The online test has been created by the charity Asthma UK with the aim of helping people manage their asthma more effectively and avoid hospital. Asthma UK say that about three-quarters of emergency hospital admissions for asthma are thought to be preventable with better support and management of the condition.

Questions in the "Triple A" test relate to factors which are linked to severe asthma attacks. They cover recent A&E admissions, use of inhalers, and need for steroids.

Results place the person into one of three colour-coded categories - red means high risk down and green means no increased risk. Respondents can then follow links to web pages on how to control symptoms and what to do when having an attack.

"This kind of test for asthma has never been done before but we're confident it will prove an effective motivator to help reduce frightening and often unnecessary hospital admissions," said Dr Samantha Walker of Asthma UK.

She added: "Asthma attacks hospitalise someone every seven minutes and kill over 1,100 people every year, so they are not to be taken lightly. The test is designed to make people sit up, take notice and make changes to the way they manage their asthma if they are shown to be at an increased risk of an asthma attack."

Alongside the launch of the test, a new National Review into Asthma Deaths begins today (February 1).

The Royal College of Physicians of London will collect details on all UK asthma deaths over the next year, to identify ways of preventing future deaths.

Clinical leader Dr Mark Levy said: "For 50 years, research has shown that the majority of asthma deaths are potentially preventable. This first UK National Review of Asthma Deaths offers clinicians and sufferers an opportunity to learn from these sad events and find ways of improving care for people with asthma in the future."

An analysis of a two year period in the United Kingdom and Ireland has found seven cases of severe reaction - anaphylaxis.

In the two years from 2008 to 2009 specialists reported 15 cases of severe reactions but only seven of these were confirmed as anaphylaxis, according to the report in the Archives of Disease in Childhood.

The cases were reported by specialists to the British Paediatric Surveillance Unit following a request for reports.

None of the children died and three were already carrying injectable adrenaline, the researchers say.

Two reactions were two a single measles vaccine - which is not generally used in the UK and only 16,000 doses were available in Britain during the period.

There were three reactions to the new HPV vaccine which is given to teenage girls. But there were no reactions to routine pre-school vaccines, including the MMR vaccine.

Researcher Dr Mich Lajeunesse, of University Hospital Southampton NHS Foundation Trust's children's allergy clinic, said: "This is extremely reassuring data for the general public and healthcare workers alike.

"Despite its limitations, the small numbers of cases reported are likely to be a true estimate of anaphylaxis rates."

Archives of Disease in Childhood January 24 2012 doi 10.1136/archdischild-2011-301163

Dr Liesbeth Duijts, of The Generation R Study Group at Erasmus Medical Centre in the Netherlands, said early infancy appeared to be a “critical period for the development of asthma”.

“We know that low birth weight is associated with an increased risk of asthma symptoms in children, but the effects of specific foetal and infant growth patterns on this risk had not been examined yet,” she said.

“In our study, weight gain acceleration in early infancy was associated with an increased risk of asthma symptoms in children of preschool age, independent of foetal growth patterns, suggesting that early infancy might be a critical period for the development of asthma.”

The study, which is published in the American Thoracic Society's American Journal of Respiratory and Critical Care Medicine, examined 5,125 children who were part of the Generation R Study, a population-based prospective cohort study.

They were followed from foetal life through to the age of four and information on asthma symptoms was obtained by questionnaires at the ages of one, two, three and four.

Dr Duijts said while there was no consistent relationship between foetal length and weight growth and the development of asthma symptoms, rapid weight gain from birth to three months following normal foetal growth was associated with increased risks of asthma symptoms.

“Our results suggest that the relationship between infant weight gain and asthma symptoms is not due to the accelerated growth of foetal growth-restricted infants only," she explained.

“While the mechanisms underlying this relationship are unclear, accelerated weight growth in early life might adversely affect lung growth and might be associated with adverse changes in the immune system.”

American Journal of Respiratory and Critical Care Medicine January 20 2012

Professor Robert Wood, of the Johns Hopkins Children's Centre, Baltimore, Maryland, and Dr Scott Sicherer of Mt. Sinai Hospital in New York, said clinicians should proceed with caution when ordering allergy tests.

Instead of using them to diagnose allergies, the tests should be used only to confirm suspicion.

Writing in the January edition of Pediatrics, Professor Wood and Dr Sicherer say that test results should be looked at in conjunction with a patient's symptoms and medical history.

If a food allergy is suspected, patients should undergo a food challenge, which involves consuming small doses of the suspected allergen under medical supervision.

“Allergy tests can help a clinician in making a diagnosis but tests by themselves are not diagnostic magic bullets or foolproof predictors of clinical disease,” Prof Wood says. “Many children with positive tests results do not have allergic symptoms and some children with negative test results have allergies.”

Skin tests and blood tests are proxies that detect the presence of immunoglobulin (IgE) antibodies, immune-system chemicals released in response to allergens that can tell if someone is sensitive to a particular substance but cannot reliably predict if a patient will have an actual allergic reaction.

However, many people who have positive skin tests or measurably elevated IgE antibodies do not have allergies.

Physicians should also caution against comparing results from different tests and laboratories because commercial tests vary in sensitivity.

Prof Wood and Dr Sicherer say blood and skin tests should be used to confirm a suspected allergic trigger after observing clinical reactions; monitor the course of established food allergies via periodic testing; confirm an allergy to insect venom following a sting that causes anaphylaxis; and to determine vaccine allergies.

However, they should not be used as general screens to look for allergies in symptom-free children or to test for drug allergies.

Pediatrics January 2012

Contact allergy affects about 20 per cent of the population in the western world, with metals such as nickel, and substances in perfume and preservatives, being among the most common allergenic substances.

Sofia Andersson, from the university’s Department of Chemistry, said that she and colleagues discovered that allergenic substances react with keratin 5 and 14 in the skin.

“The skin cells form what are known as ‘blebs’ when exposed to allergenic substances, and this can be used to test whether a substance is allergenic,” she said.

The test exposes cultured skin cells to substances for 24 hours and then photographs them. The number of cells with blebs is counted and the greater the number of blebbing cells, the more powerful is the allergenic potential of the substance.

“Thus, our new test has the potential to give a graded reply: it can quite simply determine whether an allergenic substance is extremely, strongly, moderately or weakly allergenic,” says Ms Andersson.

Meanwhile, colleague Carl Simonsson has used advanced light microscopy to demonstrate that a substance can be differently absorbed by the skin, depending on what it is mixed with. The findings may determine whether substances cause contact allergy.

“We have also been able to identify specific cells and proteins in the skin with which a contact allergen interacts. The results increase our understanding of the mechanisms behind contact allergy,” he says.

The principal barrier of the skin, the stratum corneum, helps to protects us from bacteria and viruses, but the organ is not adapted to deal with and prevent absorption of many of the chemicals that we are exposed to today.

Simonsson says using an advanced form of light microscopy known as two-photon microscopy makes it possible to follow substances absorbed into the skin.

The method not only allows us to see not only how well a substance is absorbed, it can also follow what happens to it, and the location in the skin that the substance eventually comes to.

“We have used two-photon microscopy to study a new type of ointment that it may be possible to use to improve the absorption, and thus the clinical effect, of certain drugs that are used on the skin,” he adds.

The number of hospital admissions for this problem has increased by seven times in England in the last 20 years - and about 20 deaths a year are recorded as being caused by it.

According to the National Institute for Health and Clinical Excellence, emergency treatment is not always followed by ensuring the causes of the problem are identified and tackled.

The guidance says that hospitals that provide emergency treatment for suspect anaphylaxis should have separate referral pathways for adults and children.

All patients - or their parents - should be offered an adrenaline injector before an appointment with an allergy specialist is arranged, they say.

And clinicians should ensure they record the circumstances immediately before the illness to help identify what caused it.

Dr Fergus Macbeth, of NICE, said: "Unfortunately people who have an acute episode of anaphylaxis often do not have their condition managed appropriately once the acute episode has been treated. The reasons for this include anaphylaxis not being recognised, or not being differentiated from less severe reactions. Also, people may not be referred to a specialist.

"This can reduce the likelihood of the person receiving a definitive diagnosis and can lead to anxiety, inappropriate management and recurrent episodes.

"It can also result in avoidable costs for the NHS and increase the need for acute care."

Mandy East, of the Anaphylaxis Campaign, said: "For the patient, an anaphylactic reaction is extremely worrying and it is essential that specialist care is offered in order for a diagnosis to be confirmed and for the risk of recurrent episodes to be reduced."

The Atlas confirms the north-west of England as a problem area for children with asthma - who face a high risk of hospitalisation.

Rates in Liverpool and Knowsley are six times those in parts of the south-east - with many other north-western districts also showing high rates.

And it shows massive differences in the prescribing of drugs for dementia. In some districts patients are 25 times as likely to receive them as in other districts.

It is the second annual publication of the Atlas. Some 120,000 copies of last year's Atlas were downloaded.

The health minister Lord Howe said: "The Atlas of Variation lets us look at how the local NHS is meeting the clinical needs of their local population.

"This will help commissioners to identify unjustified variations and drive up standards so patients are receiving consistently high quality care throughout the NHS."

The north-west's asthma challenge was also highlighted last month by an NHS Information Centre report.

In contrast prescribing of dementia drugs is high in northern England - and limited in the south east, the Atlas shows.

Emily Humphreys, of Asthma UK, said: "We are disappointed that there is still such variation in outcomes for people with asthma across England; when it comes to asthma care there really is a postcode lottery in terms of how likely you are to end up in hospital, which is particularly worrying given that we estimate that about 75 per cent of asthma admissions could be avoided with better care and management.

"NHS organisations now need to act on the recommendations in this report and ensure that they fully develop, implement and resource their plans for improving asthma care in order to enable healthcare professionals to work more effectively with patients to help them to manage their asthma."

The Atlas also shows how people with type 2 diabetes are twice as likely to receive top quality care in some areas of England as in others.

And the rate of patients receiving angioplasty treatment for a severe heart attack varies by eight times. This figure may be affected by rural travel times.

A new study has tested the theory by measuring stress hormones in infants.

The Swedish researchers studied some 200 children, finding that high levels of cortisol hormones were linked to increases in risk of allergy and eczema of between 30 and 60 per cent.

Stress in the evening was linked to increased risk of food allergy.

In Sweden up to 40 per cent of children have some kind of allergy.

The researchers say the findings follow on from an earlier study of families who follow the "anthroposophic" lifestyle, associated with the philosopher and educationalist Rudolf Steiner.

This showed a reduced rate of allergies among school-aged children of these families.

Researcher Dr Fredrik Stenius, of the Stockholm South General Hospital, said: "Psychosocial factors and the stress hormone cortisol are associated with allergic diseases.

"Our study found that children with low salivary cortisol levels as infants have a lower prevalence of allergies during the first two years of life, compared to other children."

Salivary cortisol levels and allergy in children: The ALADDIN birth cohort.
Stenius F, Borres M, Bottai M, Lilja G, Lindblad F, Pershagen G, Scheynius A, Swartz J, Theorell T, Alm J. Journal of Allergy and Clinical Immunology, December 2011 Dec;128(6):1335-9

The European Science Foundation has identified chronic inflammatory disease as a key area for research, setting out ten priorities.

Allergy and asthma are the most notable examples of these diseases but a host of other common diseases may share common causes.

The researchers say it is time to pin down genetic and environmental causes of these diseases - and use personal genetic analysis, known as deep phenotyping, to identify the right treatments for individuals.

They also want more research into the phenomenon of tolerance - how some people can adapt to external problems.

And they call for interdisciplinary research and effective public-private partnerships.

The experts warn that testing of probiotics, such as yoghurts, to help prevent allergy in children has given mixed results - urging caution about this approach.

The chair of the scientists' committee Dr Harald Renz, of Phillips University, Marburg, Germany, said: "Many transmissible diseases have been effectively eradicated over the last half century, yet there has been a marked increase in the incidence of chronic inflammatory diseases."

Writing in the journal Dr Lars Kristiansen, of the European Science Foundation, Strasbourg, France, says: "The socioeconomic costs of chronic diseases are staggering and ever increasing. There is an urgent need to prioritise resources and identify the most efficient scientific and societal initiatives to be adopted.

"National collaboration within the European region represents the most efficient manner in which strategies for amelioration of chronic inflammatory diseases in the western world may be achieved."

Gene-Environment Interaction in Chronic Disease – An ESF Forward Look. H. Renz, I.B. Autenrieth, P. Brandtzaeg, W.O. Cookson, S. Holgate, E. von Mutius, R. Valenta, and D. Haller. The Journal of Allergy and Clinical Immunology, Volume 128, Supplement December 2011

Cancer Research UK scientists found that the body responds to carcinogens and to allergies in a similar way.

Writing in the journal Science, which was published yesterday, scientists describe how the cells that line the body’s surfaces, known as epithelial cells, are exposed to potentially cancer causing damage every day, such as the effects of UV light and tobacco smoke.

Researchers at King’s College London and Cancer Research UK’s London Research Institute found, when examining the effect this can have on mouse skin cells, that damaged cells display a stress molecule that activates neighbouring immune cells to destroy them.

They also discovered that this activates another response that involves the body’s whole immune system, which is similar to the allergic response.

It was discovered that the stress molecules also trigger a separate part of the body’s defence system to produce large amounts of antibodies.

It is believed the body uses them to recognise and flag the toxins that have caused the damage and eliminate them before they affect the rest of the body.

This combination allows the immune system to respond to developing tumours on the body’s surface and begin allergic-type reactions to protect the rest of the body.

Professor Adrian Hayday, based both at Cancer Research UK’s London Research Institute and King’s College London, said: “Our study suggests new and simple ways for monitoring a patient’s anti-tumour responses during treatment, allowing us to see if chemotherapy, for example, is helping or hindering the body’s own response to tumours.”

Dr Julie Sharp, senior science information manager at Cancer Research UK, said the research showed that the body can react quickly to eliminate potentially cancerous cells.

“Understanding how this works could pave the way to more effective treatments that use the body’s immune system to track down and destroy cancer cells,” she added.

The intraepithelial T cell response to NKG2D-ligands links lymphoid stress surveillance to atopy. Strid, J., et al Science December 1 2011