December World Medical Journal Review
Shyam S. Mohapatra, Ph.D., WAO Guest Editor, University of South Florida College of Medicine, Tampa, FL, USA, reviewed premier December medical journal articles for practicing allergists. Read his top 3 picks below and for the other 8 reviews, click here.
1. Abnormalities of the bronchial arteries in asthma.
This study compares the structure of the bronchial arteries, which supply systemic blood to the airways, tracheobronchial lymph nodes and nerves, in post-mortem lungs of three groups of subjects (n=12): one group with fatal asthma and death due to asthma, one group with fatal asthma and death not due to asthma, and one non-asthmatic group. In the two asthmatic groups, the intimal area was significantly larger than in the control group. Gender, age, smoking and duration of asthma were found to have significant effects on the intimal area in asthmatics. The increase in intimal area was associated with smooth muscle proliferation and reduplication and calcification of elastica but not with inflammatory cell infiltration. Editor’s Comments: This paper is interesting because quantitative analysis of bronchial arteries has not been done before. However, although the differences are statistically significant, the number of subjects in each group is small and the clinical significance of these findings in the context of severe or fatal asthma is unclear. Green F.H.Y et al. Chest 2006;130 1025.
2. Safety of trivalent inactivated influenza vaccine in children 6 to 23 months old.
This paper reports on the screening for medically attended events in the clinic, emergency department or hospital after administration of trivalent inactivated influenza vaccine to children 6-23 months old between 1991 and 2003 (45,356 children with 69,359 vaccinations). This is a retrospective cohort study using self-control analysis with chart review of vaccine data from significant medically attended events at eight managed care organizations in the United States. The primary endpoint was any medically attended event associated with administration of trivalent vaccine within the risk windows of 0-3 days and 1-14 days. All individual ICD-9 codes and predefined aggregate codes were examined. The results showed that 13 of 14 medical conditions including acute upper respiratory tract infection, asthma, bronchiolitis and otitis media were less likely to occur after vaccination. Only one condition, gastritis/duodenitis was more likely to occur after 14 days of vaccination; however, it was not significant after chart review. Editor’s Comments: This report is the largest study of the safety of vaccines in infants with a variety of medical conditions suspected of reacting adversely to vaccination. It clearly establishes that flu vaccination of infants in the presence of certain diseases, including upper respiratory tract infections, allergies and asthma, is safe. It should be pointed out, however, that this is a retrospective study based on medical records and not an actual trial. In addition, the results showed that the vaccine may cause gastritis, the reason for which is unclear. Hambidge SJ et al. JAMA 2006; 296:16: 1990-7.
3. Role of small airways in asthma: Investigation using high-resolution computed tomography.
Small airways may have an important role in asthma but their pathophysiological relevance remains unclear. Their condition is assumed to reflect air trapping and may be a useful noninvasive indicator of airway disease. The objective of this study was to use high-resolution computed tomography for evaluating lung density and to determine correlations with clinical and physiologic variables in 29 patients with stable asthma. Both lungs were scanned at full-inspiration and full-expiration to measure the percentage of lung occupied by low attenuation areas (LAA%;<-960 Hounsfield units) and the mean lung density. Asthma severity, pulmonary function, methacholine airway sensitivity and reactivity, and sputum eosinophil counts were also evaluated. The results showed that the mean lung density increased and LAA% decreased in all patients during the expiratory phase compared to the inspiratory phase. In conclusion, expiratory/inspiratory high-resolution computed tomography is useful for assessing small airway involvement in airflow obstruction, airway hypersensitivity and more severe diseases such as asthma. Editor’s Comments: HRCT can be very useful in diagnosing small airway disease. Tetsuya Ueda, MD J Allergy Clin Immounol 2006; 118:1019-25.
To read the additional reviews, click here.
WAO Now: What's New in the World of WAO
2007 February GLORIA Placements
The 5th International Congress of the
Egyptian Society of Pediatric Allergy & Immunology
February 8-9, 2007
International GLORIA Faculty:
Michael A. Kaliner
Module 8: Anaphylaxis
San Diego Allergy Society
February 12, 2007
San Diego, California
US GLORIA Faculty:
Allen P. Kaplan
Module 7: Angioedema
GLORIA is supported through unrestricted educational grants from:
February 2007 Seminars & Conferences Placement
Regional Asthma Congress - Egyptian Society of
Allergy and Clinical Immunology
January 31 – February 2, 2007
WAO Invited Lecturer:
Michael A. Kaliner
World Allergy Forum
"A Global Perspective on Genetics, the Environment and Allergy"
2007 AAAAI Annual Meeting
Monday, February 26, 2007, 4:45 pm - 6:00 pm
San Diego Convention Center
Upper Level, Room 32 AB
Thomas A. E Platts-Mills, USA
Michael A. Kaliner, USA
Is Early Exposure to Allergen Protective?
Adnan Custovic, United Kingdom
How Does the Environment Influence Genetic Responses?
Robert F. Lemanske Jr., USA
Environmental Intervention in the Management of Allergic Diseases
Erika Von Mutius, Germany
We have the pleasure of announcing four new interviews with well-respected allergists. Take a moment to listen to them share their extensive knowledge.
- Prof. Jean Bousquet -- WHO-GARD: The global alliance against chronic respiratory diseases
- Prof. Paul Van Cauwenberge -- Allergic Rhinitis: A disease remodeling the upper airways?
- Prof. G. Walter Canonica -- Real life classification of allergic rhinitis
- Dr. Ronald Dahl - Allergenic Cross Reactivity
WAO Committees and Councils 2007: A Year in Review and plans for the future
The year 2006 saw the selection and successful completion of the first three WAO Short-Term Research Fellowships and the selection of the first WAO Long-Term Research Fellow. As we move into 2007 WAO will consider major epidemiological surveys of allergic disease, look in-depth at the management of anaphylaxis worldwide, and publish the Allergy Prevalence Survey responses of our member societies.
We have surveyed our membership to ascertain the educational needs of our constituents and placed GLORIA™ and Seminars and Conferences programs in every region of the World. World Allergy Forum symposia were presented at EAACI, AAAAI and ACAAI. This high level of activity will continue worldwide with three Seminars and Conferences programs, 28 GLORIA programs, and two World Allergy Forum symposia in 2007.
Specialty and Training
In 2006, the WAO Specialty and Training Council published its report "“Allergy Practice Worldwide" and also "Requirements for Physician Training in Allergy: Key Clinical Competencies Appropriate for the Care of Patients with Allergic or Immunologic Diseases - A Provisional Position Statement of the World Allergy Organization." The third document in this series, "What is an Allergist?," will be published early in 2007. These documents already are providing an important reference source for our member societies and helping them to promote our specialty on a global level.
Web site initiatives saw the launching of WAO Conversations and Interactive Case Reviews and the monthly e-letter being translated into seven languages. On the horizon for the Web site in 2007 will be a series of Web-based seminars (in conjunction with AAAAI), Ask the Expert and an online Membership Directory.
In 2006, we achieved significant progress in the Emerging Societies Program. We placed pollen traps in the CIS Region and are developing a WAO Aeroallergen Sampling Manual to support this program. The Emerging Societies Meeting in Buenos Aires produced valuable insight into allergy practice in the underserved areas of Latin and Central America; we are moving forwards with the assistance of our member societies in the region and in collaboration with ACAAI, AAAAI and the National Institutes of Health in the USA, to help our fellow allergists in these countries. 2007 will see an ESM in Bangkok for our colleagues in the Asia Pacific region, in association with a new ESM partner, the Western Pacific Allergy Organization.
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 firstname.lastname@example.org, noting “Free Journal Subscription” in the subject line, with the following details:
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And In Other News
Allergy Book Reviews
Concise Clinical Immunology for Healthcare Professionals
Mary T Keogan, Eleanor M. Wallace, and Paula O’Leary
List Price: £25.99 (about $50.00 USD)
Available from: Taylor and Francis Books
Thomas Chacko, MD, 2nd year Fellow
University of South Florida College of Medicine, Tampa, FL
This text is a concise and easy to access manual about the complex field of clinical immunology.
The purpose of this book is to provide the physician and other healthcare professionals with an introductory book on clinical immunology. It also covers basic immunology, laboratory investigations and the treatment of various immunological disorders.
This book is geared toward the novice student, the first year sub‑specialty resident in allergy and immunology, and other physicians who want to learn basic immunology as it impacts clinical immunology. It provides the key features without getting lost in details.
The book's 426 pages are divided into four chapters: basic immunology, clinical immunology, immunotechniques and diagnostic testing, and treatment of immunological disorders. Each chapter has multiple, 2-4-page sections on various subjects within a chapter. At the end of some sections, there are references for further reading. There are also various diagrams and a self‑assessment test at the end of each chapter. Case presentations (14 total) are dispersed within some chapters.
This is an excellent book on the basics of clinical immunology. The sections are arranged to allow for quick retrieval of key facts. The self‑assessment exams keep the reader actively thinking to emphasize salient information. Other sources are necessary for a more in-depth review of this complex subject, but this is a great start, even for those with considerable skills in these areas.
In summary, this book will be particularly helpful for the novice student or physician who wants to learn about clinical immunology.
Cystic Fibrosis in the 21st Century
Bush, A., Alton, EWFW., Davies, JC., Griesenbach, U. & Jaffe, A.
List price: $180.00 USD
Available from: Karger
Dr RG Stirling BSc(Hons), MBBCh(Hons), MRCPI, FRACP
Department of Allergy Immunology & Respiratory Medicine; Alfred Hospital & Monash University; Melbourne, Australia
Recent decades have seen an explosion of knowledge in Cystic Fibrosis (CF), surrounding CFTR structure, function and the mechanism by which this gene defect causes human disease. This book addresses these developments in some detail, yet also broadly scopes a range of current CF-related research activity. Further in-depth consideration is given to the challenge of clinical care in relation to airway infection, inflammation and the management of the extrapulmonary manifestations of CF.
A state of the art overview of recent advances in Cystic Fibrosis.
This volume is largely aimed at researchers and clinicians established in CF, needing to update and broaden their understanding of CF.
This book acknowledges the multidisciplinary approach necessary for advancing CF care by blending a strong scientific base to the broad clinical needs of the CF population. Edited and written by leading figures in CF research, this volume highlights developments in understanding of CFTR structure and function, yet provides useful updates in the key management and therapeutic questions for pediatric and to a lesser degree adult CF care.
This volume places substantial emphasis in the description of current knowledge of CFTR structure, function and their interrelationships. The interactions and significance of genotype, modifier genes, infection and inflammation provide many complex challenges to our understanding of CF, and this book also provides a broad yet succinct research update in a number of these areas. For the practicing clinician, however, CF in the 21st century is evolving as a disease of adulthood and many emerging adult medical issues including bone disease, GORD, non-invasive ventilation and the complex management challenges of airway clearance, psychosocial counselling, ethics, transition, palliation and transplantation, require further attention. Nevertheless, this volume provides a valuable supplement and addition for those seeking to update and broaden their understanding of Cystic Fibrosis.
Find more allergy book reviews on the WAO Website here.