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N is the relationship of environmental exposure and disease pathogenesis better illustrated than in the specialty of allergy-immunology. This relationship is found sensu lato within the pages of this issue of the Proceedings that includes a spectrum of allergic disorders ranging from those that affect the skin as well as the respiratory tract. Boguniewicz leads off this issue with a review of the 2012 update to the atopic dermatitis practice parameter, that includes strategies for better disease control, wet wrap therapy and allergy immunotherapy for treatment of this clinically perplexing dermatologic disorder. The report goes beyond the practice parameter with descriptions of novel approaches to filaggrin deficiency as well as emerging biologic therapies including dupilumab, a fully human monoclonal antibody directed at the IL-4 receptor alpha subunit recently shown to be effective in treating adults with moderate-to-severe atopic dermatitis as well as those suffering from asthma. The diagnostic applications of environmental exposure and allergic disease are next described in a report by Edwards and Martinez who performed a comprehensive literature review of food atopy patch testing, a procedure more extensively performed by our European colleagues but which is currently gaining interest in the US as a potential new test for the assessment of food allergy. The authors present a set of evidencebased recommendations for the use of food atopy patch testing in atopic dermatitis as well as other allergic diseases. The availability of a variety of new pharmacologic agents for the treatment of hereditary angioedema makes it imperative that prescribers be familiar with their efficacy data as well as their adverse event profiles. In this regard, the United States Food and Drug Administration has required that prescribing information for human derived C1 esterace inhibitor (C1-INH) include a warning for the potential occurrence of arterial and venous thromboembolic events associated with these preparations. The report by Crowther et al that reviews and assesses the strength of available evidence regarding the thrombogenicity of human plasma-derived C1-INH should be useful for prescribers to better understand the risk/benefit ratio of these products. Previous issues of the Proceedings have addressed environmental exposures and their association with asthma. Four articles which appear within the pages of this issue provide additional insight related to the detrimental effects of these exposures. In the first article, Ferrante et al review the current evidence supporting the role of passive environmental tobacco smoke exposure as a detrimental risk factor for the development of asthma in childhood. Expanding on this same topic, Ciaccio et al performed original research directed at determining the prevalence of second hand smoke exposure in the home environment in a low-income, minority population and then evaluated the association of exposure with childhood asthma, wheeze, and oral corticosteroids use. Because of its significant clinical implications regarding the identification of modifiable risk factors, this article is featured in the “For the Patient” section of this issue. This segment, found in the back of the print version of this issue and also available online, consists of a one page synopsis of a selected article, that is written in a readily comprehensible fashion to help patients better understand the content of the full article and its diagnostic and therapeutic implications. It is printed in a format to allow reproduction on the practitioner’s letterhead for distribution to patients. In addition to tobacco smoke exposure, the relationship of other environmental exposures in the home to asthma is further addressed by Pacheco et al. These investigators explored the hypothesis that urban homes of Black and Latino asthmatic children are characterized by more home-associated mechanical and structural conditions that may play a greater pathogenetic role than in households of Caucasian asthmatic children. In the final article on the topic of environmental exposures and asthma, Spanier et al address the allergic implications regarding exposure to triclosan and paraben, which are chemical agents widely used in personal care and medical products as microbicides and preservatives. Their findings suggest a potential risk regarding allergic sensitization and asthma in children. Airway inflammation, the hallmark finding of asthma, is often associated with structural changes in the lung termed airway remodeling. It is now generally accepted that cytokines such as serum angiopoetin

Environmental exposure, allergic disease and asthma: The distinguishing hallmark of allergy-immunology