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The epidemic of allergic disease is a major public health crisis. The greatest burden of allergies is in childhood, when rapidly rising rates of disease are also most evident. General practitioners (GP) have a key role in recognising and addressing aller-gy-related problems and identifying whether a child requires referral to a paediatric allergist.This article focuses on IgE-mediated food allergies and allergic rhinitis, the most commonly seen conditions in paediatric im-munology. We will discuss prevention, diagnosis, management and treatment strategies.Currently there is no cure for food allergy. Oral tolerance induction continues to be a significant focus of research. All children with a possible food allergy should be referred to an allergist for further testing and advice. Children who develop allergic rhinitis need a regular review by their GP. Immunotherapy should be discussed early in the disease process and needs to be com-menced by an allergist.

The study aims to examine recent childhood asthma hospitalisation rates in the Asia Pacific countries of Australia, Hong Kong and Singapore. On the background of reported decline in many countries with high asthma prevalence during late 1990s.Annual asthma hospitalisation (ICD9-CM: 493 or ICD10-AM: J45-46)* and population data from 1994 to 2008, of children aged 0-14 years old, were obtained from the Australian National Hospital Morbidity Database, from the Hospital Authority in Hong Kong and from the Ministry of Health in Singapore. Data were stratified in two age groups: 0-4 and 5-14 years old, and also in different periods of calendar years. Time-series regression analyses were used to examine temporal trends. Diagnostic transfer was addressed by examining bronchitis hospitalisations.Significant decreases of up to 6.5% per annum in childhood asthma hospitalisation rates were found over the study period. However, the latter half of the study period showed increases in hospitalisation rates in all countries studied. No evidence of diagnostic transfer was found.Although there has been a decrease in childhood asthma hospitalisation rates since the 1990s, a modest increase was observed from 2003 to 2008. Ongoing monitoring is required.

Food allergy is a substantial and evolving public health issue, recently emerging over the last 10-15 yr as a 'second wave' of the allergy epidemic. It remains unclear why this new phenomenon has lagged decades behind the 'first wave' of asthma, allergic rhinitis and inhalant sensitization. In regions like Australia, which lead the respiratory epidemic, challenge-proven IgE-mediated food allergy now affects up to 10% of infants. Although their parents were among the first generation to experience the large-scale rise in allergic diseases, disorders of oral tolerance were previously uncommon. Of further concern, this new generation appears less likely to outgrow food allergy than their predecessors with long-term implications for disease burden. Allergic disease has been linked to the modern lifestyle including changing dietary patterns, changing intestinal commensal bacteria and vehicular pollution. It is not yet known whether the rise in food allergy is a harbinger of earlier and more severe effects of these progressive environmental changes or whether additional or unrelated lifestyle factors are implicated. New studies suggest environmental factors can produce epigenetic changes in gene expression and disease risk that may be potentially heritable across generations. The rising rates of maternal allergy, a strong direct determinant of allergic risk, could also be amplifying the effect of environmental changes. Preliminary evidence that non-Caucasian populations may be even more susceptible to the adverse effects of 'westernisation' has substantial global implications with progressive urbanization of the more populous regions in the developing world. Unravelling the environmental drivers is critical to curtail a potential tsunami of allergic disease.