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December Medical Journal Review
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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. WAOのWeb編集担当、南フロリダ大学Shyam S. Mohapatra先生による12月の医学雑誌レビュー

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.

喘息における気道リモデリングにはいくつかの要素があるが、気管支動脈の構造変化については知られていなかった。著者らは喘息および非喘息患者剖検肺をもちいて気管支動脈の構造について種々のパラメーターをもちい定量的に比較検討した。その結果、喘息死および他の原因により死亡した喘息患者はいずれも非喘息患者と比較し、気管支血管内膜の肥厚が認められた。この血管内皮の肥厚は平滑筋の増大および弾性線維の石灰化と関連していた。しかし、炎症細胞の浸潤は認められなかった。編集者注：このような喘息患者肺血管に関する定量的な検討は初めてであり興味深い。しかし、症例数が少く、また喘息症状との相関は不明であり、今後検討を続ける必要がある。

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.

45000人の小児を対象とした不活化インフルエンザワクチンの効果に関する後方視コホート研究の結果である。ワクチン注射により上気道感染、喘息、細気管支炎、中耳炎の罹患率は有意に低かった。編集者注：インフルエンザワクチンの有効性に関する最も大規模な研究成果であるが、後方視により研究であり、また、多くの症状に有効性が証明される一方、理由は不明だが胃炎症状の出現が有意に多かったことに注意をする必要がある。

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.

末梢気道は喘息病態に重要と考えられているが不明な点が多い。本研究では、喘息患者の最大呼気時、吸気時における高密度CTスキャンを実施し、他の呼吸機能試験や検査との比較が行われている。その結果、最大呼気時、吸気時における高密度CTスキャンは末梢気道閉塞の診断に有用であることがわかった。

4. Successful management of mite-allergic asthma with modified extracts of Dermatophagoides pteronyssinus and Dermatophagoides farinae.
The objective of this prospective, double-blind, placebo-controlled study of 64 subjects was to evaluate the clinical efficacy and safety of a vaccine containing depigmented, polymerized allergens of Dermatophagoides pteronyssinus and D. farinae (equal amounts) in individuals diagnosed with mild to moderate asthma and rhinoconjunctivitis. The bronchial provocation test (BPT) was used to determine clinical efficacy. Among 54 patients who completed the study, the allergen-treated group experienced a significant improvement in BPT (p < 0.001), while the placebo group did not (p = 0.648). At the end of the study, allergen (n=20) vs. placebo (n=9) group (p=.013; odds ratio, 5.71[1.76, 18.51]) needed more than twice the amount of allergen to obtain a positive BPT. The active group showed median improvement of 53.76% in total symptom and 58.09% in medication scores over placebo. Thus, immunotherapy with a mixture of modified allergen extracts of D. pteronyssinus and D. farinae is safe and efficacious to treat mite-allergic asthma. Editor’s Comments: Although polymerized allergens have been tested in other allergies, there have been few reports on their use in dust mite therapy in mild/moderate asthmatics. This study demonstrates that polymerized allergen immunotherapy is safe and effective. Jose-Carlos Garcia-Robaina, MD, PhD J Allergy Clin Immounol 2006;118:1026-32

ダニ特異的IgE抗体が陽性のアレルギー性鼻結膜炎、軽症～中等症の喘息患者に対する脱色重合などの処理をおこなったヤケヒョウヒダニ・コナヒョウヒダニのアレルゲンの免疫療法の効果を検討した。症例数は64名、プラセボ対照とし、気管支へのアレルゲン負荷bronchial provocation test (BPT) により効果を判定した。その結果、実薬による免疫療法実施群は偽薬対照群に比して、50%以上の改善が認められ、有意な副作用の増加もなかった。編集者注：変性ダニアレルゲンによる減感作注射は有効で安全である。

5. FceRI-mediated signal strength plays a key role in regulating basophil signaling and deactivation.
This study characterized the mechanisms for the control of FceRI-triggered basophil activation, which is a critical mediator of the symptoms of allergic disease and its underlying TH2-type response. Human basophils were purified by Ficoll density centrifugation and negative selection with immunomagnetic beads. Levels of various intracellular signal proteins were measured by Western blotting, and mediator release was analyzed either spectrofluorometrically (histamine) or by ELISA (IL-4 and IL-13). Supraoptimal anti-IgE concentrations led to lower mediator release than optimal concentrations but simultaneously to greater histamine release. In parallel, basophil signaling proteins (syk, p38 mitogen-activated protein kinase, and extracellular signal-regulated kinases 1 and 2) were more rapidly phosphorylated at higher anti-IgE concentrations but more transiently activated in the supraoptimal range. This regulation involved the inositol 5’ phosphatase, SHIP, which was phosphorylated with supraoptimal anti-IgE but not with lower concentrations. Basophils stimulated with N-formyl-methionylleucyl-phenylalanine failed to phosphorylate SHIP in the supraoptimal concentration range. Editor’s Comments: It appears that the kinetics of IgE-mediated signaling and mediator release in primary human FceRI+ cells varies substantially. This paper shows that the magnitude of stimulation and the phosphatase SHIP play an important role in terminating these events. Bernhard F. Gibbs, PhD. J Allergy Clin Immounol 2006; 118:1060-7.

IgE抗体で感作されたヒト好塩基球を抗ヒトIgE抗体で刺激するとヒスタミンやサイトカインの遊離がみられる。著者らは、抗ヒトIgE抗体の濃度を変化させたときの反応について検討した。至適濃度を超える抗ヒトIgE抗体で刺激した場合、ヒスタミンやサイトカインの遊離率は低下した。しかし、ヒスタミン遊離反応時間は短縮した。そのときのシグナル伝達を調べたところ、抑制性シグナルのSHIPのリン酸化が亢進していた。至適濃度以下ではSHIPのリン酸化はみられなかった。

6. Sequence, haplotype, and association analysis of ADRB2 in multiethnic asthma.
This study identified ADRB2 polymorphisms and haplotypes in White and African American subjects and correlated them with asthma phenotypes. A 5.3 kb region of ADRB2 was sequenced in 669 individuals --429 Whites and 240 African Americans. Twelve polymorphisms, representing an optimal haplotype tagging set, were genotyped in Whites (338 patients and 326 control subjects) and African Americans (222 patients and 299 control subjects). The study identified 49 polymorphisms, 21 of which were novel. Thirty-one polymorphisms (frequency > 0.03) were used to identify 24 haplotypes (frequency > 0.01) and assess linkage disequilibrium. An association of genotype with the ratio FEV1/FVC was observed in African Americans. This report demonstrates that additional genetic variants besides +46 (Gly16Arg) are important in determining asthma phenotypes. For example, the length of a poly-C repeat (+1269) in the 3’ untranslated region of ADRb2 may influence lung function and may account for variation in b-agonist responses, especially in African Americans. Editor’s Comments:  A comprehensive evaluation of gene variation, haplotype structure, and linkage disequilibrium is important in understanding the influence of the b2-adrenergic receptor gene ADRB2 on disease susceptibility, pulmonary function, and therapeutic response in different ethnic groups with asthma. This study demonstrates that there are additional ADRB2 genetic variants besides +46 (Gly 16 Arg) and +79 (Gln 27 Glu) that are important in determining asthma phenotype. Gregory A Hawkins AM J Respir Crit Care Med Vol 174 20061101-1109, 2006.

白人ではβ２受容体の遺伝子多型Gly16Argアミノ酸置換がβ２受容体の機能、特に、反応性の低下の有無に影響することがよく知られている。今回、著者らはアフリカ系米国人においてGly16Argアミノ酸置換とは別な遺伝子多型poly-C repeat (+1269)が存在し、それが喘息発症に関係している事を見いだした。訳者注：Gly16Argアミノ酸置換の影響は東洋人にはあてはまらないらしい。

7. Polymorphisms in the muscarinic receptor 1 gene confer susceptibility to asthma.
Here the authors investigated the role in asthma of the human cholinergic receptor muscarinic-1 (CHRM1) gene located on chromosome 11q13. The receptor is widely distributed in the lungs and may be involved in airway constriction, epithelial cell proliferation and inflammation. In a case-controlled study using 326 Japanese patients with asthma and 333 healthy control subjects, 9 single-nucleotide polymorphisms in the CHRM1 gene were examined. The functional consequences of the -9697C > T and -4953A > G polymorphisms at the regulatory region were also determined using an mRNA reporter assay, which suggested associations with asthma. Haplotype analysis showed that the -9697T/9695T/-4953A haplotype was associated with a lower risk of asthma (p= 0.00055) and the 9697C/-6965T/-4953G haplotype was associated with an increased risk of asthma (p=0.020). The -9697T/-4953A haplotype was also associated with lower luciferase activity in vitro compared with the 9697C/-4953G haplotype. Taken together, these results suggest that the CHRM1 gene on chromosome 11q13 is an important determinant for susceptibility to asthma. Editor’s Comments: Since the beginning of asthma genetic studies, several candidate genes linked to asthma phenotypes have been found at the 11q13 locus. This study demonstrates that CHRM1, which is also at 11q13, is an important susceptibility gene for asthma. Yukiko Maeda Am J Respir Crit Care Med Vol 174 2006 1119-1124.

染色体11q13に存在する遺伝子多型と喘息発症が関係することはよく知られている。また、11q13にはIgE受容体β鎖が存在することが知られていた。著者ら（北海道大学檜山先生のグループ）は、染色体11q13に存在し、遺伝子発現量に影響する機能的なムスカリン受容体(CHRM1) の遺伝子多型が喘息発症と関係することを見いだした。

8. A3 adenosine receptor signaling contributes to airway mucin secretion after allergen challenge.
Mucus hypersecretion is characteristic of asthma, but the cellular and molecular mechanisms that regulate mucin production and secretion are poorly understood. This study uses genetics to investigate the contribution of the A3 adenosine receptor, A3AR, to mucus production and secretion in a mouse model of allergen-induced pulmonary disease. A3AR is part of a signaling pathway that is upregulated in the mucin-producing goblet cells of the airway, but mucin production in response to allergen is similar in wild-type and A3AR-deficient mice. Overexpression of this receptor in Clara cells neither induces mucin production itself nor enhances mucin production in response to allergen challenge, and A3AR is not required for mucus cell metaplasia. In contrast to the lack of effect on mucin production, agonist-induced mucin secretion was reduced in A3AR-deficent mice. Thus, mucin secretion induced by allergen treatment is stimulated via A3AR. In pulmonary disorders in which adenosine levels are elevated, signaling through this receptor may contribute to airway obstruction by mucus. Editor’s Comments: Mucus production and secretion in the airway is a complex phenomenon, and this study shows that the two processes are distinct. A3AR signaling does not affect mucus production but does promote mucus secretion. This is important since adenosine levels in the lung are increased as a result of inflammation and damage. Hays W. J. Young Am J Respir Cell Mol Biol Vol 35 2006 549-558.

ムチンの過剰な産生は喘息の特徴の一つである。著者らは、遺伝子欠損マウスを使った喘息モデルをもちいてアデノシン受容体A3がムチンの産生過剰に関係していることを見いだした。

9. Respiratory syncytial virus infection reduces B2-adrenergic responses in human airway smooth muscle.
This study addresses the hypothesis that respiratory syncytial virus (RSV) has direct effects on cAMP formation and B2-adrenergic receptor (ADRβ2) density and that the ADRβ2 haplotype influences this response. A recombinant RSV expressing green-fluorescent protein (rgRSV) was first used to determine whether RSV could infect cultured human airway smooth muscle cells (HASM). Then, the influence of RSV infection on β2-adrenergic responsiveness was determined by measuring differences in isoproterenol (ISO)-induced cyclic AMP (cAMP) formation, ADRβ2 density and Gi expression in HASM cells infected with RSV, with ultraviolet-inactivated RSV, or with vehicle. The cultured HASM cells were efficiently infected by RSV, and ISO-induced cAMP formation was significantly reduced in RSV-infected cells, compared to cells infected with ultraviolet-inactivated RSV or mock-infected, in a time- and concentration-dependent manner. Forskolin-induced cAMP formation and Gi expression were not altered in cells infected with RSV, suggesting that the influence of RSV on β2-adrenergic relaxation was upstream of cAMP formation. ADRβ2 density was reduced in cells infected with RSV and the Arg16Gln27 ADRβ2 haplotype was associated with decreased ISO-induced cAMP formation (p<0.05) and with decreased ADRβ2 density at baseline (p<0.05).  Editor’s Comments: The use of b2-agonists in the treatment of airway obstruction associated with RSV infection has been controversial. The results of this study show that β2-agonist effects may be related to direct effects of RSV on HASM, and that the ADRβ2 genotype may predict bβ-adrenergic responses. Paul E. Moore Am J Respir Cell Mol Biol Vol 35 2006 559-564.

RSウイルス感染は培養ヒト気道平滑筋細胞のβ２受容体密度を低下させることがわかった。

10. Airway hyperreactivity in exacerbation of chronic asthma is independent of eosinophilic inflammation.
The authors of this report have developed an animal model to investigate the mechanisms underlying an acute exacerbation of chronic asthma. Ovalbumin (OVA)-sensitized BALB/c mice were exposed to aerosolized OVA, either as a chronic low-level challenge for four weeks, a single moderate-level challenge, or chronic low-level followed by single moderate-level challenge (the acute exacerbation group). Compared with animals receiving chronic challenge alone, mice in the acute exacerbation group exhibited more marked inflammation, with involvement of intrapulmonary airways and lung parenchyma, and increased numbers of lymphocytes and eosinophils in bronchoalveolar lavage fluid. They also developed airway hyperreactivity (AHR) to methacholine, demonstrable as increased transpulmonary resistance and decreased compliance. This pattern of AHR was absent in chronically challenged animals but was present in animals given a single moderate-level challenge. However, compared with animals receiving a single moderate-level challenge, inflammation and AHR were induced more rapidly in the acute exacerbation group. Eosinophil-deficient GATA1 dbl mice exhibited undiminished AHR in the acute exacerbation model. Thus, mice with pre-existing airway lesions resembling mild chronic asthma, when exposed to a moderately high concentration of inhaled antigen, experience the symptoms of an acute exacerbation. The inflammatory response involves distal airways and is associated with a distinct pattern of AHR, which develops independently of the enhanced eosinophilia. Editor’s Comments: Eosinophilia has been considered the hallmark of allergic asthma. This study shows that the extent of airway hyperreactivity and eosinophilia actually depends upon the magnitude of antigen exposure in a specific state of the disease. Thus, chronic asthma can be devoid of eosinophilia.  Jessica S. Siegle Am J Respir Cell Mol Biol Vol 35 2006 565-570.

著者らは喘息モデルマウスをもちいて慢性喘息の気道過敏性は好酸球炎症とは関係していないことを報告している。訳者注：今月の担当者はいつものロッキー教授ではなく、PhDの先生であるためか、モデル動物を使った基礎的な論文が多い。

11.  Role of epithelial damage and angiogenesis in childhood asthma.
Airway remodeling and inflammation are characteristic features of adult asthma that have been little studied in childhood asthma. This study examines epithelial and vascular changes as well as the inflammatory response in airways of asthmatic children. The study analyzed bronchial biopsies obtained from 44 children undergoing bronchoscopy for clinical indications other than asthma: 17 had mild to moderate asthma (aged 2-25 yr), 12 had atopy without asthma (1-11 yr), and 15 were controls without atopy or asthma (1-14 yr). Epithelial cell loss, basement membrane thickness, number of vessels and inflammatory cells were quantified in sub epithelium by histochemisty and immunohisto-chemisty. The results showed increased epithelial loss and basement membrane thickening in children with asthma compared to controls (p = 0.005 and 0.0002, respectively) and atopic children (p = 0.002 and 0.005, respectively). The number of vessels and eosinophils was increased in asthmatic children (p = 0.03 and p = 0.0002, respectively) and in atopic children without asthma (p = 0.03 and p = 0.008, respectively) compared to controls. When the results were stratified according to age, the children younger than six years with asthma had increased epithelial loss, basement membrane thickening, and eosinophilia compared to controls of the same age. In conclusion, epithelial damage and basement membrane thickening, which are characteristic pathologic features of adult asthma, are present even in childhood asthma. Other changes, such as airway eosinophilia and angiogenesis were also observed in atopic subjects suggesting that they may represent early events in the natural history of asthma. Editor’s Comments: This is an excellent study essentially showing that childhood asthma is not significantly different from adult asthma. Angelo Barbato Am J Respir Crit Care Med Vol 174 2006 975 -981. 

気道リモデリングは小児ではみられないといわれているが、著者らは小児喘息でも成人喘息と同様な上皮障害や血管新生が認められることを示した。

WAO Now: What's New in the World of WAO

2007 February GLORIA Placements

世界のアレルギー診療のレベルの向上を目指したGLORIAに関連した学会の案内。

The 5th International Congress of the
Egyptian Society of Pediatric Allergy & Immunology
February 8-9, 2007
Giza, Egypt
International GLORIA Faculty:
Michael A. Kaliner
Presentation:
Module 8: Anaphylaxis
www.espai-eg.org

San Diego Allergy Society
February 12, 2007
San Diego, California
US GLORIA Faculty:
Allen P. Kaplan
Presentation:
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
Hurgada, Egypt
WAO Invited Lecturer:
Michael A. Kaliner
www.asthmaegypt2007.com

World Allergy Forum

"A Global Perspective on Genetics, the Environment and Allergy"

2007 AAAAI Annual Meeting

米国アレルギー学会の案内。

Monday, February 26, 2007, 4:45 pm - 6:00 pm
San Diego Convention Center
Upper Level, Room 32 AB

Moderator:
Thomas A. E Platts-Mills, USA

Co-Moderator:
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


WAO Conversations

今月のWAO Conversationsには以下の４名によるインタビューが掲載されている。ダウンロードして、MP3プレイヤーで聴くことができる。

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

今後のWAO関係の催しの案内。

Research Council
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.
 
Education Council
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.

Communication Council
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. 

Emerging Societies
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.

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And In Other News

Allergy Book Reviews

今月の書籍紹介は以下のように、臨床免疫学に関する教科書と嚢胞性線維症に関する新しい考え方の記載された書籍の２冊である。

Concise Clinical Immunology for Healthcare Professionals
Mary T Keogan, Eleanor M. Wallace, and Paula O’Leary
ISBN: 9780415298308
ISBN-10: 041529830X

List Price: £25.99 (about $50.00 USD)
Available from: Taylor and Francis Books

Reviewer:
Thomas Chacko, MD, 2nd year Fellow
University of South Florida College of Medicine, Tampa, FL

Description:
This text is a concise and easy to access manual about the complex field of clinical immunology.

Purpose:
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.

Audience:
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.

Features:
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.

Assessment:
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.
ISBN-10: 3-8055-7960-8
ISBN-13: 978-3-8055-7960-5

List price: $180.00 USD
Available from: Karger

Reviewer: 
Dr RG Stirling BSc(Hons), MBBCh(Hons), MRCPI, FRACP
Department of Allergy Immunology & Respiratory Medicine; Alfred Hospital & Monash University; Melbourne, Australia

Description:    
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.

Purpose:         
A state of the art overview of recent advances in Cystic Fibrosis.

Audience:       
This volume is largely aimed at researchers and clinicians established in CF, needing to update and broaden their understanding of CF.

Features:        
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.

Assessment:    
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.

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