Immunisations Allergens eg house dust mite

FIG. 3. A hypothetical view of factors regulating the balance between T helper (Th) 1 and Th2 immune responses in various communities.

& P. G. Bardin, unpublished observations 1997). Perhaps tuberculosis is good treatment for asthma!

In conclusion, PBMC from healthy children produce markedly less IFN-y than those of adults, but no consistent differences are found in the production of other cytokines. It is tempting to propose that the immunopathology found in adults is not only due to a vigorous memory response (the Koch phenomenon), but also to age-related changes in cytokine secretion. Secondly, in a Western Cape community with rampant tuberculosis, disease incidence was linked not only to socioeconomic deprivation, but also to serum IgE levels. It remains to be determined if this association simply reflects higher parasite loads in the more disadvantaged subdistricts or whether it implies a causal relationship, i.e. whether chronic Th2 stimulation predisposes a community to tuberculosis (Fig. 3). Thirdly, the decrease in IgE levels following tuberculosis may be due to chronic Th1 stimulation during disease. This finding supports the argument that effective anti-tuberculosis vaccination, inducing a long-lasting Th1 response, might have beneficial effects such as a reduction in atopy.

A.D.B, is a Wellcome Trust Senior Research Fellow in South Africa. The work was supported by the Glaxo Wellcome Action TB initiative.

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