December Medical Journal Review（12月の医学雑誌レビュー）
WAO Member Society Spotlight（WAO所属学会紹介）
WAO Now: What's New in the World of WAO（WAO最新ニュース）
And In Other News（その他のニュース）
　

December World Medical Journal Review（医学雑誌レビュー）

Prof. Richard F. Lockey, MD, WAO Web Editor-in-Chief, reviewed premier November medical journal articles for practicing allergists. WAOのWEB編集委員長であるロッキー教授による12月の医学雑誌からの文献紹介です。

1. IRREVERSIBLE LUNG FUNCTION IN YOUNG ADULTS WITH A HISTORY OF CHILDHOOD ASTHMA
Eighty-four (78% male) of 121 adults (17-30 years) who were included in the Childhood Asthma Study (1984-1994) were reevaluated by spirometry at age 17-30 years. Forty (48%) had severe spirometric abnormalities, twenty-eight of whom were given 1 mg/kg prednisone for one week and reevaluated. Twenty-one (75%) did not improve. Adult and childhood spirometric results were positively correlated (r = 0.49-0.72, P<.0001). Abnormal adult spirometric results were associated with: 1) longer duration of asthma at enrollment as a child, 2) increased childhood methacholine sensitivity and 3) premature birth. Editor's comment: More information is needed about early onset of asthma and how to prevent irreversible lung changes. Limb SL, et al. J Allergy Clin Immunol 2005; 116: 1213-19.

1984年から1994年に米国でおこなわれたスパイロメーターによる肺機能を含む実態調査に協力した小児喘息患者121名のうち、現在、成人となった84名に関して再調査をおこなった。40名において肺機能の著しい低下が認めらた。そのうち28名にプレドニゾロン1mg/kgを処方して1週間後に再測定をおこなったが改善したものはわずか7名であった。このような不可逆性の肺機能変化は小児期からの喘息歴の長さ、小児期のメタコリン過敏性の程度および早期出産の程度と比例していた。

2. TRANSGENIC RICE FOR ALLERGY IMMUNOTHERAPY
Transgenic rice was used to express and orally deliver specific peptide epitopes of Japanese tree pollen, Cry j 1 and Cry j 2 to attenuate the development of allergic immune responses and inhibit allergen-specific IgE and IgG production in mice. This oral administration inhibits allergen-specific Th2 responses and decreases the level of allergen-specific CD4 + T cell-derived allergen-associated T helper 2 cytokine production of IL-4, IL-5, and IL-13 and histamine release. These experiments demonstrate that it is feasible to develop an effective peptide-based oral vaccine using transgenic plants to treat allergic diseases. Editor's comment: This paper suggests that "Atopically challenged children" may be able to eat rice to prevent allergic diseases. Takagi H, et al. PNAS 2005; 102: 17525. Editorial by Ma S, et al. 2005; 102: 17255.

日本で研究開発中であるスギ花粉症緩和米の基礎研究成果に関するPNAS論文の紹介。マウスのT細胞が認識するスギ花粉アレルゲンの断片ペプチドの遺伝子を導入し て栽培した米を食べさせることにより、マウスのスギ花粉によるアレルギー反応やTh2サイトカイン産生が低下した。 訳者注：日本では遺伝子導入米と書くだけで反対する人が多いためスギ花粉症緩和米というように呼ばれているが、米国ではtransgenic miceと韻を踏んだtransgenic riceということば自体が話題になっているようだ。

3. ESOPHAGEAL EOSINOPHILS IN PATIENTS WITH POLLEN ALLERGY
Thirty-eight patients with symptomatic allergic rhinitis (with or without asthma) sensitive to grass pollen and 25 healthy non-atopics and 25 patients with GERD underwent gastrointestinal endoscopy during the grass season. High levels of esophageal eosinophils were found in ten allergic patients (26%), five GERD patients (21%) but not in healthy controls. Eosinophilic infiltration at the distal esophagus (versus the entire esophagus) was more prominent in the reflux group vs. the allergic group. The authors speculate that these findings may reflect the systemic and common mucosal aspects of allergic inflammation. Editor's comment: High levels of eosinophils in the esophagus can be associated with inhalant allergens. Onbasi K, et al. Clin Exp Allergy 2005; 35: 1423. Editorial by Spergel JM, 2005; 35: 1421.

ブタクサ花粉症の患者ではシーズン中に食道に好酸球性炎症が認められた。胃食道逆流症を合併した喘息でも好酸球性炎症がみられたが、花粉症では上部の食道に多く認められた。

4. PROTECTIVE EFFECT OF PNEUMOCOCCAL VACCINATION IN ELDERLY SUBJECTS
These authors studied the effectiveness of the 23-valent pneumococcal vaccine to prevent pneumonia and death in the elderly in Spain (n511, 241) by means of a multivariate Cox proportional-hazard models, adjusted by age, sex, influenza vaccination status, comorbidity and immunological status. The pneumococcal vaccination did not alter the risk of hospitalization from pneumonia or overall pneumonia but was associated with a considerable reduction of death risk from pneumonia. Editor's comment: The 23-valent polysaccharide pneumococcal vaccine is effective for older subjects. This article is accompanied by an editorial calling for vaccination of older individuals to both pneumococcal and influenza vaccines and for better pneumococcal vaccines. Vila-Córcoles A, et al. Eur Respir J 2005; 26: 1087. Editorial by de Roux A, Lode H, 2005; 26: 983.

スペインの高齢者に対する肺炎球菌ワクチンの使用成績について調査がおこなわれた。その結果、肺炎による入院のリスクには影響しなかったものの死亡リスクを下げることが判明した。

5. SEVERE ASTHMA EXACERBATIONS DURING PREGNANCY
One hundred and forty-six patients were examined in a prospective study of asthma and pregnancy. Severe asthma occurred in 8% with mild asthma, 47% with moderate asthma and 65% with severe asthma at a mean gestational age of 25.1 + 0.9 weeks. Among those with severe exacerbations, there were 2 male stillbirths and a significant increased rate of male low birth weight. Forty-three percent of severe exacerbations occurred in the winter, 34% were associated with self-reported viral infections and 29% with non-adherence to inhaled corticosteroid medication. The authors conclude that the exacerbation rate in pregnant women with asthma is high and associated with poor outcomes for the male fetus. Editor's comment: Asthma is a risk factor during pregnancy. Murphy VE, et al. Obstetrics & Gynecology 2005; 106: 1046.

喘息患者の妊娠に関して調査がおこなわれた。大発作は軽症喘息の8%, 中等症の47%, 重症喘息の65%に認められた。妊娠週数の平均は25週で冬に多くウイルス感染を伴っていることが多かった。男子においては出生体重が有意に低下していた。妊娠は喘息発作のリスクファクターであり、吸入性ステロイド等の治療を継続する必要がある。

6. INFLUENZA-ASSOCIATED DEATHS IN CHILDREN IN THE UNITED STATES, 2003-2005
Health Department related deaths associated with laboratory-confirmed influenza in the U.S.A. in residents less than 18 years were analyzed at the Center for Disease Control and Prevention. Of 143 deaths, 53% were less than five years, 33% had an underlying condition recognized as a risk factor for the disease and 20% other chronic conditions. Twenty percent had chronic pulmonary disease with or without asthma. Editor's comment: Influenza vaccine is necessary for children, especially for those with chronic diseases such as asthma. Bhat N, et al. N Eng J Med 2005; 353: 2559.

2003年から2005年の米国におけるインフルエンザ死亡例の調査結果が報告された。死亡例143名のうち53%が5歳以下の小児であった。20%は喘息を含む慢性肺疾患を合併していた。喘息児はインフルエンザ死のリスクファクターであり、ワクチン接種が推奨される。

7. EPINEPHRINE ADMINISTRATION FOR ALLERGIC REACTIONS IN SCHOOL
This study determined the incidence of anaphylaxis in schools, the surrounding circumstances associated with anaphylaxis, practices used to manage such reactions and opportunities for improvement. One-hundred and nine school districts in Massachusetts were surveyed from September 2001 to August 2003. Thirty-one percent of students who received epinephrine had allergies to multiple substances and 25% had allergies to peanut or tree nuts only. Twenty-two (19%) occurred outside the school building during school hours. The average time from onset to administration of epinephrine was ten minutes and epinephrine was most often administered by the school nurse. Ninety-two percent of the cases were transferred for emergency care. Editor's comment: This article identifies opportunities for improvement in the treatment of students with a history of anaphylaxis. McIntyre CL, et al. Pediatrics 2005; 116: 1134.

2001年から2003年のマサチューセッツ州におけるアレルギー児に対する学校でのエピネフリン注射の実態調査が行われた。ピーナッツやナッツ類の単独アレルギーは25%であった。症状出現からエピネフリン注射までの平均時間は10分であり、多くは学校専属の看護師によって実施された。訳者注：日本でもschool nurseによるエピネフリン注射が実施できるようになることを望む。

8. SOY FORMULA FEEDINGS AND SOY AND PEANUT ALLERGY
These authors question whether or not peanut allergy is associated with the intake of soy formula in milk-sensitive individuals. One-hundred and seventy infants with documented cow's milk allergy randomly received either a soy formula or an extensively hydrolyzed formula (EHF). They were followed to age four years. Peanut allergy developed in two of the soy and four of the EHF groups. The authors conclude that soy formula used during the first two years of life does not increase peanut-specific IgE or peanut allergy. Editor's comment: Eating soy formula does not cause peanut allergy. Klemola T, et al. Pediatr Allergy Immunol 2005; 16; 641.

牛乳アレルギーの患児に対して大豆乳の投与が行われるが著者らは大豆乳投与により交叉反応を介してピーナッツアレルギーのリスクが高まるかどうかに興味をもち調査した。その結果、大豆乳はピーナッツアレルギーのリスクには影響しないことが判明した。

9. EFFECT ON ASTHMA OF TREATING ALLERGIC RHINITIS WITH INTRANASAL CORTICOSTEROIDS
This study determined the effects of inhaled (into the lungs) or topical nasal beclomethasone dipropionate (BDP) administered separately or in combination to control asthma and bronchial hyperresponsiveness (BHR) in patients with allergic rhinitis and asthma. It is a double-blind, parallel, three-group study of 74 patients over 16 weeks. Nasal and pulmonary symptoms, pulmonary function and BHR were compared at four and 16 weeks. All three groups, including those using only intranasal glucocorticoids, demonstrated decreased nasal and pulmonary symptoms, which started at four weeks and continued throughout treatment. The authors conclude that the treatment of allergic rhinitis is essential to manage and control asthma. Editor's comment: Another study which demonstrates the concept of united airways. Stelmach R, et al. Chest 2005; 128: 3140.

アレルギー性鼻炎とアレルギー性喘息を合併する患者をステロイド(BDP)点鼻薬使用群、ステロイド吸入薬使用群あるいは両者の併用群に分け、ダブルブラインドで厳密に喘息症状の評価を行った。その結果、ステロイド点鼻薬だけでも喘息症状を有意に改善した。

10. REVIEW ARTICLES, ONE ON HOUSE-DUST MITES AND THE ATOPIC PATCH TEST IN ATOPIC DERMATITIS AND THE SECOND ON LACTOSE INTOLERANCE
The Journal of the Allergy Society of South Africa (ALLSA) contains two excellent review articles. The first involves the controversy associated with atopic patch testing and the care of patients with atopic dermatitis. The second is an excellent review on lactose intolerance, when it should be suspected and how to diagnose and treat it. Editor's comment: Excellent reading – web page address for ALLSA is: www.allergysa.org. Fox A. Current Allergy & Clinical Immunology 2005; 18: 108 and Stear GIJ, et al. 2005; 18: 114.

アトピー性皮膚炎患者に対するアトピーパッチテストに関する総説および乳糖不耐症に関する総説を紹介している。 南アフリカアレルギー学会雑誌に掲載されていて自由に閲覧できる。

11. A PRACTICE PARAMETER ON THE DIAGNOSIS AND MANAGEMENT OF SINUSITIS
This is a 34-page summary of the practice of medicine as it relates to sinusitis and includes 288 references. Editor's comment: Must reading for all physicians. Slavin RG, Spector SL, Bernstein IL (eds). J Allergy Clin Immunol 2005; 116: S13-47.

副鼻腔炎の診断に関する総説。

WAO Member Society Spotlight – Malaysian Society of Allergy and Immunology（所属学会紹介）

Malaysian Society of Allergy and Immunology

今月のWAOメンバー紹介はマレーシアのアレルギー免疫学会です。1998年設立、200名の会員で学会参加者数は600-750名だそうです。

Founded in 1998, this humble society has grown slowly but surely into one of the most active societies in the WAO. Although relatively small with approximately 200 members, this society has become quite influential in increasing allergy awareness in the Southeast Asia region.

The need for such a society is great in Malaysia as allergy is a huge problem and does not receive the awareness that is necessary. Although the awareness of allergy has increased tremendously due to the efforts of the society, much more work has to be done to push allergy into the mainstream.

From the start, our society has been privileged to have had the guidance of mentors in allergy such as Profs. SGO Johansson, Sergio Bonnini, Paul Potter, Cas Motala, Ronald Walls, Connie Katelaris and, very recently, Carlos Baena-Cagnani. These internationally renowned allergists, including past and present Executive Committee members of the WAO, have guided the society, and helped launch new modules of GLORIA in Malaysia. Four GLORIA educational modules have been launched in Malaysia and disseminated locally with our society being one of the most enthusiastic and prolific disseminators of these modules anywhere in the world.

Although a relatively small society, we are often perceived as the hub of allergy in the immediate region and, as such, have assisted other societies in the region to join WAO or to upgrade their status within WAO by organizing and hosting an Emerging Societies Meeting (ESM) three years ago. This was mostly locally orchestrated, but this year, a WAO sanctioned ESM will take place in conjunction with our 7th Malaysian Congress of Allergy and Immunology in Kuala Lumpur, Malaysia from the 10-12th March 2006. At the same time, we will also be having conjoint symposia with our neighbor, the Allergy and Immunology Society of Thailand, to promote the upcoming World Allergy Congress 2007.

Fellow members of the WAO and friends, please come and visit us for a meeting and also have a holiday of your life in this beautiful country!
　

WAO Now: What's New in the World of WAO （最新ニュース）

Allergy Practice Worldwide: A Report by the World Allergy Organization Specialty and Training Council

WAOによる世界の国々におけるアレルギーに関する認知度を高めるための運動の紹介です。

To support the case for the development of allergy as a specialty worldwide, Allergy Practice Worldwide: A Report by the World Allergy Organization Specialty and Training Council is published this month in both WAO journals, Allergy & Clinical Immunology International - Journal of the World Allergy Organization, and International Archives of Allergy and Immunology (Warner JO, et al; Allergy Clin Immunol Int - J World Allergy Org 2006; 18:4-10, and Int Arch Allergy Immunol 2006;139:166-174).

This valuable report provides data from WAO member societies on the estimated prevalence of allergic disease, the number of trained allergists seeing adult and pediatric allergy patients, and information about the clinicians most likely to see patients with allergic disorders. An on-line version is available at www.acii.net and at www.karger.com/iaa.

WAO Short-Term Research Fellowship 2006 Applications

短期滞在型の研究フェローに対する助成金のお知らせ。

The World Allergy Organization (WAO) offers two Short-Term Research Fellowships, to commence in 2006, to support junior allergists to visit a center of their choice to learn a research technique. The envisaged duration of each attachment is 2-3 weeks. WAO will contribute up to a maximum of $2,500 USD, to include travel and accommodations, for each Short-Term Fellowship.

Priority will be given to junior clinicians within five years of award of the most recent professional degree, who are specializing in allergy and who are affiliated to an academic department or clinical institute. Applicants must be current members of a WAO member society.

The Short-Term Fellowships will be applied to a project which meets one of the WAO Research Priorities:

• Genetic factors involved in the development of allergic disease and response to treatment
• Allergen characterization and standardization
• Clinical and basic studies in allergy and asthma

Application forms may be downloaded from: http://www.worldallergy.org/wao_societies/06fellowship.doc

The World Allergy Organization's flagship educational program, GLORIA™ (Glo bal R esources i n A llergy™), will begin 2006 with two module placements at the following meeting:

WAOが推進しているGLORIA™ (Glo bal R esources i n A llergy™)会議が下記の学会期間に行われる。

The Fourth International Congress of the Egyptian Society of Pediatric Allergy & Immunology
16-17 February 2006
Cairo Sheraton Hotel

GLORIA Symposia:
Module 5: The Symptoms and Treatment of Asthma
16 February 2006 from 11:00 a.m. – 12:30 p.m. in Salah El-Deen Hall

Module 6: Food Allergy
17 February 2006 from 9:30 a.m. – 11:00 a.m. in Salah El-Deen (A) Hall

GLORIA Training Session
16 February 2006 from 5:00 p.m. – 5:45 p.m. in Nefertiti Hall

GLORIA Faculty: Prof. G. Walter Canonica, Italy and Prof. Carlos E. Baena-Cagnani, Argentina

Sign up for On-Line Journal Subscription
WAO and Hogrefe & Huber Publishers are offering a limited number of free on-line subscriptions to Allergy & Clinical Immunology International - Journal of the World Allergy Organization for members in developing countries. If you are interested in receiving a complimentary, on-line subscription, please send an e-mail to info@worldallergy.org, noting "Free Journal Subscription" in the subject line, with the following details:

First name
Last name
Postal address
City, State/Province and postal code
Country
E-mail address
Name of Member Society
　

And In Other News （その他のニュース）

Allergy Book Review
Allergy: An Atlas of Investigation and Management
SH Arshad, ST Holgate, NF Adkinson, Jr, KS Babu
2005 Clinical Publishing Ltd

今月のアレルギー関連の本の紹介です。疫学、臨床症状や治療法について図が多く掲載されています。

List Price: $139.95 USD
Available from Atlas Medical Publishing

Reviewer: Steven L. Cole, DO
Division of Allergy and Immunology
University of South Florida College of Medicine

Description:
This atlas reviews epidemiology, clinical manifestations and treatment of allergic disorders. The text provides for a general overview of allergic disorders commonly encountered in the allergist's office as well as a review of diagnostic tests.

Purpose:
The purpose is to provide up-to-date information on the mechanism, epidemiology, diagnosis, and treatment of allergic disorders. It is designed to present the reader with the most salient features of each disorder to facilitate learning and memory recall. The majority of texts in allergy are lengthy and at times cumbersome to read; however, this text succeeds in focusing the reader on key aspects of disease manifestation and management.

Audience:
The atlas is targeted to medical students, residents and clinicians in primary care specialties. The book is also a useful guide for practicing allergists and allergists-in-training to quickly review illustrations and algorithms of atopic disorders.

Features:
The eleven chapters cover the major allergic disorders seen in the field of allergy. Particular attention is given to asthma and diagnostic testing. Numerous illustrations and color photographs can be found in every chapter. The photographs are the most striking feature of this book and clearly set it apart from similar texts on the subject. Most chapters also include tables and algorithms to aid in the discussion and understanding of the material covered in the text. A deficiency noted in the text is a lack of detail in management issues and specific dosing of medications.

Assessment:
While the written description of physical exam findings is no substitute for the clinician's own experience at the bedside, the color photographs and informative illustrations found in this atlas provide the learner with the next best thing. Although well-written and easily understood chapters covering complex subject matters are a rarity in medicine, this book is an excellent resource for review and a convenient visual guide of allergic disorders. It is certain to complement the shelves of anyone who has an interest in allergic disorders. 

Find more allergy book reviews on the WAO Website here.