Introducing a new resource, the World Allergy Organization Journal (WAO Journal), the official publication of the World Allergy Organization (WAO). Packed full of original research, in-depth reviews and up-to-the-minute reports, this online-only journal offers the deal forum for allergy/immunology professionals worldwide to share knowledge and explore groundbreaking topics.
For the first six months of publication (January - June 2008), the WAO Journal will be available for FREE online. Visit www.waojournal.org now and you'll get instant access to cutting-edge discoveries published exclusively online - 24 hours a day, 7 days a week.
新しいWAOの機関誌WAO Journalが創刊されました。On-lineだけの雑誌であり、本年６月号まではFree onlineの予定です。
Make sure to sign up for eAlerts at www.waojournal.org to receive notice that a new posting of the WAO Journal is online.
Prof. Richard F. Lockey, MD, WAO Web Editor-in-Chief, and Guest Reviewer Gary Hellermann,
PhD, reviewed premier medical journal articles for practicing
1. Computed tomography (CT)-an increasing source of radiation exposure.
Compared to regular X-rays, CT scans result in much higher cumulative doses of radiation. This review describes various procedures, typical doses, uses and the biological effects of ionizing radiation. No major studies of the health risks from CT scans have been done, but extrapolation from known CT doses to those received in other circumstances suggests caution, especially in light of the very large numbers of people undergoing CT procedures. Editor's comment: Because a CT results in high doses of ionized radiation, other procedures (including an extensive and accurate history and physical), such as MRI or ultrasound, may provide satisfactory diagnostic results when substituted for a CT. Brenner DJ et al., N Eng J Med 2007; 357:2277-2284.
2. Determinants of response to fluticasone propionate (FP) and salmeterol/fluticasone propionate combination (SFC) in the Gaining Optimal Asthma control (GOAL) study.
Asthmatics with uncontrolled disease were given either FP alone or SFC. The GOAL data analysis seeks to determine the factors affecting outcomes and how to better manage asthma. Subjects were categorized into totally controlled (TC), well-controlled (WC) or not well-controlled (NWC) groups. Statistical methods were used to establish the odds ratios for specific factors which reduced the chances for improvement. The primary determinant for the NWC group was smoking, even though all groups improved, especially with SFC. Editor's Comment: The take-home message is clear: tell your asthma patients, if they want to get better, they must stop smoking. Pederson SE et al., J Allergy Clin Immunol 2007; 120:1036-1042.
3. Comparative study of budesonide inhalation suspension (BIS) and monteleukast (M) in young children with mild persistent asthma.
This study compares BIS to M over one year in children 2 to 8 yrs with mild persistent asthma. Subjects (395) in multicenter groups were randomized to receive BIS (0.5 mg) or M (4-5 mg) daily. Outcomes were length of time to first exacerbation and subsequent additional treatment for exacerbation, rates of exacerbation, PEF and QoL assessment. Both BIS and M provided good asthma control, but B was better. Editor's comment: While BIS improves asthma control better than M, the ease of use of the latter sometimes may be advantageous, particularly in young children. Szefler SJ et al., J Allergy Clin Immunol 2007; 120:1043-1050.
4. Genetic effect of CCR3 and IL5RA gene polymorphisms on
eosinophilia in asthmatic patients.
Two factors which affect the eosinophil numbers are the
chemokine receptor, CCR3, and the eosinophil survival mediator,
IL-5. In this study, single-nucleotide polymorphisms (SNPs) in
the genes for CCR3 and IL-5 receptor alpha subunit in a group of
576 Korean asthmatic patients and 180 healthy persons are
correlated with asthma susceptibility and eosinophilia. Among
the SNPs in the CCR3 gene, all are located in introns and none
are associated with asthma susceptibility. However, some
asthmatic subjects with CCR3 alterations had lower eosinophil
numbers compared to the more common SNPs associated with
eosinophilia. IL5RA SNPs resulted in increased eosinophil
numbers in asthmatic subjects and when paired with a CCR3 SNP,
the effects on eosinophilia were enhanced. Editor's comment:
The statistical association of specific SNPs with asthma
contributes to the knowledge of asthma pathology. Lee J-H et
J Allergy Clin Immunol 2007; 120:1110-1117.
5. Defective T-cell activation caused by impairment of the
TNF receptor 2 co-stimulatory pathway in common variable
CVID is characterized by decreased production of B cells and
immunoglobulins and an increased susceptibility to bacterial
infections. Hereditary defects in T-cell receptor signaling are
implicated, but in most cases, the exact abnormality is unknown.
This paper examines the TNF-mediated co-stimulatory pathway of
T-cell activation in a group of CVID patients compared to
healthy controls. The CVID subjects have a normal primary TCR
signal (CD69) as well as normal calcium store flux and PKC-theta
activation, however, TCR co-stimulation through TNF-RII was
severely impaired. Editor's comment: CVID is a complex
disorder and understanding genetic defects is important to
design new therapies. Aspalter RM et al.,
J Allergy Clin Immunol 2007; 120:1193-1200.
6. Genetics of Asthma: Potential implications for reducing
This review presents what is known about specific gene
alterations in minorities and points out areas where there are
weaknesses due to small sample size or genetic and environmental
heterogeneity. Polymorphisms (SNPs) in the disintegrin and
metalloprotease 33 (ADAM33) gene, the IL-4 receptor, the HLA
loci and others are discussed in African-American or Hispanic
populations compared to whites. Significant differences in the
frequency of SNPs and haplotypes are seen. Editor's comment:
Elucidation of asthma pathology mechanisms depends on obtaining
information on all racial groups. Scirica CV and Celedon JC,
Chest 2007; 770S-781S.
7. Diesel-enriched particulate matter (PM) functionally
activates human dendritic cells (DC).
Human DC were expanded from peripheral blood by culturing them
in the presence of specific cytokines and exposed to PM from
cars (gas) or trucks (diesel). The activation phenotype of the
DCs was determined by flow cytometry of maturation markers and
endocytosis of FITC-dextran. PM from car exhaust had little
effect on DC activation, but diesel PM increased secretion of
TNF, IL-6 and IFN-gamma and upregulated MHC-II. Both car and
diesel exhausts promoted a Th2 cytokine response. Diesel PM
specifically stimulates endocytosis by DCs which is different
from other activators such as LPS. The enhanced antigen uptake
combined with stimulation of maturation marker expression seems
to be a unique feature of diesel exhaust and may account for
some of its inflammatory effects. Editor's comment: The
mechanism of diesel PM effects on DCs remains to be elucidated
through additional experiments. Porter M, et al.,
Am J Resp Cell Mol Biol 2007; 37:706-719.
8. Respiratory effects of exposure to diesel traffic in
persons with asthma.
A group of 60 nonsmoking asthmatics with mild to moderate
symptoms were recruited and tested during a period free from
exacerbations or respiratory infections. They were allowed to
continue their regular medications, but not oral
corticosteroids. Participants walked for about two hours in one
of two areas-a busy street with heavy diesel traffic only or a
park away from traffic. Air in each area was sampled and numbers
and sizes of PM determined. Spirometry was performed before,
during and after the sessions and subjects were asked to record
asthma symptoms. Sputum samples were collected for cell counts
and analysis of cytokines and ECP. Fractional exhaled NO and
breath condensate pH were also measured. Results showed a
greater reduction in FEV1 in subjects walking in the city area
compared to the park, and moderate asthmatics had a greater drop
in FEV1 than mild asthmatics. Other measurements such as
decreased pH and increase in sputum myeloperoxidase also
Correlated with increased PM. Editor's comment: No difference
in symptoms were reported between the city and the park groups,
but the extensive physical data implicate diesel PM as
pro-inflammatory. McCreanor J et al.,
N Engl J Med 2007; 357:2348-2358.
9. A study to evaluate safety and efficacy of mepolizumab
in patients with moderate persistent asthma.
Airway eosinophilia is a prevalent problem in chronic asthma and
treatments that reduce IL-5, the cytokine involved in
proliferation, survival, migration and maturation of eosinophils
(E), seems an ideal target for anti-E therapy. This multicenter,
DBPCS of the humanized anti-IL-5 antibody, mepolizumab, seems to
argue against this conclusion. Subjects ranged in age from 18 to
55 years and had FEV1s of 50-80 % of predicted. Their asthma
control required high doses of ICS (1000 micrograms
beclomethasone or equivalent). Doses of mepolizumab, 250 or 750
mg, were given i.v. at monthly intervals and outcomes were
measured in terms of FEV1, E counts in serum and sputum, diary
cards and QoL questionnaires. There was a significant reduction
in the tendency for exacerbation in the group receiving the
highest dose of mepolizumab, but otherwise no change in other
parameters was observed. Editor's comment: Further
investigation into the reasons why anti-IL-5 treatment does not
work for asthma may tell us more about its pathogenesis.
Flood-Page P et al., Am
J Resp Crit Care Med 2007; 176:1062-1071. (editorial
by PM O'Byrne, pp. 1059-1060).
10. Ceramide: A key signaling molecule in a guinea pig
model of allergic asthmatic response and airway inflammation.
Ceramide is a membrane-associated sphingolipid that is
pro-inflammatory and pro-apoptotic. Using ovalbumin-sensitized
guinea pigs, the authors found that lung ceramide production was
elevated after allergen challenge. Bronchoconstriction, dyspnea
and cough also increased. Pretreatment with an inhibitor of
ceramide synthase blocked the allergen-induced inflammatory
effects and epithelial cell death. Editor's comment:
Pharmacological manipulation of ceramide levels may prove to be
a useful therapy for inflammatory lung disease. Masini E et
J Pharmacol Exp Ther 2007; [Nov. 27, epub ahead of print].
11. Medical progress: sarcoidosis.
First described in 1899, sarcoidosis is characterized by the
formation and accumulation of benign granulomas containing
activated T-cells and macrophages secreting cytokines and
chemokines. The clinical characteristics, different organ
involvement, the differential diagnosis, sarcoidosis in children
and treatment are reviewed. Editor's comment: Great review of
a disease whose etiology remains elusive. Iannuzzi MC et
N Engl J Med 2007; 357:2153-2165.
Parasites And Allergy (Chemical Immunology and Allergy Vol. 90)
Editors: Monique Capron, Francois Trottein; 2006
Available from: Karger
List Price: $160.00 USD
Steven L. Cole, DO
Division of Allergy and Immunology, Department of Internal Medicine
University of South Florida College of Medicine and James A. Haley Veterans' Hospital, Tampa, FL
This volume of Chemical Immunology and Allergy series focuses on the correlation between helminth infections and allergic diseases. Each chapter includes an abstract and a discussion of relevant literature followed by concluding remarks.
The purpose of this book is to critically examine the role of parasitic infection in influencing the immune response in atopic disorders. A collection of international experts highlight the salient issues and controversies of regulatory mechanisms involved in the Th1 and Th2 response in helminthic infection.
The scope of this book is somewhat narrow in that it is aimed primarily at researchers involved in immune mechanisms of disease, but specialists in allergy and immunology, infectious disease, and other clinicians will find it useful as well.
Each chapter includes a discussion of primary research pertinent to the authors' expertise, and focuses on cells involved in immune regulation and their relationships to various parasitic infections. There is a generous offering of diagrams depicting the mechanisms of parasitic involvement in allergic inflammation.
This book is a significant contribution to the debate of the role of parasites in allergic inflammation, and is a good resource for scientists and specialists in the field. Students new to the discipline of allergy and immunology will find it difficult to fully grasp many of the concepts introduced in this volume, but it will serve as a good reference guide on this topic. The charts and graphs throughout the book are well-designed, and the illustrations are effective at capturing the key concepts of the discussion.
Find more allergy book reviews on the WAO Website here.