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ploring causal relationships for the effects demonstrated in this study. REVIEWERS COMMENTS. This large study is one of the few longitudinal studies to have examined the relationship between sibling exposure and allergic rhinitis; most other studies have been cross-sectional. The method of evaluation of sibling exposure quantifies both timing and dose and helps to pinpoint a potentially fruitful area for further research (before 2 years). One limitation is that the specific viral infections recorded for this study did not include viruses that primarily cause airway damage, such as respiratory syncytial virus and influenza. The mechanism for the effect of tonsillectomy is open to speculation. Possibilities include its significance as a marker of antibiotic use or, alternatively, a marker of severe, repeated, upper respiratory infection resulting in inflammation and, therefore, increased risk of sensitization via increased mucosal permeability.

egg. Sources of dietary advice included allergists (85%), dietitians (45%), and other health care providers (24%). Avoidance of all egg-containing products was recommended to 84%. A subset of the participants reported receiving conflicting advice; 39% reported that they were advised to avoid all egg traces, and 26% were advised that baked egg-containing foods were permitted. Of the 141 of 167 participants who were advised to avoid all egg products, 113 (80%) of 141 were adherent to dietary advice. Adherence rates were similar for other given dietary advice (avoiding trace egg or permitting baked egg). Adherence was not related to initial reaction severity or the source of advice (eg, doctors versus other sources). Eighty-four children underwent an egg OFC, and 27 (32%) of 84 passed. There were no statistically significant differences in demographic characteristics, initial reaction severity, accidental ingestion rates, advice given, or adherence patterns between those who passed versus failed the OFC. CONCLUSIONS. Adherence to dietary advice was not related to patient characteristics, type or source of advice given, or initial reaction severity. Acquisition of oral tolerance was not related to strict adherence, accidental ingestions, or other patient characteristics such as reaction severity, type of dietary advice given, or atopic status. REVIEWER COMMENTS. The results are perhaps surprising because neither exposures nor lack of exposures seemed to influence outcomes, although various confounding influences are difficult to assess. Measures of egg-specific immunoglobulin E were not reported; therefore, it is not clear whether serological markers would have better predicted outcomes. Other mechanisms, including antigen properties, serological markers, and host genetics, may aid in predicting oral tolerance acquisition. A better understanding of the natural history of oral tolerance acquisition would inform future therapies aimed at inducing oral tolerance, such as oral immunotherapy.

PURPOSE OF THE STUDY. Because pet allergies are associated with asthma, the authors investigated whether highefficiency particulate-arresting (HEPA) filtration had any effect on reducing indoor allergens and bronchial hyperreactivity in children with asthma who were sensitized to cat and dog. STUDY POPULATION. A total of 30 children with asthma (age: 6-17 years) who were sensitized and exposed to cat and/or dog allergen(s) at home completed the study. The children did not have dust mite or mold sensitivities, and those being treated for asthma stayed on treatment throughout this time.

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