In this month's issue of the journal, we include a number of important articles from Australia, where the Australian federal government has invested significantly in allergy research through the National Allergy Centre of Excellence (NACE). Several articles in this month's issue arise from NACE work and highlight the value of a coordinated, nationally funded allergy research programme. Vale et al. present the new Australian Society of Clinical Immunology and Allergy (ASCIA) guideline for infant feeding to prevent food allergy, summarised in Figure 1 1. A key change from the previous version of this guideline in 2016 is advice to ‘try again’ if there is a minor perioral rash after trying a food allergen. This recognises the importance of continued allergen consumption to induce immune tolerance, and the non-severe nature of most allergic reactions during infancy. The new ASCIA guidance aligns better with international infant feeding guidelines than many other healthcare professional society guidelines, by recommending complementary food introduction at around age 6 months 2. Timing of complementary food introduction has become a hotly debated topic in recent years, with allergy professionals and researchers sometimes pitched against public health bodies—something we discussed in detail last year 3. Overall, the ASCIA guideline is a refreshing departure from the tendency of allergy guidelines to contradict public health advice, and provides clear advice for professionals and parents/carers looking after infants. But what should professionals and families do if prevention fails, and their infant does have an allergic reaction to a food? Here again, NACE has the answer… As Brettig et al. describe, NACE is pioneering the first national roll-out of a food allergy oral immunotherapy programme 4. The programme is currently limited to peanut, the commonest long-term food allergy in Australia—and allows major public hospitals around the country to offer peanut oral immunotherapy in infancy within the state-funded health service. This innovative programme focuses on infants, on the basis that oral immunotherapy appears to be safest and most effective in younger children 5. By building in formal evaluation of the ADAPT programme, the findings of the NACE team's early intervention work to treat food allergy are likely to have international impact. While there is a significant focus on food allergy prevention and treatment in Australia, the country also has specific, local allergy issues. Anaphylaxis to Jack Jumper Ants (JJA) is the commonest cause of insect sting anaphylaxis in some regions of Australia, affecting an estimated 2.7% of Tasmanian residents. In this issue, Le et al. describe one of very few randomised controlled trials of insect venom immunotherapy undertaken globally 6. They undertook a factorial randomised controlled trial which evaluated the effects of an adjuvant (delta-inulin) and the effect of 25 mcg versus 50 mcg maintenance dosing on outcomes of JJA venom immunotherapy 7. The adjuvant was not associated with increased efficacy or safety, and interestingly the efficacy outcomes were similar for 25 mcg versus 50 mcg maintenance dosing, suggesting the possibility of a lower dose protocol for JJA treatment in the future (Figure 2). Other work in this issue highlights the strength in depth of the Australian allergy research community, which spans from large-scale epidemiology, well-characterised cohort studies and innovative clinical trials through to cutting edge cellular and molecular immunology 8. Australian allergy research may have an outsized impact, but other nations and regions are also developing important population-level initiatives to improve allergy education and research. In this issue we also publish new consensus guidance on food allergy from the Indian Academy of Paediatrics (IAP) 9. An accompanying editorial by Dr. Neeraj Gupta, Chairperson of the Paediatric Allergy and Applied Immunology chapter of IAP, reflects on the dramatic increase in allergy awareness in India, and summarises the most important recent national allergy initiatives in the world's most populous country 10. R.J.B. wrote this editorial. The author declares no conflicts of interest.
Robert J. Boyle (Wed,) studied this question.