WAO News and Notes - Medical Reviews
Volume 6, Issue 2 Reviews - February 2009
Announcing the WAO Web Site's new look at www.worldallergy.org
Medical Journal Reviews

Gary Hellerman, PhD, in collaboration with Richard Lockey, MD, WAO Web Chief Editor, conducted these reviews of premier medical journal articles for practicing allergists. Read their top three picks here, and link to the remaining reviews from the list below.

You may also visit the Medical Journal Review section of the WAO Web site. To read translations of past Medical Journal Reviews, click here.

1. Predicting worsening asthma control following the common cold. The effects of rhinovirus infection on asthmatics vary, but upper respiratory infections commonly worsen asthma and lead to exacerbations. In this multicenter study, 413 adult asthmatics were followed for over a year to determine if the severity of a cold could predict loss of asthma control. To quantify the loss of asthma control, subjects completed the mini-Asthma Control Questionnaire (mini-ACQ) and to measure cold severity, the Wisconsin Upper Respiratory Symptom Survey-21 (WURSS-21). The questionnaires were done about every 8 weeks, and upon the onset of a cold, the WURSS-21 was completed daily for the duration of the cold and the mini-ACQ was done at 7 and 14 days after its onset. Significant loss of asthma control occurred in 134 subjects and the WURSS-21 scores on the second day were predictive of subsequent worsening of asthma. Editor's comment: Documentation of cold symptoms by asthmatics may help reduce the post-cold loss of asthma control. Walter MJ et al., Eur Respir J, 2008; 32: 1548-1554.

感冒後に喘息が悪化することはよく知られているが、この研究では、2日目の感冒症状の重症度を Wisconsin Upper Respiratory Symptom Survey-21 (WURSS-21) により定量化し、その後の喘息症状 mini-Asthma Control Questionnaire (mini-ACQ) との相関をみた。その結果、この両者には相関関係が認められた。感冒症状の重症度を把握することにより、その後の喘息症状を予測できる可能性が示された。

2. Azathioprine or methotrexate maintenance for ANCA-associated vasculitis. Patients with Wegener's granulomatosis (WG) or microscopic polyangiitis (MP) can be induced into remission by a course of i.v. corticosteroids and cyclophosphamide. Either methotrexate (Mtx) or azathioprine (Aza) can then be given as an immunosuppressant for post-treatment maintenance. This study compares the efficacy and safety of Mtx vs Aza administered to 126 WG or MP patients in remission. One group of 63 randomized patients received 2.0 mg/kg Aza per day while the other was given 0.3 mg/kg Mtx per week, increased to 25 mg per week, for 12 months. Adverse events (AEs) requiring discontinuation of the drug or causing death were the primary endpoints recorded over a mean period of 29±13 months. During maintenance therapy, 29 Aza patients (46%) and 35 Mtx patients (56%) had one or more AEs and among these individuals, 7 in the Aza group and 12 in the Mtx group had AEs severe enough to cause discontinuation or death. The relapse-free survival rates were 71.8% for Aza compared to 74.5% for Mtx, and the hazard ratio for risk of relapse with Mtx vs Aza was 0.92. The conclusion is that the safety and efficacy of Mtx and Aza are not statistically different. Editor's comment: Given the equivalency of the two medications, the decision of which one to use for maintenance control of ANCA-associated vasculitis can be made based on the individual's tolerance. Pagnoux C, et al. N Engl J Med 2008; 359:2790-2803.

ウェゲナー肉芽腫症、チャーグ・ストラウス症候群、顕微鏡的多発血管炎などの抗好中球細胞質抗体 ANCA 陽性血管炎に対する治療として免疫抑制薬アザチオプリンとメトトレキセートそれぞれの効果を検討した。その結果、両者とも同等に有効(再発なしの寛解率 70% 以上)であり、同程度の副作用( 50% 前後)がみられた。

3. A syndrome with congenital neutropenia and mutations in G6PC3. Mutations in several different genes are linked to severe congenital neutropenia (SCN) with susceptibility to bacterial infection, lack of mature neutrophils, heart and urogenital defects and increased risk of leukemia. A genome-wide linkage analysis of two consanguineous families of children with SCN resulted in the identification of a homozygous mutation in the gene for glucose-6-phosphatase, G6PC3, that abolished G6P activity. The parents were heterozygous for the mutation. An additional seven unrelated SCN patients were found to have biallelic G6PC3 mutations. None had hypoglycemia commonly seen in glycogen storage disorders also associated with neutropenia. The defect in glucose-6-phosphatase caused loss of mature neutrophils through apoptosis and was associated with increased susceptibility to infection, heart defects, superficial vein prominence and urogenital abnormalities. Mutant G6PC3 activity measured by in vitro glucose production was at background levels compared to the wild type enzyme. Neutrophils, hematopoietic progenitor cells and other cells such as fibroblasts from SCN patients showed an increased rate of spontaneous and induced apoptosis. The tendency to apoptosis in myeloid progenitor cells was reversed by transfection with a plasmid expressing wild type G6PC3. Enzymatic analysis of neutrophils from SCN patients revealed a decrease in the anti-apoptotic protein Mcl-1 which may account for the increased apoptosis. Editor's comment: This paper should be read as a model for excellence in experimental design, data analysis and presentation. Boztug K et al. New Engl J Med 2009; 360:32-43. (also see the editorial by Dale and Link, pp 3-5

重症好中球減少症の家系についてゲノムワイドな遺伝子解析を行い、グルコース 6 リン酸代謝酵素 G6P3C の変異が原因であることをつきとめた。両親は G6P3C のヘテロ変異、患者はホモ変異をもっていた。患者はアポトーシスに起因する成熟好中球減少の他に、泌尿生殖器、心臓、上大静脈に奇形を認めることがあった。

All 10 reviews are posted here.

WAO Journal

February 2009
ISSN: 1939-4551

WAO の公式機関誌 WAO Journal の紹介です。非ステロイド系抗炎症剤過敏症の新しい疾患群に関する報告などが掲載されています。アクセスするためにパスワードが設定されています (www.WorldAllergy.org) が、日本アレルギー学会の会員 (WAO の会員 ) であれば誰でも簡単に無料で閲覧できます。

Original Study
A Novel Phenotype of NSAID Hypersensitivity: The High-Risk Patient
Mario Sánchez-Borges, Arnaldo Capriles-Hulett, and Fernan Caballero-Fonseca

Editorial
"United Airways Disease" in immigrants: an emerging entity
Giovanni Passalaqua

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Additional Journal Reviews

その他の医学雑誌レビュー

  1. Prescription, OTC, and Supplement use in U.S. older adults

    55 歳以上の米国人は処方薬や OTC 薬、栄養食品などを併用し、副作用をおこすリスクが高い

  2. Viral infection in CAP adult patients

    成人市井肺炎の原因としてhuman metapneumovirus (hMPV) の頻度が高い

  3. The Brussels Declaration and asthma management

    発展途上国の喘息管理に関するブリュッセル宣言( Eur Resp J より)

  4. Inhaled steroids for asthma symptoms but normal lung function

    呼吸機能は正常だが喘息様症状は呈している非喘息患者に対して吸入ステロイド薬は有効であった

  5. Chitosan carrier for synthetic allergen peptides in mice

    Def f1 ダニ抗原を多糖類キトサン微粒子に結合させダニアレルギーモデルマウスに注射すると気道過敏性や好酸球性炎症が軽減した

  6. Mice lacking 12/15-LO are active in allergic inflammation and remodeling

    15- リポキシゲナーゼ (LO)( マウスでは 12-LO) は好酸球に多く発現する酵素である。この欠損マウスでは好酸球数、アレルギー性炎症が減弱していた

  7. Pulmonary fibrosis

    Eur Resp J に掲載された肺線維症に関する包括的な総説である
World Allergy Congress (WAC) 2009 - Buenos Aires, Argentina,  6-10 December 2009

Deadlines

Abstract Submission: 11 May 2009
Click here to submit your abstract online

本年 12 月にブエノスアイレスで開催される世界アレルギー機構会議 WAC の演題締め切りと割引率の遊離な前登録の締め切りは 5 月 11 日

Early Registration: 11 May 2009
Online registration will be available soon!

Medical Book Review

Immunology, infection and immunity
2004 American Society for Microbiology (ASM) Press
Editors: Gerald B. Pier, Harvard Medical School; Jeffrey B. Lyczak, Harvard Medical School, Lee M. Wetzler, Boston University School of Medicine
ISBN: 978-1-55581-283-6

今月の書籍紹介は免疫と感染に関する上記タイトルの本である。感染免疫に興味のある臨床医や研究者向けである。医学生には難しい。

Available from: American Society for Microbiology (ASM) Press
$89.95 with electronic study guide

Reviewer:
James J. Yun, MBBS
Advanced trainee
Immunology & Allergy
Campbelltown Hospital
New South Wales, Australia

Description
While there are many textbooks that attempt to describe the complex immune system in great details, there are few, if any, that focus on one of the key roles of immune system - immunity from infection. Immunology, infection, and immunity deals with this ongoing struggle between infectious agents and host defence system. It approaches this topic mainly from an immunology point of view without neglecting components of infection. As a standalone textbook in immunology, it faithfully explains various components of immune system in depth like many others. While it provides a solid description of immune system's interaction with pathogens, it is weaker on the specific details of infectious agents themselves. Then again, this is not a microbiology textbook. As an immunology textbook, it has chapters on immune system dysfunction. They are not heavy in details but they do provide a concrete description of these complex subjects.

Purpose
The purpose is to provide the reader with a detailed description of the immune system, its role in maintaining immunity and its dysfunction in terms of infection and other immunological conditions.

Audience
The textbook is suitable for clinicians and researchers with a special interest in the discipline of immunology and microbiology. Medical students may find it too heavy but the texts are quite a good reading and the illustrations are excellent. This book will be a useful adjunct to a library. Certain sections of the book will provide useful materials for in-depth reading at both undergraduate and graduate level curriculum.

Features
The first half of the book is devoted to the description of various components of immune system. It is well written, sufficiently detailed, great in illustrations and exceptional in tying the immune system with infection, especially at molecular level. The second half of the book describes the ongoing struggle between host defence mechanism and various pathogens. It provides a good overview and principles of immunity but lacks in details of specific pathogens. The last section of the book provides a brief but solid review of immune dysfunctions in terms of immunodeficiency, cancer immunology, immune overactivity and transplantation. Its strength is in explaining the role of immunology in the pathogenesis of diseases but it is lacking in clinical description and management.

Assessment
While Immunology, infection, and immunity is not the most comprehensive immunology textbook in either breadth or depth, it provides an excellent explanation of the immune system in its role in maintaining immunity and the mechanisms by which infectious agents overcome this immunity. As a stand alone immunology textbook, it is not lacking in any way. However, it is certainly not a clinical textbook but rather describes the connection between the discipline of immunology and microbiology from an immunological perspective.

Find more allergy book reviews on the WAO Website here.

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