Medical Journal Article Reviews

Juan Carlos Ivancevich, MD, WAO Web Editor-in-Chief, in collaboration with Phil Lieberman, MD, Web Editor of Medical Literature Reviews, 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 menu. Medical Journal Review section of the WAO Web site.

To read translations of past Medical Journal Reviews, click here.

1. Inflammatory phenotypes in adults and children with acute asthma.
To investigate inflammatory phenotypes in stable adult asthma, stable childhood asthma, and acute asthma, and to examine whether infection with Chlamydophila pneumoniae is a possible cause of noneosinophilic asthma, the researchers studied 51 adults with stable (n = 29) or acute (n = 22) asthma, and 77 children with stable (n = 49) or acute (n = 28) asthma. Sputum samples were collected from all of the participants and assessed for inflammatory cell types and C. pneumoniae DNA. Patients with sputum eosinophil levels of more than 3% were classified as having eosinophilic asthma, and those with neutrophil levels of more than 61% and eosinophil levels of less than 3% were classified as having neutrophilic asthma. Patients with neutrophil levels of more than 61% and eosinophil levels of more than 3% were classified as having mixed granulocytic asthma; and those with neutrophil levels of less than 61% and eosinophil levels of less than 3% were classified as having paucigranulocytic asthma. The researchers found that eosinophilic asthma was the most common phenotype in children with acute asthma (50.0%), followed by mixed granulocytic (35.7%), and neutrophilic and paucigranulocytic asthma (both at 7.1%). In adults with acute asthma, the most common phenotype was neutrophilic asthma (81.8%), followed by mixed granulocytic asthma (18.2%). The eosinophilic and paucigranulocytic phenotypes were not found in any of the adults with acute asthma. Paucigranulocytic asthma was the most common phenotype in adults with stable asthma (51.7%), followed by neutrophilic (27.6%), eosinophilic (17.2%), and mixed granulocytic asthma (3.5%). Paucigranulocytic asthma was also the most common phenotype in children with stable asthma (49.0%), followed by eosinophilic (28.6%), neutrophilic (20.4%), and mixed granulocytic asthma (2.0%). C. pneumoniae DNA was detected in just one sputum sample, from a child with acute asthma. The authors concluded that the pattern of inflammatory phenotypes differs between adults and children, with eosinophilic inflammation being more prevalent in both acute and stable childhood asthma, and neutrophilic inflammation being the dominant pattern of acute asthma in adults. Current C. pneumoniae infection does not appear to explain the noneosinophilic phenotype in asthma nor increase respiratory acute exacerbation.
Editor's comment: This Australian study shows that inflammatory phenotypes differ between adults and children with acute or stable asthma and are rarely caused by C. pneumoniae.
Wang F, He XY, Baines KJ et al. Different inflammatory phenotypes in adults and children with acute asthma. European Respiratory Journal 2011 [Published online before print, doi: 10.1183/09031936.00170110].
Abstract

2. The risk for asthma attacks may be predicted by a simple questionnaire.
To investigate if a composite measure such as the Asthma Control Questionnaire (ACQ), which assesses the adequacy of asthma control by using symptoms, activity limitation, use of rescue medications, and lung function, may capture several aspects of asthma control and prediction of risk, the authors analyzed data from 292 patients with moderate-to-severe atopic asthma. The patients were 18-65 years old (mean age 41 years), who had participated in a 12-week study of an IL-4 receptor antagonist. The participants completed the ACQ before treatment initiation and every 2 weeks for 16 weeks after treatment began. For the ACQ, patients were asked to recall their symptoms during the previous week and to respond to six questions regarding nighttime waking, symptoms on waking, activity limitation, shortness of breath, wheeze, and rescue medication use on a scale from zero (no impairment) to six (maximum impairment). The patients' lung function was also scored on a similar scale. The composite score was then calculated from these seven items, ranging from zero (totally controlled) to six (severely uncontrolled). In total, 31 patients each experienced one exacerbation over the course of the study period. After adjusting for age, race, gender, and height, the researchers found that each one-point increase in ACQ composite score was associated with a hazard ratio of 1.5 for an exacerbation during the following 2-week period. Analysis of individual components of the ACQ revealed a similar but less pronounced predictive trend, with hazard ratios ranging from 1.1 to 1.3 for each one-point increase in individual component scores. The baseline ACQ composite score was not associated with the overall exacerbation risk during the 12-week study. A significant correlation was found between measurements of the ACQ composite score over time and the risk of future asthma exacerbation. The results with the ACQ composite measure were superior to those of the individual ACQ components. These results confirm the utility of measuring the composite ACQ score in clinical trials as well as clinical practice.
Editor's comment: The composite score on the Asthma Control Questionnaire (ACQ) predicts patients' risk for asthma attacks over the following 2 weeks.
Meltzer EO, Busse WW, Wenzel SE et al. Use of the Asthma Control Questionnaire to predict future risk of asthma exacerbation. The Journal of Allergy and Clinical Immunology 127: 167-172, 2011.
Abstract

3. Allergic disease and thrombosis risk.
Previous studies have shown that the coagulation pathway can be activated in the airways of patients with allergic asthma and allergic rhinitis, and that platelet activation can also play a role in allergic inflammation. In the current study, the authors compared the prevalence of allergic rhinitis, allergic asthma, and atopic dermatitis in 129 patients (aged 20-45 years) with venous thromboembolism (VTE) versus 144 VTE-free controls matched for age, gender, and smoking status. The overall prevalence of atopic diseases was significantly higher among the patients with VTE (38%) compared with controls (22.9%). The prevalence of allergic rhinitis was significantly higher in patients relative to controls (30.2% vs 18.8%), whereas the prevalence of asthma (5.4% vs 3.5%) and atopic dermatitis (2.3% vs 0.7%) did not differ significantly between the two groups. VTE patients with atopic diseases had a 32.0% higher plasminogen activator inhibitor (PAI)-1 level and a 21.4% longer clot lysis time than nonatopic VTE patients. The researchers remarked that the mechanism(s) underlying the association between atopic diseases and VTE remain obscure, but suggested that a PAI-1-mediated impairment of fibrinolysis could in part account for the increased prevalence of atopy among VTE patients. They concluded that their preliminary report sheds new light on the complex links between allergic inflammation/atopic diseases and blood coagulation.
Editor's comment: Patients with venous thromboembolism (VTE) are nearly twice as likely to have atopic diseases, such as allergic rhinitis, as individuals with no history of thrombosis.
Undas A, Cieśla-Dul M, Drążkiewicz T et al. Association between atopic diseases and venous thromboembolism: a case-control study in patients aged 45 years or less. Journal of Thrombosis and Haemostasis 2011 [Published online before print. doi: 10.1111/j.1538-7836.2011.04198.x]
Abstract

All 11 journal article reviews are posted in the literature review section of the WAO website.

Reviews of medical books can be accessed on the Reviews and News section of the website.

PREVIEW:
This Month in the Journal

World Allergy Organization Journal
February 2011
Volume 4, Issue 2
ISSN: 1939-4551

Editor-in-Chief: Lanny J. Rosenwasser, M.D.

World Allergy Organization Guidelines for the Assessment and Management of Anaphylaxis
F. Estelle R. Simons, Ledit R. F. Ardusso, Beatrice Bilò, Yehia M. El-Gamal, Dennis K. Ledford, Johannes Ring, Mario Sanchez-Borges, Gian Enrico Senna, Aziz Sheikh, and Bernard Y. Thong, for the World Allergy Organization
United States

ORIGINAL ARTICLES

Assessing Peanut Consumption in a Population of Mothers and their Children in the UK: Validation of a Food Frequency Questionnaire
Aikaterini Sofianou-Katsoulis, David Mesher, Peter Sasieni, George Du Toit, Adam T. Fox, and Gideon Lack
United Kingdom

Effects of a Novel GA2LEN Training Program on Urticaria on the Knowledge of General Practitioners in Saudi-Arabia
Marcus Maurer, Carsten Bindslev-Jensen, Nicole Schoepke, and Torsten Zuberbier
Germany

REVIEW ARTICLE

Antihistaminic, Anti-Inflammatory, and Antiallergic Properties of the Nonsedating Second-Generation Antihistamine Desloratadine: A Review of the Evidence
G. Walter Canonica, and Michael Blaiss
Italy

SUPPLEMENT

Hereditary Angioedema Caused by C1-Esterase Inhibitor Deficiency: A Literature-Based Analysis and Clinical Commentary on Prophylaxis Treatment Strategies
Richard G. Gower, Paula J. Busse, Emel Aygören-Pürsün, Amin J. Barakat, MD, Teresa Caballero, Mark Davis-Lorton, Henriette Farkas, David S. Hurewitz, Joshua S. Jacobs, Douglas T. Johnston, William Lumry, and Marcus Maurer
United States

Additional Journal Reviews

4. Irritable larynx as a cause of chronic cough (CC).
5. Mechanisms of resistance to oral theophylline treatment of hyposmia.
6. Different contributions of biologic factors to asthma severity in blacks and whites.
7. Tobacco smoke, asthma, and wheeze in teenagers.
8. Tear neuropeptides and specific allergen challenge in allergic conjunctivitis.
9. Biomarkers as diagnostic tools for food allergy.
10. DNA vaccines.
11. Filaggrin gene defects and the risk of allergy.

To read translations of past Medical Journal Reviews, click here.

WAO News & Reviews content is now searchable.

Medical Book Review

Patterson's Allergic Diseases (Seventh Edition)
Editors: Leslie C. Grammer; Paul A. Greenberger
2009 Lippincott Williams & Wilkins
ISBN: 978-0-7817-9425-1

List Price: $154.95
Available from: Lippincott Williams & Wilkins

Reviewer:
Salman Aljubran, MD
Division of Allergy and Clinical Immunology
Department of Internal Medicine
University of South Florida
James A. Haley Veterans' Hospital
Tampa, Florida USA

Description
Patterson's Allergic Diseases (Seventh Edition) is a comprehensive single volume reference that covers a wide spectrum of immunologic and allergic conditions. It is the first edition that has not been reviewed by Dr. Roy Patterson, the founding editor, since its inception in 1972.

Purpose
This textbook is a guide to the general approach, diagnosis, and management of allergic and immunological diseases.

Audience
It is intended for medical professionals who encounter such diseases in their daily practice

Features
This single volume textbook is divided into ten sections. The first section is devoted to the biological and clinical aspects of the immune system, i.e., a basic review of immunology, followed by a section which discusses the pathogenic and environmental aspects of allergy and asthma in a concise manner. The third section is about the principles of evaluation and treatment, the main focus of which is to obtain a good medical history, performed a physical examination and use diagnostic studies as confirmatory tools. The fourth discusses anaphylaxis and food and drug allergy. Asthma is discussed in length in the next section, including asthma clinical trials, and is followed by a section devoted to immunologic pulmonary diseases. The next section focuses on upper respiratory tract diseases, with the eighth section devoted to cutaneous allergic diseases. The ninth section discusses medications and novel therapies used to treat allergic diseases. Special problems, such as management of allergic diseases in pregnancy, eosinophilic esophagitis, chronic cough, sleep disorders, management of psychologically complicated patients, and controversial and unproved methods in allergy diagnosis and treatment are discussed in the final section.

The features of this textbook which are outstanding include an easily understandable format with charts and tables that are excellent references to obtain useful clinical information, often alleviating the necessity to read the textbook for specific details.

Assessment
This book would be a valuable addition to any medical professional's library, at any career level, regardless of specialty.

More reviews of medical books can be accessed on the Reviews and News section of the website.