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WAO News & Notes

January Medical Journal Review(1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) 

 

January 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1月の医学雑誌からの文献紹介です。

1. TREATING ACUTE RHINOSINUSITIS – EFFICACY OF MOMETASONE FUROATE NASAL SPRAY, AMOXICILLIN, OR PLACEBO
Subjects ( > 12 years; n = 981) were randomized to mometasone furate (MFNS) 200 µg once or twice daily for 15 days, amoxicillin 500 mg TID for 10 days, or respective placebo. MFNS 200 mg BID was superior to both placebo (P <.001) and amoxicillin (P <.002) at improving the major symptom score. This improvement was noted at 2 days and throughout treatment. Likewise, the global response was significantly greater with MFNS 200 µg BID vs. amoxicillin (P = .013) and placebo (P = .001). Editor's comment: MFNS 200 mg twice daily monotherapy is an effective treatment for acute rhinosinusitis associated with an URI. Meltzer EO, et al. J Allergy Clin Immunol 2005; 116:1289 副鼻腔炎の治療に抗生物質に加えてステロイド点鼻を併用すると抗生物質単独よりも効果があることは多くの臨床研究により確認されていますが、ステロイド点鼻単独の効果についての検討はありませんでした。この研究では12歳以上の合併症のない急性副鼻腔炎症例に対してステロイド点鼻薬(フランカルボン酸モメタゾン:日本では治験中)を投与し、抗生物質アモキシシリン、プラセボとランダム比較試験を行いました。その結果、ステロイド点鼻薬単独の方が抗生物質投与単独、プラセボよりも有効であったそうです。訳者注:米国ではアモキシシリン耐性菌が増えているので、その影響もあるかもしれ ません。しかし、いずれにしてもここまで有効であるとは驚きです。訳者らが発表したようにステロイドは気道上皮細胞に作用して抗菌物質ディフェンシンを分泌させる作用がある(Homma T. et al. Am J Resp Cell Mol Biol 2004;31:463)ことが関係している可能性もあります。

2. SYSTEMIC AND UPPER AND LOWER AIRWAY INFLAMMATION AND EXACERBATION OF COPD
Sputum, nasal wash and serum samples from 41 subjects with COPD exacerbations were analyzed for pathogenic microorganisms and inflammatory markers and were compared to subjects with stable COPD. COPD exacerbation is associated with greater nasal, sputum, and serum inflammation than controls. The degree of upper airway inflammation correlated with the degree of lower airway inflammation. The degree of systemic inflammation correlated with the degree of lower airway inflammation and was greater in the presence of a sputum bacterial pathogen. The authors conclude that exacerbation of COPD is a pan-airway inflammatory process which may account for complications associated with COPD exacerbation. Editor's comment: As in asthma, airway inflammation is united in COPD. Hurst JR, et al. Am J Respir Crit Care Med 2006; 173:71 著者らは増悪期と安定期の慢性閉塞性肺疾患(COPD)患者について喀痰、鼻汁、血清などの検査を行い比較し評価しています。その結果、COPD増悪期では鼻汁、喀痰など上気道炎症の症状が強かったそうです。喘息とアレルギー性鼻炎との関係のように、COPDも上気道炎症と密接に関係しており、上気道炎症状のコントロールが重要であるとしています。訳者注:確かにCOPDでは冬季にかぜをひいて悪化しますが、やはり禁煙が必要です。

3. CLINICAL EFFECTS OF PROBIOTICS IN CHILDREN 6 TO 18 MONTHS WITH ATOPIC DERMATITIS
In a previous study (DBPC), these authors reported that the administration of 1 X 109 Lactobacillus fermentum twice daily for 8 weeks compared to placebo resulted in significant clinical improvement in very young children with moderate to severe atopic dermatitis (AD). These same investigators now report that such treatment relative to baseline levels of response is associated with significant increases in T-helper type 1 (Th1-type) cytokine IFN-γ responses to phytohaemaglutinin and Staphylococcus aureus enterotoxin B (SEB) at the end of the supplementation period as well as eight weeks after ceasing supplementation. The increase in IFN-γ to SEB could be correlated with the decrease in the severity of AD. Editor's comment: Probiotics are harmless and may be helpful in young children with moderate to severe AD. Prescott SL, et al. Clin Exp Allergy 2005; 35:1557 6-18ヶ月の乳児アトピー性皮膚炎患者(平均11.6ヶ月)にプラセボとの比較において乳酸菌(Lactobacillus fermentum)を投与したところアトピー性皮膚炎の症状スコア(SCORAD)が有意に改善しました。乳酸菌を投与された患者末梢血においては、黄色ブドウ球菌毒素SEBに対するインターフェロンγ分泌能が増加していました。著者らはSEBに対するIL-10, IL-13, TNFα産生能も検討していますが、有意差はありませんでした。また、ダニ、卵白アルブミンや牛乳βラクトグロブリンに対する反応性も検討していますが、卵白に対するIL-13産生能を除き、プラセボと有意差がなかったそうです。乳酸菌を投与すると乳酸菌および黄色ブドウ球菌に対するTNFα産生能(生体防御能)が亢進するためではないかと考察しています。訳者注:追試が必要ですが、衛生環境(エンドトキシン)効果が無効な年長児や成人アトピー性皮膚炎患者に対しても同様に有効であるのかどうかという検討も必要と思われます。

4. PULMONARY FUNCTION TESTING AND THE MANAGEMENT OF ASTHMA IN CHILDREN
Children with asthma (n = 367, age 4 to 18 yrs) had spirometry before they were clinically evaluated by a nurse practitioner or pulmonologist. Spirometry was abnormal in 45% of the visits, related to underlying asthma severity but not to clinical findings. Such results changed management decisions in 15% of visits. The authors conclude that health care professionals often overestimate the degree of asthma control which can result in suboptimal therapy. Editor's comment: The National Asthma Educational Prevention Program Expert Report 2 recommends that spirometry be performed at the time of initial evaluation and that repeat spirometry be done after new therapy is initiated and peak expiratory flow (PEF) is stabilized to document normalization of airway function. Spirometry provides a more complete assessment of lung function than does PEF, especially of the small airways. Spirometry is also recommended at regular intervals to ensure maintenance of airway function. Nair SJ, et al. J Pediatr 2005; 147:797 小児喘息患者の状態を正確に把握するためにはピークフローメーターよりもスパイロメーターによる呼吸機能検査が必要であるとする報告です。ピークフロー測定だけでは喘息の状態を過小評価し薬剤を必要以上に減量してしまう傾向があるとしています。

5. MANAGEMENT OF ASTHMA BETTER UNDER THE CARE OF SPECIALIST
One thousand, two hundred fifty-six patients (mean age, 36.1 yrs, 54% female) were consecutively recruited in pharmacies to complete a questionnaire on their asthma management. Eleven point four percent, 36.6% and 52.0% were under the care of specialist (SPE), general practitioners (GP) and both GP and SPE, respectively. Fifty-two point two percent of those in the SPE group versus 26.4% and 21.5% in the GP and the SPE groups, respectively, were properly controlled. The SPE group used fixed combinations of long-acting beta-agonist and inhaled corticosteroids and the patient received less short-acting beta-agonist, antitussives and antibiotics. Editor's comment: Specialty care matters. Laforest L, et al. Eur. Respir J 2006; 27:42 喘息治療に関してアレルギー専門医による治療は一般医師に比較して優れていることを統計学的に確認しています。専門医は長時間作用型β2刺激薬LABAや吸入ステロイドを使用することが多く、一般医師は短時間作用型β2刺激薬を使用することが多いとしています。

6. THE GENOME SEQUENCE OF ASPERGILLUS FUMIGATUS
This paper reports the complete genetic sequence of the filamentous fungus Aspergillus fumigatus, which causes respiratory tract diseases and is allergenic. Several allergens have been previously described from this mold species. The complete sequencing has allowed identification of nine additional potential allergens or isoallergens, which heretofore have been unidentified. Although the genomic sequence analysis has revealed the entire list of allergens, the clinical significance of the new allergens remains to be established. Editor's comment: This is one fungal species for which all the allergens are identified. Nierman WC, et al. Nature 2005; 438:22 ゲノム解析技術の進歩により、種々の生物のゲノムが次々と解読されていますが、これはアスペルギルスのゲノム構造に関する論文の紹介です。アスペルギルスのアレルゲンは今まで7つ発見されてきましたが、ゲノム配列から新たに9つのアレルゲンが同定されました。訳者注:もう他にアスペルギルスのアレルゲンは存在しないということもいえるのですね。「新しい生体分子を発見できない時代」になりつつあります。

7. DERMATOPHAGOIDES AND BLOMIA SKIN TEST SENSITIZATION IN ALLERGIC PATIENTS IN VENEZUELA
The object of this study was to determine cutaneous sensitization rates to 3 mite extracts, Dermatophagoides pteronyssinus, Blomia kulagini, and Blomia tropicalis. Of 204 patients studied, almost all were sensitive to all three extracts, however, 9.3% were sensitive only to D. pteronyssinus and 2.4% only to B. tropicalis. None reacted exclusively to B. kulagini. The authors conclude that isolated sensitivity occurs to these different dust mite extracts. Editor's comment: Some patients can be exclusively sensitized to D. pteronyssinus or B. tropicalis. Capriles-Hulett A, et al. Allergy Clin Immunol Int – J World Allergy Org 2005; 17:224 3種類のダニ抗原(うち2種類は熱帯地方のみに存在)に対するベネズエラのアレルギー患者の反応性に関する検討です。

8. SEAFOOD AND IODINE: AN ANALYSIS OF A MEDICAL MYTH
Seventy-five subjects in this study were confirmed to have shellfish or fish allergy. Of the 75, 92% (n = 69) believed that iodine in seafood was the cause of seafood allergy. Sixty-five percent (n = 49) of the patients either learned or were told that they should avoid radiocontrast media (RCM). Editor's comment: Many patients and physicians still believe the myth that iodine is responsible for shellfish and/or fish sensitivity and that RCM should be avoided. Huang S, Allergy and Asthma Proc 2005; 26:468 米国では魚介類に対するアレルギーをもつ患者の92%は魚介類に含まれるヨードが原因だと信じているそうです。訳者注:日本では流行っていない迷信ですね。

9. A REVIEW OF TOLL-LIKE RECEPTORS AND THEIR ROLE IN HOST DEFENSE AGAINST BACTERIAL INFECTIONS
This is an excellent review on toll-like receptors and their importance as principle mediators of rapid microbial recognition. These receptors function mainly by detection of structural patterns that do not exist in the host. In many instances, they insure a productive relationship between host and microbes. Editor's comment: The role of the innate immune system in health and disease continues to be investigated. Schnare M, et al. Int Arch Allergy Immunol 2006; 139:75 生体防御に関するToll様受容体の総説です。

10. THE PATHOGENESIS OF OBSTRUCTIVE SLEEP APNEA (OSA)
Sleep apnea is a relatively new syndrome having been described in the medical literature over the past 100 years. The first article describes what is known about its pathogenesis and the second, the advances which have taken place in understanding and treating sleep-disordered breathing. Editor's comment: Both articles are excellent reviews about OSA which has been reported to be a risk factor for asthma exacerbation. White DP, Am J Respir Cell Mol Biol 2006; 34:1 and Pack AI, Am J Respir Crit Care Med 2006; 173:7. No abstract is available from Am J Respir Cell Mol Biol. 睡眠時無呼吸の病態に関する総説です。

11. SAFETY OF LONG-ACTING BETA-AGONISTS
Long-acting beta-agonists (LABAs) may increase the chances of severe asthma and death. In this editorial, Dr. Martinez concludes that patients with mild to moderate asthma should be treated primarily with inhaled glucocorticoids (ICS) and supplemented with leukotriene-receptor antagonists and/or low-dose theophylline therapy. For more severe disease, he states that reevaluation of the patient should precede any additional therapeutic intervention because of non-compliance and coexisting problems which exacerbate asthma. Only then does he state that LABA's should be added to relieve symptoms. Editor's comment: LABA's and ICS have become one of the standards of care for moderate to severe asthma. More studies are necessary to better define the safety and possible risk-benefit of LABA's. Martinez FD, N Engl J Med 2005; 353:2637. No abstract is available for this article. 喘息発症に関するコホート調査いわゆるTucson研究で著名なMartinez教授が喘息のLABAの使用について常用すべきでないというコメントをNew England Journal of Medicineに発表しています。


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

今月のWAOメンバー紹介はイタリアのアレルギー臨床免疫学会です。1953年設立の伝統ある学会です。

Two thousand and three marked the 50th anniversary of the foundation of the Italian Society of Allergy and Clinical Immunology (SIAIC). The SIAIC is one of the oldest scientific Societies of allergy and clinical immunology in the world and one of the oldest medical societies in Italy. Its mandate covers three main areas:

  • Education and training in allergy and clinical immunology.
  • Promotion and research in allergy and clinical immunology.
  • Care and education of patients with allergies, immunodeficiencies, autoimmune disorders and other immunologic diseases.

The SIAIC is part of national and international networks. At a national level, Regional Sections safeguard the interests of and interact with practicing allergists and allergists working in medical institutions and teaching hospitals. In addition, a newly established section for Junior Members is devoted to the many aspects of education of Fellows in Allergy and Clinical Immunology and Fellows in Internal Medicine and Pediatrics interested in the specialty. At an International Level, the SIAIC represents Italy within the European Academy of Allergy and Clinical Immunology (EAACI) and is a member of the World Allergy Organization (WAO).

The SIAIC has launched a number of practical activities regarding the diagnosis and treatment of patients with allergic and immunolgic disorders. From a practical point of view, the SIAIC has produced a series of guidelines and position papers on major topics in allergy that have already been published or are in press in SIAIC's journal, Italian Journal of Allergy and Clinical Immunology (GIAIC), e.g., biological products; immunotherapy; drug allergy; adverse reactions to general anesthetics; insect allergy; immunodeficiencies; food allergy; and allergy to latex. The journal publishes original articles and reviews in English and in Italian (with abstracts in English).

SIAIC's website (www.siaic.net) provides updated news and scientific events at national and international levels in the field of allergy and clinical immunology.

The SIAIC recognizes the importance of postgraduate education and scientific meetings as an educational tool. It holds an annual national congress, with the next annual SIAIC meeting in Turin (April 27 ? 29, 2006) under the leadership of Giovanni Rolla (grolla@mauriziano.it)

In spring 2004 the SIAIC introduced in Italy the annual Allergy Day. The next one will be held March 18, 2006 and organized by all Regional Sections. The SIAIC participated in the first World Allergy Day organized by WAO and the posters produced for the occasion were shown at the World Allergy Congress 2005 in Munich.


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

New on the Home Page this month - "WAO Conversations" and "Interactive Case Reviews"
 
WAO Conversations: Learn from experts from around the world. During short interviews, you will hear internationally acknowledged experts on key topics in allergy share their thoughts and insights on specific topics. This month, hear Hugh Sampson reflect on his many years of experience researching into food allergy and comment on new directions in this important field of allergy. To hear the interview, http://www.worldallergy.org/conversations/
新しい企画の紹介です。世界中の著名なアレルギー学者とのインタービューを聴くことができます。今月は食物アレルギーの世界的権威Hugh Sampson教授の話です。MP3形式ですのでダウンロードしてi-podで聴くことができます。Locky教授による「食物アレルギーは自分でそう信じている人は12%なのに実際チャレンジしてみると2.3%しか陽性でなく、5分の4の人の食物アレルギーは偽物(Fake)か少なくとも憂うつ症(hypochondria)と主張している論文もあるがどう思うか?」という刺激的な質問から始まっています。英語の聴き取り 練習として是非トライして下さい。

Interactive Case Reviews: Test your knowledge by reviewing our interactive case studies from Clinical Case Reports published in the ACII-JWAO, fascinating cases will be selected and their backgrounds presented along with photographs. The case study will be presented and questions will be posed with possible diagnoses listed. Upon making your selection, you will immediately learn whether or not your diagnosis corresponds to that of the experts and can read how they came to their diagnosis. This month we review a case of periorbital swelling, presented by John T. Ramey and Richard F, Lockey. To read the review, http://pull.xmr3.com/p/1738-1861/84443274/clickto8_eviews-ramey_lockey-index.php.html.

Translations of the E-letter Now Available
E-letterの各国語訳を見ることができるようになりました。

The e-letter is now being translated into seven languages - Arabic, Chinese, Japanese, Polish, Portuguese, Russian and Spanish. To access a translation, click on the respective language's name, located below "This Month's Feature" on the Home Page. As more translations become available, they will be added to the site. To see a list of languages, http://www.worldallergy.org/.

World Allergy Forum: AAAAI 2006 Annual Meeting
米国アレルギー学会においてWAO主催のシンポジウム(舌下免疫療法)が行われます。

"Sublingual Immunotherapy ・Is There a Role?"
Sunday, 4 March 2006
10:45 a.m. ・12:00 p.m.
Miami Beach Convention Center ・Room A201 - 205

A superb international faculty chaired by Michael Kaliner will provide an update on Sublingual Immunotherapy. G. Walter Canonica (Genova, Italy) will analyze the long-term efficacy and safety of sublingual immunotherapy. Anthony J. Frew (Brighton, UK) will describe the mechanisms of sublingual immunotherapy and how it differs from injection immunotherapy, and Linda Cox (Fort Lauderdale, FL, US) will discuss whether the US is ready for sublingual immunotherapy.

WAO Emerging Societies Program Meeting to be held in Conjunction with the 7th Malaysian Congress of Allergy and Clinical Immunology

March 10-12, 2006
Kuala Lumpur, Malaysia

Prof. Connie H. Katelaris and Prof. Cassim Motala, WAO Board Members, will travel to Malaysia for an Emerging Societies Meeting, to be held at the 7th Malaysian Congress, March 10-12, 2006. Prof. Motala will be traveling to Malaysia as part of the WAO Seminars & Conferences program and both he and Prof. Katelaris will give GLORIA presentations.

The focus for this meeting will be to provide outreach in regions where established allergy societies do not exist, to help existing allergy societies improve their outreach and scope of activities, and to help establish excellent standards for local research programs.

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
HIV Second Edition
Howard Libman & Harvey J. Makadon
American College of Physicians – American Society of Internal Medicine (2003)

今月のBookレビューはエイズウイルスHIVに関するものです。

List Price: $53.00 USD
Available from: http://www.rsmpress.co.uk/bklibman.htm

Reviewer: Dr Lucinda Berglund MB BS
Advanced Trainee, Immunology Registrar, Westmead Hospital, NSW Australia

HIV is a practical book addressing the management of patients with HIV. It ranges from discussing basic concepts such as viral load to details of antiretroviral regimes and resistance mutations. There is a strong emphasis on primary care, from pre-test counseling and diagnosing HIV, to community prevention and screening measures. It provides practical advice about ongoing management issues including monitoring for adverse medication effects and how to investigate and treat opportunistic infections. Information is up to date and evidence-based with extensive references.

The book is divided into ten chapters which can easily be read consecutively but also has a detailed index for use as a reference. Each chapter is written by several different authors and ends with a summary of key points. Concise tables present information including differential diagnoses of common symptoms and treatment options. A useful drug glossary lists doses and toxicities of frequently prescribed medications.

This book would be an excellent resource for general practitioners; general physicians; junior, doctors in training and medical students.

Find more allergy book reviews on the WAO Website here.

The World Allergy Organization's mission is to build a global alliance of allergy societies to advance excellence in clinical care, research, education and training. Visit us on the Web at www.worldallergy.org

WAO世界アレルギー機構は世界中のアレルギー学会の連携をはかり、臨床、研究、教育等の向上と充実を目指すことを使命としています。是非、www.worldallergy.orgにアクセスして下さい。

World Allergy Organization (WAO)
Secretariat
555 E. Wells Street, Suite 1100
Milwaukee, WI 53202-3823
Email: info@worldallergy.org

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