The German reunification offers a unique opportunity to study the impact of environmental factors on the development of childhood respiratory and allergic disorders in ethnically similar populations. We investigated the prevalence of asthma, hay fever, atopy, and bronchial hyperresponsiveness (BHR) in 9- to 11-year old children in West Germany (n = 5,030) and East Germany (n = 2,623). A self-administered questionnaire was distributed to the parents. Children underwent cold air challenge and allergy skin prick tests. Atopic sensitization was considerably more frequent in West German children than in their peers in East Germany (36.7% versus 18.2%; odds ratio [OR] = 2.6, p < 0.0001). The prevalence of current asthma and hay fever was significantly higher in West Germany when compared with that in East Germany (5.9% versus 3.9%; OR = 1.5, p < 0.0001 and 8.6% versus 2.7%; OR = 3.4, p < 0.0001, respectively). Bronchitis, however, was more prevalent in East Germany than in the western part of the country. The prevalence of BHR as assessed by cold air challenge was higher in West Germany compared with that in East Germany (8.3% versus 5.5%, OR = 1.6, p < 0.001). Logistic regression showed that the West German study area was no longer a significant independent determinant of asthma once sensitization to mites, cats, and pollen was taken into account. We conclude that sensitization to aeroallergens is strikingly more frequent in West Germany than in East Germany and this may explain the differences in the prevalence of asthma and hay fever between the two parts of the country.

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* Detecting urinary tract infection in early childhood is important for preventing renal damage * Suprapubic aspiration of urine is considered in Britain to be a difficult technique * This study showed that use of ultrasound guidance makes suprapubic aspiration in children and babies easy and safe * Low bacterial counts were present in the urine of two fifths of the children with abnormalities ofthe urinary tract * Clinicians should regard low bacterial counts as important had vesicoureteric reflux. Secondly, few of the nonbacteriuric specimens showed pyuria. All the children from whom these specimens came were being investigated for febrile illnesses. Thus the view that pyuria often occurs as a non-specific response to fever seems untenable. Two thirds of the children with sterile pyuria were neonates, of whom many were premature and many were taking antibiotics; the possibility of bloodbome urinary tract infection, known to occur in neonates,"3 is strong. Radiological abnormalities were found in about a third of the children who were investigated.We suggest that clinicians should always seek an explanation for sterile pyuria and should consider the possibility of urinary tract infection if sterile pyuria persists.We thank Drs G M Lewis, M J Hardman, and E R Wozniak for permission to include their patients and Veronica Symes for typing the manuscript. Design-Cross sectional survey among schoolchildren aged 9-11 years. Skin prick tests in the children and selfcompletion ofwritten questionnaire by their parents.

The origin of the epidemic of IgE-associated (allergic) diseases is unclear. MeDALL (Mechanisms of the Development of ALLergy), an FP7 European Union project (No. 264357), aims to generate novel knowledge on the mechanisms of initiation of allergy and to propose early diagnosis, prevention, and targets for therapy. A novel phenotype definition and an integrative translational approach are needed to understand how a network of molecular and environmental factors can lead to complex allergic diseases. A novel, stepwise, large-scale, and integrative approach will be led by a network of complementary experts in allergy, epidemiology, allergen biochemistry, immunology, molecular biology, epigenetics, functional genomics, bioinformatics, computational and systems biology. The following steps are proposed: (i) Identification of 'classical' and 'novel' phenotypes in existing birth cohorts; (ii) Building discovery of the relevant mechanisms in IgE-associated allergic diseases in existing longitudinal birth cohorts and Karelian children; (iii) Validation and redefinition of classical and novel phenotypes of IgE-associated allergic diseases; and (iv) Translational integration of systems biology outcomes into health care, including societal aspects. MeDALL will lead to: (i) A better understanding of allergic phenotypes, thus expanding current knowledge of the genomic and environmental determinants of allergic diseases in an integrative way; (ii) Novel diagnostic tools for the early diagnosis of allergy, targets for the development of novel treatment modalities, and prevention of allergic diseases; (iii) Improving the health of European citizens as well as increasing the competitiveness and boosting the innovative capacity of Europe, while addressing global health issues and ethical issue

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