Phillipa Ellwood and colleagues from the International Study of Asthma and Allergies of Children (ISAAC) reporting in Thorax (doi:10.1136/thoraxjnl-2012-202285) looked at the association of reported food type intake and the risk of developing asthma, rhinoconjunctivitis and eczema in Phase Three of this impressive study. They used written questionnaires on the symptom prevalence of asthma, rhinoconjunctivitis and eczema and food intake over a 12 month period for 13–14-year-old adolescents and parents/guardians of 6–7-year-old children. For adolescents and children, there was a potential protective effect of consumption of fruit ≥3 times per week and an increased risk of severe asthma in adolescents and children with the consumption of fast food ≥3 times per week as well as an increased risk of severe rhinoconjunctivitis and severe eczema. The effect was unaffected when factors such as geographical location, gender and socioeconomic status were taken into account. Whilst the effect size was small and as the authors clearly state an association does not mean causation if fast food is an aggravating factor for very common childhood conditions the findings may have major public health significance owing to the global rise in fast food consumption.