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In a substantial proportion of atopic eczema patients clinical sensitivity to food is not confirmable by either skin prick test or IgE RAST. The diagnosis of provocative food factors in this condition is, therefore, highly dependent on dietary manipulations which are time consuming and sometimes dangerous. In an attempt to find an alternative laboratory procedure we have questioned the clinical relevance of specific IgG4 measurement in the sera of these patients in the light of previous reports demonstrating raised total serum IgG4 in patients with atopic eczema. Thus, a highly reliable ELISA was developed to measure IgG4 specific to 3 cow’s milk proteins and 2 hen’s egg proteins in the sera of milk- and egg-allergic eczema patients and non-eczematous controls. The study provides clear evidence showing that the detection of milk- and egg-specific IgG4 in atopic eczema patients has no clinical value.

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Summary A new standardized precision needle which virtually removes operator variation from skin prick testing with allegens is described. The instrument is simple and robust, and the results of its use are demonstrated. The most important finding was that the use of strong pollen extracts produced very inconsistent and irregular weals, but when suitably diluted, or used on mildly sensitive skins, reproducibility of the response was excellent and it is therefore ideal for titration of skin sensitivity and biological assessment of the potency of allergens. The standard needle was also compared with two other methods of skin prick testing. Results were similar but the standard needle showed the least variation.

1. Five years' experience in the use of beclomethasone dipropionate aerosol (BDA) in the treatment of 315 patients with upper respiratory tract allergy is reviewed. 2. A total of 223 patients with perennial rhinitis was treated. In 23, where the nasal allergy had recurred after oral corticosteroid therapy for asthma was withdrawn, BDA was effective in 69% of cases. A similar success rate (68%) was recorded in 169 patients suffering from perennial allergic rhinitis alone, but a satisfactory response was observed in only 45% of 31 patients with nasal polypi. 3. In 92 patients with seasonal allergic rhinitis freedom from symptoms was achieved in 80%. 4. A total of approximately 534 patient‐years of treatment has been recorded without any evidence of side‐effects either clinically or on nasal biopsy.