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WAO News & Notes

February Medical Journal Review(2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)
 

 

February World Medical Journal Review(医学雑誌レビュー)

Mark C. Glaum, M.D., Ph.D., WAO Guest Editor, Assistant Professor of Medicine and Pediatrics University of South Florida College of Medicine, reviewed premier February medical journal articles for practicing allergists. 今月はWAOのWEB編集委員長である南フロリダ大学ロッキー教授に代わって同大学Glaum講師による2月の医学雑誌からの文献紹介です。

1. SALMETEROL MULTICENTER ASTHMA RESEARCH TRIAL (SMART)
To compare the safety of adding salmeterol or placebo to "casual" asthma care, subjects (> 12 years old n=26,355) with physician-diagnosed asthma were randomized to receive salmeterol, 42 mcg twice daily via MDI or placebo MDI over 28 weeks in a double-blind observational study. Telephone follow-up was scheduled monthly. The study was terminated prior to completion due to safety findings. In the salmeterol group, there were small but statistically significant increases in respiratory-related deaths (24 vs 11; relative risk [RR]=2.16; 95% confidence interval [CI], 1.06-4.41) and asthma-related deaths (13 vs 3; RR, 4.37; 95% CI, 1.25-15.34) and in combined asthma-related deaths or life-threatening experiences (37 vs 22; RR, 1.71; 95% CI, 1.01 to 2.89). Differences occurred largely in African-American subpopulations. The study was not designed to control for adherence to other asthma medications, and follow-up was conducted only by phone interview every four weeks. Editor's comment: Studies specifically designed to assess safety of long-acting beta 2 agonists (LABA) in combination with inhaled corticosteroids are needed to stratify the potential risk of using LABA in subpopulations of asthmatic patients.
Nelson HS, Weiss, ST, Bleeker ER, et al. Chest 2006; 129:15-26

長時間作用型β2刺激薬(LABA)であるsalmeterolの多施設共同治験に関する結果が掲載されています。この治験は26,355人の喘息患者を対象にsalmeterolの有効性をプラセボ比較において検討しようとしたものです。しかしながら、安全性の面で問題が見つかり中止になりました。すなわち、コントロール群と比較し、呼吸関連死(24例対11例)や喘息死(13例対3例)が有意に高いという結果が得られました。この差は主にアフリカ系米国人において顕著でした。訳者注:白人種ではβ2刺激薬の副作用が生じにくいβ2受容体の遺伝子多型をもつ人とそうでない人が存在するといわれていますが、日本人やアフリカ系米国人ではわかっていません。副作用を生じやすい遺伝子多型では吸入ステロイド薬との併用も安全といえるのかどうか遺伝子多型別に検討する必要があります。

2. OMALIZUMAB PROTECTIVE FOR RUSH IMMUNOTHERAPY
Adults (mean age 33, n=159) with ragweed allergic rhinitis were enrolled in a randomized double-blind placebo-controlled study to receive 9 weeks of omalizumab (0.016 mg/kg/IgE/month) or placebo followed by one-day rush immunotherapy (RIT) with Amb a 1 (1.2-4 micro g). After maintenance dose was achieved, omalizumab or placebo was continued for an additional 12 weeks along with maintenance immunotherapy. As expected, levels of ragweed-specific IgG increased with immunotherapy (>11 fold), while free IgE levels decreased in omalizumab-treated patients (>10 fold). Subjects receiving omalizumab experienced fewer adverse reactions (33%) during RIT than those receiving placebo (55%), and post-hoc blind analysis suggested an even greater reduction in serious adverse events (symptoms in >1 organ system) in the omalizumab group vs placebo (5.6% vs 25.6%) following RIT. Once maintenance was achieved, subjects receiving omalizumab plus immunotherapy also reported fewer symptoms in the ragweed season as compared to placebo. Editor's comment: Omalizumab may protect against systemic reactions from immunotherapy in allergic rhinitis patients.
Casale TB, Busse WW, Kline LN, et al. J Allergy Clin Immunol 2006; 117:134-40

ブタクサ花粉症の患者159名に対し、抗ヒトIgE抗体(Omalizumab)と急速減感作の併用療法をそれぞれの薬剤プラセボを対照として検討しています。具体的には9週間Omalizumabで治療したのち、一日(6時間)でブタクサ抗原Amb a 1の急速減感作(30-60分毎に濃度を上げながら抗原液を注射)を投与しています。そして、その後維持量の抗原エキスを毎週12週間投与しました。その結果、Omalizumab投与群では非結合IgEが10分の1以下になり、重篤な副反応が5分の1に減少しました。ブタクサ抗原投与群ではブタクサ特異的IgG抗体が10倍増加し、症状も軽減したようです。訳者注:この論文では記載 されていませんが、通常の減感作注射では抗原特異的なinducible 制御性T(Treg)細胞あるいはModified Th2細胞と呼ばれる細胞からのIL-10産生が刺激されます。IL-10はIgE抗体を消失させることはできませんが、抗原特異的IgG4とIgEの比率を大きく増大させます。

3. ROLE OF TUMOR NECROSIS FACTOR ALPHA IN REFRACTORY ASTHMA
Subjects with refractory (severe persistent) asthma, mild to moderate asthma and non-asthmatic controls underwent peripheral blood draw to assess for TNF-alpha activity on mononuclear cells. Compared to non-asthmatic controls and mild to moderate asthmatics, subjects with severe persistent asthma demonstrated increased expression of membrane-bound TNF-alpha, TNF-alpha receptor 1, and TNF-alpha converting enzyme on peripheral blood mononuclear cells. Ten subjects (ages 25-59 years) with refractory asthma were then enrolled in a randomized, double-blind, placebo-controlled, crossover study to determine if TNF-alpha blockade would improve methacholine sensitivity, asthma quality of life scores and post-bronchodilator FEV1. Following ten weeks of treatment with the TNF-alpha receptor antagonist, etanercept, subjects in the treatment group were less sensitive to methacholine provocation and showed improvement in asthma quality of life scores and in post-bronchodilator FEV1. Editor's comment: This pilot study suggests that TNF blockade may improve symptoms and pulmonary function of severe asthmatics. Larger clinical trials are warranted to validate this association. Please note excellent accompanying editorial.
Berry MA, Hargadon B Shelley M, et al. N Engl J Med 2006;354;7: 697-708, Erzurum SC;354;7: 754-58

重症喘息患者では末梢血単核細胞の膜結合型TNF-alphaやTNF-alpha受容体1などの発現が亢進していました。そこで、TNF-alpha受容体拮抗薬をこれらの喘息患者に使用したところ、メタコリン吸入試験、QOLスコアアンケート、気管支拡張薬使用後の1秒量などにおいて改善を認めています。編集者注:より大規模な治験が望まれる。同じ号の秀逸なeditorialも見て下さい。

4. LEUKOTRIENE PATHWAY POLYMORPHISMS INFLUENCE MONTELUKAST RESPONSIVENESS IN ASTHMA
This is a pharmacogenetic ancillary study associated with a randomized double blind parallel-designed trial designed to compare the efficacy of placebo, theophylline or montelukast as add-on therapy in mild to moderate persistent asthma. DNA was collected from 252 participants who were randomized to receive montelukast or placebo. Asthmatic subjects receiving montelukast as add on therapy who demonstrated improvement in FEV1 or asthma exacerbation rate as compared to placebo, demonstrated unique genetic polymorphisms associated with the leukotriene pathway. In particular, examination of the gene encoding for membrane-bound 5 lipoxygenase (ALOX5) revealed several polymorphisms associated with improved clinical response to montelukast. Editor's note: Pharmacogenetic studies will allow clinicians to tailor therapeutic regimens for unique asthma phenotypes.
Lima JJ, Zhang S, Grant A, et al. Am J Respir Crit Care Med 2006; 173:379-85

ステロイド吸入薬との併用薬としてのロイコトリエン受容体拮抗薬モンテルカストとテオフィリンの有効性についてプラセボと比較して検討しています。そしてこれらの患者の遺伝子多型について検討しました。その結果モンテルカスト投与により呼吸機能の改善が見られた症例ではALOX5遺伝子多型が関連していることがわかりました。

5. EXPOSURE TO INDOOR NITROGEN DIOXIDE (NO2) AND CHILDHOOD ASTHMA
This cohort study evaluated 728 asthmatic children (age<12) to examine the association of respiratory symptoms with NO2 levels in the home. The frequency of asthma-related symptoms was recorded by a parent one month prior to measurement of NO2 in the subject's home. Mean (SD) levels of NO2 were 8.6 (9.1) ppb in homes with electric stoves vs 25.9 (18.1) ppb in homes with gas stoves. Both of these numbers are well below the USA Environmental Protection Agency (53 ppb) outdoor standard. When controlling for age, ethnicity, medication use and season, children living in homes with elevated NO2 and gas stoves had significantly increased likelihood of wheeze, shortness of breath and chest tightness. Editor's comment: Indoor pollutants may contribute to worsened asthma symptoms.
Belanger K, Gent J, Triche EW, et al. Amer J Respir Crit Care Med 2006;173: 297-303

728名の12歳以下の喘息児において、自宅室内空気中の二酸化窒素NO2の濃度を測定して、喘息症状との相関をみました。ガスストーブのある家は電気ストーブのある家に比べ3倍NO2濃度が高いことがわかりました。そして、NO2の濃度は喘鳴、息切れ、胸部圧迫感などの症状と相関していることがわかりました。

6. T-CELL-MEDIATED HYPERSENSITIVITY TO QUINOLONES
Many drug-related exanthemas are non-IgE-mediated, and methods available to reliably test for drug hypersensitivities are limited. Six patients with cutaneous eruptions associated with quinolone antibiotics were investigated by in vivo and in vitro methods to determine the nature of drug-T cell interactions and to evaluate for any cross-reactivity among quinolones. Patch tests against suspect parent drugs were positive in three of six patients. Lymphocyte proliferation studies demonstrated enhanced tritiated thymidine uptake upon exposure to suspected quinolone drugs in all six subjects, while no increase in uptake was reported for drug-exposed and naive control subjects. Cross-reactivity among quinolone drugs was observed. Editor's comment: New methodologies may aid in the evaluation of non-IgE-mediated drug reactions.
Schmid DA, Depta JPH, Pichler WJ, et al. Clin Exper Allergy 2006; 36:59-69

多くの薬疹はIgE抗体非依存性の反応です。しかしながら、そのような反応に関する信頼できる検査法はあまりありません。著者らはキノロン系抗生物質による薬疹の診断ではリンパ球増殖試験が有用であるとしています。訳者注:日本ではこの方法は以前から検査会社に外注可能となっています。

7. ACE INHIBITORS AND OBSTRUCTIVE SLEEP APNEA
Based on an observation of a patient with ACE-induced cough and obstructive sleep apnea (OSA) who had improvement in both conditions following discontinuation of the ACE inhibitor, 8 subjects with OSA on an ACE inhibitor for hypertension were enrolled in a prospective study. Four subjects experienced cough after initiation of ACE inhibitor treatment, and the other four did not. Subjects underwent arterial blood gas sampling, measurement of exhaled nitric oxide (NO) and ambulatory polysomnography during ACE inhibitor treatment and one month after substitution of the ACE inhibitor with diuretic therapy. Subjects with cough on the ACE inhibitor demonstrated an increased apnea-hypopnea index, increased exhaled NO and lower mean oxygen saturation than subjects without cough. Each of these parameters improved with substitution of the ACE inhibitor in subjects with cough. Editor's comment: ACE inhibitors are known to trigger symptoms of cough and may also worsen OSA.
Cicolin A, Mangiardi L, Mutani R, et al. Mayo Clin Proc 2006;81(1): 53-55
 

高血圧治療薬としてもちいられるアンギオテンシン変換酵素ACE阻害薬は、高血圧患者に合併している睡眠時無呼吸や咳嗽に対しても有効であることを示した論文です。

8. DIAGNOSIS AND MANAGEMENT OF COUGH: ACCP EVIDENCE-BASED CLINICAL PRACTICE GUIDELINES
This is an updated version of the original evidence-based consensus panel report on "Managing Cough as a Defense Mechanism and as a Symptom" originally published in a 1998 edition of Chest. This updated edition attempts to focus guidelines on evidence supporting the diagnosis and management of cough in adult and pediatric populations. This 292-page supplement separates discussion of the etiology of cough into more than 20 separate chapters dealing with associated clinical conditions including: rhinosinusitis, asthma, the common cold, gastroesophageal reflux, acute bronchitis, lung tumors, aspiration, habit, hemodialysis and others. In addition to providing clinical practice guidelines and algorithms, this edition centralizes a vast body of literature studying the etiology of cough. Editor's comment: Chronic cough is a common complaint, and it is often a difficult condition to diagnose and treat.
Irwin RS, Baumann MH, Bolser DC, et al. Chest 2006; 129:supplement

1988年のChestに掲載された"防御反応、症状としての咳嗽の管理"というコンセンサスリポートの続報です。292ページにわたるこのChestの別冊には副鼻腔炎や喘息など咳嗽に関連した20章の論文が掲載されています。

9. REVIEW OF ANTIBIOTIC ALLERGY
This clinical case vignette and review highlights a common reason for allergy consultation. Evidence supporting the role for limited antibiotic skin testing is presented and current guidelines, when applicable, are discussed. The review concludes with clinical recommendations from the authors who are recognized experts in the field. Editor's comment: This is a "must read" for consultants who see patients with antibiotic drug allergy and for primary care physicians who commonly encounter cutaneous drug eruptions.
Gruchalla RS, Pirmohamed M N Engl J Med 2006;354;6: 601-09

抗生物質に対するアレルギーに関する総説の紹介です。診断チャートなどわかりやすく書かれています。編集者注:必読。

10. PHARMACOTHERAPY FOR PEDIATRIC ASTHMA
This is a concise review of asthma treatment strategies in pediatric populations. There are several useful charts that summarize relative inhaled corticosteroid dose equivalencies, short-acting therapeutic strategies, and asthma controller medication treatment guidelines adapted for pediatric practice. Editor's comment: This review summarizes pediatric asthma therapeutics in an easily accessible format.
Ostrom NK, J Pediatrics 2006;148: 108-14 No abstract is available for this article.

小児喘息への薬物療法に関する総説です。やはりチャートを多用してわかりやすく記載されています。


WAO Member Society Spotlight (所属学会紹介)

今月のWAOメンバー紹介は3月3日から7日までマイアミで行われた米国アレルギー学会の紹介となります。

2006 AAAAI Annual Meeting: the Scientific Basis of Allergy Practice

With more than 400 educational sessions at the AAAAI Annual Meeting, March 3-7, in Miami Beach, Florida, delegates learned about the latest developments in the specialty and how that cutting-edge research applies to patient care.

Key sessions included:

Keynote sessions
High profile speakers addressed issues with a global impact during the two Keynote Sessions. Clinical Trials and the Public Trust was presented by Jeffrey M. Drazen, MD, editor of The New England Journal of Medicine, and Human Disease: A Sum Game of the Gene and the Environment was presented David A. Schwartz, MD, MPH, director of the National Institute of Environmental Health Sciences.

Plenary Sessions
The Plenary Sessions were the premiere scientific sessions of the Annual Meeting. Sessions included Seeing is Believing: Host and Hostility, Anaphylaxis: Bridging the Gap from Basic Science to Clinical Practice (Presidential Plenary), The Science of Evidence-Based Medicine in Asthma, and Allergic/Immunologic Diseases: Dissection and Modulation.

Science & Surf: Featured Poster Session & Reception
Delegates had the opportunity to learn, network and enjoy tropical breezes during the Science & Surf: Featured Poster Session & Reception. Delegates learned about science of high significance in the field and earned CME/CE when they visited the featured poster session.

Anaphylaxis Day activities
From the Presidential Plenary Session and special seminars, to intubation simulations and new Anaphylaxis Education Tool Kits, Anaphylaxis Day emphasized the importance of the role of the allergy/immunology specialist in anaphylaxis management and prevention.

3月5日のプレナリーセッションはアナフィラキシーに関してGalli教授、Sampson教授らによる発表が行われ、参加者にはアナフィラキシーの教育や治療のためのキットが配布されました(3月5日はブッシュ大統領によりAnaphylaxis Dayと宣言されました)。

Bring Your Own Patient Sessions
New workshops offered delegates the opportunity to submit difficult patient cases from their practices for discussion by leading experts in the field. Topics included Patients with Difficult to Treat Urticaria, Patients with Recurrent Infection but Normal Screening, Patients with Difficult to Treat Asthma and Patients with Difficult to Treat Food Allergies.

Member Service Programs
These new programs addressed critical information for the successful practice of allergy/immunology. Topics included Maintenance of Certification (American Board of Allergy and Immunology), Regulatory Issues Affecting the Specialty (Food and Drug Administration), and Legislative Issues Affecting the Specialty (Joint Council of Allergy, Asthma and Immunology).

Michael A. Kaliner, MD, FAAAAI, received the AAAAI Distinguished Clinician Award. WAO's president has published more than 475 articles, reviews, and books relating to allergies, sinusitis and asthma. He has served as editor, or on the editorial boards, of many allergy and asthma journals, including The Journal of Allergy and Clinical Immunology (JACI), eMedicine Journal, and Allergy & Clinical Immunology International - Journal of the World Allergy Organization (ACII-JWAO).

Visit the AAAAI's Annual Meeting Web site, www.annualmeeting.aaaai.org for important post-meeting resources, including CME/CE certificates, session handouts, Annual Meeting news and a collection of photos from the 2006 Annual Meeting.

米国アレルギー学会のWEBページにおいていくつかのセッションのビデオや配布教材を閲覧することができます。
 


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

WAO Short Term Research Fellowship Program

Applicants are reminded that the deadline for applications for the WAO Short Term Research Fellowship program is March 31, 2006. For further details, click here.

WAOがサポートする短期滞在フェローシップの募集要項に関する案内です。

World Allergy Forum Held at AAAAI Annual Meeting

"Sublingual Immunotherapy" Is There a Role?"
Our superb international faculty, chaired by Michael A. Kaliner, provided a worldwide update on sublingual immunotherapy. The first speaker, G. Walter Canonica (Genova, Italy), presented an analysis of long-term efficacy and safety of sublingual immunotherapy and the presentation by Anthony J. Frew (Brighton, United Kingdom) focused on the mechanisms of sublingual immunotherapy and how it differs from injection immunotherapy. The symposium was concluded by Linda Cox (Fort Lauderdale, FL, U.S.), who discussed whether the United States is ready for sublingual immunotherapy.
Click here
to view abstracts and presentation slides

米国アレルギー学会におけるWAOのセッション"舌下免疫療法"に関する教育スライドが上記ページに掲載されています。

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
Pediatric Dermatology
Bernard A Cohen
Elsevier Mosby, Third Edition, 2005

今月は小児皮膚科学の紹介です。美しいカラー写真が数多く掲載され、ページへのアクセスがしやすいのでベッドサイドでも使えます。全ての臨床医のみならず学生にも向いてます。

List Price: $219.00 USD
Available from: http://us.elsevierhealth.com/product.jsp?isbn=1416024689

Reviewer: Dr Preeti Joshi
Staff Specialist, The Children's Hospital at Westmead NSW Australia

Purpose:
This beautifully illustrated textbook provides a clear and comprehensive coverage of dermatological problems in children. It is well-organized and indexed in a problem-orientated fashion, making it easy-to-access information at the bedside.

Audience:
The book is addressed to all clinicians and, for clinical immunologists, the chapters devoted to disorders of the hair, nails and oral cavity will prove particularly useful. Medical students too, will find that the book covers many common conditions and explains their salient features.

Features:
While the text is succinct and easy to read, the outstanding feature of the book is the photography. This is indeed a very impressive collection of photographs, particularly for a single author. There are approximately four large, well-lit color plates on each page, often with multiple photos to illustrate different features of the disease. The text itself is supplemented by helpful algorithms for identifying the aetiology of common presenting problems such as neonatal rashes. For those requiring more detail, there is an up-to-date further reading list at the end of each chapter.

Assessment:
In summary this is a pleasing book with exceptional photographs. It is an excellent resource for reference but is also pleasant enough to read from cover to cover. Any clinician who treats children will find this a useful addition to their library.

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)
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Email: info@worldallergy.org

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