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.
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