . We will spend the first year teaching the students about respiratory disease and the associated problems and we will help them to develop their research skills so they are much more able to focus on key question relevant to respiratory diseases. After this training year, the students will engage in an in-depth research project studying a specific aspect of lung disease� Professor Davies went on to explain: �These awards are good for the future of department because we are now in a position to train excellent students to fill the gap where there has previously been a lack of research expertise in the area of respiratory medicine. Eventually we will have better trained post doctoral fellows and hopefully, as the programme develops well get more and more students to join the programme so strengthening research into respiratory disease across the UK.� Nicole Bedke, a current MRC Capacity Building student said: �It�s a privilege to carry out research at the cutting edge of respiratory medicine learning from so many eminent scientists� Professor Stephen Holgate, Chair of the UK Respiratory Research Strategy Committee, said: �More people in the UK are becoming ill as a result of respiratory conditions. Two major disease areas, lung cancer and lung fibrosis, were still under-represented in the research applications but this simply highlights why it is so important that we encourage young scientists to begin their careers in respiratory research, build their knowledge and find out more about how and why these conditions are on the rise so that we can offer effective treatments in the future. All of the funding partners believe the collaboration is a fantastic opportunity to strengthen respiratory research.�� AAIR is proud to be providing funding of �120,000 towards these Studentships. Facts and figures 5.2m people in the UK are currently receiving treatment for asthma, that�s one in twelve people. 4.1 million of the people who have asthma are adults, 1.1m are children, An estimated 3 million people in the UK have Chronic Obstructive Pulmonary Disease (COPD), 24,160 died from the condition in 2005.

The Pollen Season is Round the Corner. Are you Ready for Hay Fever Again?
	Are you one of those millions of people for whom early summer is a misery rather than a pleasure? Are you worried that allergic rhinitis will ruin your examination results? Allergic rhinitis tends to be considered a trivial disease by many people and even by some doctors. However, you know different! All the time your nose is running and then it gets blocked. Your eyes are itchy and watery and you can't see clearly. You can't stop sneezing and you can't breathe properly. Your sleep is disturbed, you have headaches and you feel tired all the time. It is a warm sunny day and everyone around you is happy and enjoying the release from the cold dark days of winter. And yet to you, even the simplest of daily activities appears like a large mountain to be climbed and the thought of going out with friends or enjoying a leisure day with your family seems like a distant dream.
It was with someone exactly like you in mind that Dr Diana Arion, Dr De Yun Wang and I wrote "Simply Allergic Rhinitis". This book explains with easy text and pictures what allergy is and what is happening in your nose during the hay fever season. It also explains minimising the effects of hay fever is not simply a matter of taking a tablet on a `bad day', but involves a co-ordinated management plan. For example, reduce pollen exposure by keeping you windows shut at home, particularly in your bedroom at night. Decide which treatment you are going to take, antihistamine tablets or corticosteroid nasal sprays. Remember that both tablets and sprays are much more effective when taken regularly than taken occasionally. Finally, consider starting your drugs before the pollen season really gets underway because it is much easier to prevent symptoms developing than it is to reverse them once they are establish. AAIR and Prof Church are giving away 15 Simply Allergic Rhinitis books to the first 15 people who write or small The AAIR Charity with their full name and address. By Prof Martin Church.
	*How much do you know about hay fever triggers?* Question 1. Where are your hay fever symptoms more likely to be worse: A: A field of yellow rapeseed flowers B: A grassy meadow Question 2. During the hay fever season, is it better to sleep with your bedroom windows: A: Closed B: Open Question 3. Where would be best to go on holiday during the hay fever season: A: The Norfolk Broads B: The Costa del Sol Question 4. If on one day during the hay fever season your symptoms are particularly bad, would you get more rapid relief by: A: Taking an antihistamine tablet B: Using a steroid nasal spray Q1 B Q2 A Q3 B Q4 A

AAIR`s top asthma expert warns that we must change the way, asthma 's managed Co-chairing the European Summit for Change in Asthma Management, Professor Stephen Holgate said the current trend of asthma therapy is not reflective of current medical knowledge and needed to be changed. The summit, which took place at the European Parliament in Brussels, heard asthma is a systemic inflammatory disease affecting more than just the lungs and so the need to control inflammation is essential. Professor Holgate said current guidelines and practice are based on a historical view of diagnosis and treatment of asthma - which only measure airflow in the lungs and may not truly capture whether the inflammation is under control or if other parts of the body are affected by the same type of inflammation. Furthermore, patents respond differently to treatments and one option may not suit all and therefore treatment should be individualised to meet the needs of each patient.
	Unfortunately, current methods of assessing therapies that influence the wider aspects of allergic inflammation are not reflected in guidelines, which currently are restrictive in their recommendations and limit the choice of treatments available for clinicians to choose from. Conclusions from the summit, which saw leading asthma experts and EU policy makers join together, form part of the draft Brussels Declaration stating that Clinical and Regulatory changes must be made to asthma management to ensure it reflects current scientific understanding of the disease and the needs of patients. Professor Holgate said the Summit and the resulting draft Declaration was a great step forward: "This meeting has been extremely valuable as A has allowed health care professionals, scientists and patient groups to work directly with regulators and policymakers to establish where and how improvements need to be made in order for asthma patients to receive optimum treatment. However, our work does not end here. It is vital that all of the actions agreed upon are also acted upon to ensure asthma patients benefit fully".
It is estimated that over 30 million people in Europe have asthma and the number is rising. In addition, deaths from asthma have reached 180,000 annually and the economic costs of asthma in Europe is thought to be in the region of �17 billion per year with an annual productivity loss estimated at �9.8bn.

Food Allergy or Food Intolerance? As January 22nd - 26th was Food Allergy and Intolerance Week we asked Diana Arion, MD consultant in allergy and clinical immunology to answer some common questions. Q. What is the difference between food allergy and food intolerance? Intolerance is generally when you cannot digest a specific food, this can be caused by a genetic deficiency of the enzyme which is involved in digesting that food (the person is born with a lacking enzyme) or it can occur in people who had long lasting diarrhoea and whose normal structure and function of the lining of the digestive tract has been impaired. Because the body cannot digest the food, the digestive tract is irritated and becomes inflamed. An allergy is a deficiency in the immune system, which causes it to wrongly perceive a harmless food as a potentially dangerous enemy. The immune system then triggers a defence to eliminate it. The marker of allergy is the presence of antibodies from the IgE class. In both cases the food should be avoided.
	Q. Can any food cause an allergy? Any food with proteins can cause a reaction. However, 90 per cent of food allergies are caused by a limited number of foods. For example in infants the foods are more often milk, eggs and wheat. As we get into childhood and diet is more diverse, peanut and tree nut allergies become more common, in adulthood we often see fish and shellfish allergies. Q. Is it possible to know by the symptoms which food is to blame? The body expresses an illness through quite a limited range of symptoms. Usually any food can result in any of the characteristic symptoms of allergy or food intolerance and therefore you cannot identify the culprit food based only on the symptoms that it elicits.
Q. What are the likely reactions? The symptoms of food allergy can be limited to the organs of the digestive tract or they can involve other organs e.g. skin, respiratory organs, the heart and blood vessels. Symptoms of the digestive tract can start in the mouth and throat with redness, itching and/or swelling which can cause severe breathing difficulties or even asphyxia. Further down the digestive tract we see nausea, vomiting, abdominal cramps and diarrhoea. Food allergy is frequently a cause of eczema it is also the primary cause of anaphylaxis in which in addition to all or any of the symptoms described above the person can also present asthma attacks (not only in people suffering from asthma), heart racing and severe decrease in the blood pressure which can lead to the loss of consciousness. Food intolerance manifests first with digestive symptoms such as nausea, vomiting, abdominal cramps and diarrhoea. If the problem is not treated in time growth and nutrition problems can occur, manifesting as anaemia, chronic tiredness, and/or bones, muscle and skin disorders. Q. What advice can you offer someone who thinks they have a food allergy or intolerance? I would underline the need to see doctor. In allergy there are commercial tests used to check if allergies to substances, including foods. However, these tests, even when accurate, have no value if not interpreted in a clinical context (there are people who have positive tests and no symptoms and therefore are considered ill and vice versa, persons who have the disease but caused by another allergen that has been tested). Based on the history of the disease the doctor will know which allergens are more suggested to be involved and will test them; also he is the only one that can make the correlation between the test results and the clinical symptoms (simply showing a reaction to a skin prick test does not necessarily mean that your symptoms are caused by the allergen). The final accurate diagnosis may involve other test and also a differential diagnosis with other diseases that may present with similar symptoms. The same is valid for food intolerance. As more diseases can manifest with similar digestive symptoms the involvement of the doctor in choosing the right tests, making the correct interpretation of the results and making the right diagnosis is crucial. Q. Should you take any steps prior to visiting a doctor? Keeping a food diary is very important to provide a good history. Record all foods eaten (even those not swallowed e.g. chewing gum), if the symptoms occur every time when you ate that food, how was it cooked. Also record the times you eat and the times the symptoms develop. For food allergy The Gold standard of tests is an Oral Challenge, which means the suspected food is given in increasing quantities at 20-30 minute intervals (during which the occurrence of symptoms is evaluated). However this test can, potentially be very dangerous so should only be carried out by a doctor at a hospital.

UNIQUE OPPORTUNITY FOR AAIR SCIENTISTS Once again AAIR scientists are involved in a pioneer project, joining forces with eight other countries to discover more about childhood food allergies.
	In the biggest ever study of its kind, more than 10,000 babies and their families are being recruited in Greece, Germany, Spain, Poland, Lithuania, Netherlands, Iceland and the United Kingdom as part of a large European project called EuroPrevall. The study known as PIFA (Prevalence of Infant Food Allergy), aims to identify the prevalence, cost and cause of food allergy across Europe. Pregnant mothers are being recruited before delivery then keep a diary of everything their infants eat in the first year of life.
Children are being reviewed at their first and second birthdays and infants with symptoms suggestive of food allergy are also being seen. The UK cohort is being recruited in Winchester, Eastleigh and Andover and represents a partnership between The Royal Hampshire County Hospital and the University of Southampton. AAIR�s Graham Roberts, a Clinical Senior Lecturer and Consultant Paediatrician, said: �This is the first time that such a large number of infants have been recruited and followed-up within Europe. This will give us a unique opportunity to work out why some young children develop food allergies. This may provide novel treatments to prevent food allergy. Additionally important information is being collected about asthma and other allergic diseases. This will allow us to gain a better understanding of these conditions and how they interrelate with food allergy in childhood.� The importance of this study (which is being supported by the Foods Standards Agency) is clear as around 11-26 million people in Europe suffer from food allergies. This figure is thought to be increasing, as are the variety of foods that cause allergies and the frequency of severe reactions. The first baby in the study was born at the end of December 2005. The study will follow all the infants until they are 2 years old, results are expected Autumn 2009.

John Warner - 16 Years Dedication AAIR sends its very best wishes to one of our leading professors who has moved to a new position at St Mary�s Imperial College London after 16 years dedication. John Warner was Professor of Child Health and honorary consultant paediatrician at Southampton General Hospital. AAIR's Frank Anderson said: �John is a clinical scientist of international reputation who has rolled back the frontiers in relation to the development of allergies in childhood that result in a range of conditions including asthma, eczema and life threatening allergies to nuts and other food substances.
	�Having established the Department of Child Health in Southampton as in international centre for allergy research, we wish him the greatest success in his new adventure of creating a great department at Imperial College. Professor Warner said: �We have contributed uniquely to world understanding of the early events of foetal life which constituted to allergy and asthma. I will remember an immensely friendly department, where the staff are very kind and work together. They are all so incredibly nice people, good friends and super scientists.�

The Thrasher Research Fund
AAIR�s Dr Andrew Walls and Dr Jo Zhou with Thrasher President Dr Dean Byrd and Mr Aaron Pontsler	The Thrasher Research Fund, a USA-based charity which provides funding for research projects benefiting children, recently paid a visit to Southampton General Hospital. They gave a presentation on their work and checked on the progress of the research being conducted by AAIR�s Dr Andrew Walls and Dr Jo Zhou. Dr Walls said of their project that is being funded by the Thrasher Research Fund: �The work has led to the development of a new test that can allow the more effective diagnosis of anaphylactic shock. We are currently applying this new test to investigate the potential role of allergic disease in sudden unexpected deaths in infants.� The Thrasher Research Fund has since approved a further installment of funding.

State of the art controlled time-lapse microscope. AAIR is currently raising �80,000 to help make one of our biggest ever, single purchases � a state of the art controlled time-lapse microscope. This will be a powerful tool for studying a wide variety of dynamic events, which normally happen too slowly to appreciate. The microscope will provide a window into cells so structures can be visualized and monitored as they assemble or change enabling the behavior of living cells and tissues to be studied over intervals ranging from minutes to days. Department professor Donna Davies said: � We are incredibly excited by the capabilities of �live cell imaging�. It really does open up a new window onto cell behavior giving us much more detailed insight into those processes that are likely to be involved in the changes that occur in asthmatic airways that lead to the development or worsening of asthma Professor Davies is currently directing studies to understand how the asthma gene, ADAM33, affects the airways in asthma and why asthma sufferers appear to be more prone to virus infections, especially the common cold, that lead to worsening of asthma symptoms. Her group has already found that there are several different types of ADAM33 that occur in different parts of the cell, so they plan to use the microscope to study how ADAM33 moves or �traffics� within a cell, as this seems to be important for its function. They have also found that ADAM33 markedly affects cell behaviour and they plan to use the microscope to help pinpoint exactly what ADAM33 is doing, bringing much greater understanding of its function in asthma. Several other projects will also benefit from the microscope, including those looking at the role of ADAM33 during lung development, the effects of virus infection on asthmatic airway cells and studies examining interactions between airway cells and the different types of inflammatory cells that accumulate in asthmatic airways.

New Statistics. British Children now top the international league table for allergies according to a study recently published in the medical journal The Lancelot. The international study of asthma and allergies showed 47% of UK children (3.5 million) now suffer from allergies such as asthma and eczema. The study covered 193,000 children aged 6 � 7 and 305,000 aged 13 � 14 across the world. Britain had one of the biggest increases in allergy rates making it the worst affected country with cases of asthma doubling over the past two decades and cases of hay fever and eczema trebling. Another study also showed potentially life-threatening allergies had increased dramatically during the past decade with a 700% rise in hospital admissions for anaphylaxis or sever reactions and a 500% rise in admissions due to food allergies. AAIR�s Dr Peter Howarth said: �We cannot identify what is causing the problem but one of the main problems is that we live in too clean an environment.�

Research by the Southampton Respiratory Group highlighted at Major International Lung Conference. Two pieces of research undertaken by Professors Donna Davies and Stephen Holgate have been highlighted in the �Clinical Year in Review� at the American Thoracic Society International Conference, which took place in San Diego earlier this year. The purpose of the Clinical Year in Review is to update clinicians on newly published studies and to identify recent advances in pulmonary medicine.
	These studies are the culmination of several years� work and have been selected from thousands world-wide. For the Southampton group to have two papers out of the total of just thirteen cited in the asthma section demonstrates that their work is recognized internationally to be at the cutting edge of asthma research. The first highlighted study was the group�s demonstration that airway cells from asthmatic volunteers do not mount a normal antiviral response to the common cold virus, which is a major cause of worsening asthma symptoms. The researchers also showed that addition of interferon beta, the antiviral protein that was found to be deficient in asthmatic cells, protected against infection. This may pave the way for a novel treatment for viral-induced asthma attacks.
The second study that was highlighted was the group�s clinical trial studying for the first time the effect of blocking a mediator called TNF� in steroid refractory asthma. Although this therapy needs to be tested in larger asthma trials, the improvements seen in the initial study and a second study performed in Leicester are very encouraging. Donna E. Davies Professor of Respiratory Cell and Molecular Biology Allergy and Inflammation Research

It's official! AAIR researcher Lynn Andrews has made classroom science exciting Lynn has won a Science Communicator's Award after inspiring pupils at Poole Grammar School with imaginative lessons in science. The award came after Lynn took part in the nationwide 'Researcher in Residence' scheme, which asks science researchers to work with teachers in making school science, technology, engineering and maths more relevant and exciting for young people. The scheme's project manager Marilyn Brodie said: "We were impressed by Lynn's efforts to engage the pupils. Her willingness to host laboratory visits made a real difference to the pupils' experience of science and so was invaluable." Lynn said: "The children particularly enjoyed the live experiments. We have such fantastic scientific equipment they could see microscopic pictures, which they found fascinating. It was very rewarding and good to show the children that a career in science does not necessarily mean just working in a laboratory."

BREAKTHROUGH BY AAIR RESEARCHER
	AAIR scientist Dr Andrew Walls and his team have come up with a new test, which may eventually help prevent potentially life-threatening anaphylactic shocks. Anaphylactic shock is an extreme form of allergic reaction where the body's immune system decides that something harmless, such as peanuts or wasp stings, poses a great danger, and launches a massive overreaction. It is thought this new test could help in the reliable diagnosis of anaphylactic shock. Dr Walls said: 'A reliable diagnosis is important reduce the risk of suffering a further life-threatening reaction. This could involve avoiding the allergen that provoked the reaction and carrying an Epipen that will allow rapid injection of adrenalin at an early stage of anaphylaxis.� The team found the enzyme carboxypeptidase, released by mast cells in tissue, can be used to identify an anaphylactic reaction. Tests so far have proved successful; levels of this enzyme have been considerably higher in people who had an anaphylactic reaction compared to those who had not.
Dr Wall added: 'It's early days yet but we're hoping that the research will lead to a simple and rapid test for anaphylaxis becoming available. It is more that five years since our laboratory first started work on the new test. It is satisfying to see the potential in laboratory diagnosis becoming apparent. It will be important for the test to become more widely available. �The support of AAIR and other medical charities including Thrasher Research Fund, Sir Jules Thorne Charitable Trust, Action Research has been crucial for the work of our research group. We are grateful to them�.

EXCITING NEW DISCOVERY
Microscopy image of embryonic lung showing a section of an airway tube surrounded with smooth muscle (green) and ADAM33 positive cells (red) and the nuclei of the cells (blue).	AAIR scientists have again attracted worldwide attention following pioneering research, which suggests a known rogue asthma gene plays a key role in the developing lungs of embryos. The exciting discovery, made by Hans Michael Haitchi and the University of Southampton team, opens up important new research horizons. It could, in time, lead to new treatments or even better prevention of disease by blocking the harmful reactions between the gene and the environment early in life at the origin of the disease. The research, partly funded by AAIR, follows on from the major breakthrough in 2002 when the gene, Adam33 was discovered through joint research, again involving a Southampton team. This gene was associated with the inheritance of asthma and airway twitchiness and recent studies of young children from parents with asthma or allergy have shown these children with breathing problems have small changes in the Adam33 gene � suggesting it may have effects in early life.
Hans and his colleagues concentrated on whether the asthma gene Adam33 was found in the foetus, what role it played in during the earliest stages of airway development and how it might react with an allergic or smoking environment during the embryo�s development Hans said: �Adam33�s expression in embryonic lung tissue and its interaction with allergy mediators suggest that it plays a key role in airway formation. It could contribute to the development, later in life, of chronic respiratory conditions such as asthma or COPD� *COPD (chronic obstructive pulmonary disease) is an umbrella term covering chronic bronchitis and emphysema - the top two lung diseases.

Medical Research

The Brooke Laboratory

Prof. Donna E. Davies

Prof. Ratko Djukanović

Prof. Stephen Holgate

Dr. John Holloway

Dr. Peter Lackie

Dr. Tony Sampson

Dr. Andrew Walls

Dr. Susan Wilson

Dr. Peter Howarth

Prof. Peter Friedmann

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