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.
1. IRREVERSIBLE LUNG FUNCTION IN YOUNG ADULTS WITH A HISTORY OF CHILDHOOD
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.
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.
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;
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.
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.
6. INFLUENZA-ASSOCIATED DEATHS IN CHILDREN IN THE UNITED STATES,
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.
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,
Pediatrics 2005; 116: 1134.
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.
9. EFFECT ON ASTHMA OF TREATING ALLERGIC RHINITIS WITH INTRANASAL
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.
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:
Current Allergy & Clinical Immunology 2005; 18: 108 and Stear GIJ,
2005; 18: 114.
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.
Member Society Spotlight – Malaysian Society of Allergy and Immunology（所属学会紹介）
Malaysian Society of Allergy and Immunology
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!
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
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
WAO Short-Term Research Fellowship 2006 Applications
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
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:
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:
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
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.
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
"Free Journal Subscription" in the subject line, with the following details:
City, State/Province and postal code
Name of Member Society
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
List Price: $139.95 USD
Atlas Medical Publishing
Reviewer: Steven L. Cole, DO
Division of Allergy and Immunology
University of South Florida College of Medicine
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.
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.
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.
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.
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