The atopic diseases, including rhinitis and pollinosis, are becoming increasingly troublesome conditions. Professor Miyoshi is a leading clinician and investigator in the field, his most recent work demonstrating the importance of cedar pollinosis in China.

The search for improved understanding of the origin of atopic disorder is vital, if we are to produce effective and tolerable treatments, and to mount an effective strategy to prevention.

Genetic aetiological factors are significant, and dissection of the heterogeneous genetic elements is now proceeding more effectively, aided by the human genome project. We may finally find that different sufferers need different therapeutic agents, and that we can predict to some degree which they should be.

The environmental is of course important, but not simply as a source of allergens. The swift rise in the atopic diseases in recent decades points to a vital environmental change, some change that has made more and more people unable to restrain their immune responses against allergens. Curiously, more people also seem less able to restrain their immune responses to other antigens, for instance those involved in the insulitis of diabetes and inflammatory bowel disease. There are now strong pointers to the possibility that certain patterns of microbial exposure in early childhood may influence the development of appropriate immune restraint or regulation. Will certain microbial "vaccines" give us the chance of effective prevention of atopy, we shall see.

Professor Miyoshi and his team's research activities excellently illustrate the problem facing us, and the need for us to press on with our endeavours. We have much to do.