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WAO News & Notes - March

World Medical Journal Reviews
WAO Now: What's New in the World of WAO
And In Other News . . .


World Medical Journal Reviews

Prof. Richard F. Lockey, MD, and WAO Web Editor-in-Chief, reviewed premier medical journal articles for practicing allergists. Read his top 3 picks below and for the other 8 reviews, click here.

1. BUDESONIDE/FORMOTEROL MAINTENANCE PLUS RELIEVER THERAPY, A NEW STRATEGY IN PEDIATRIC ASTHMA
(A)Three hundred and forty-one (341) children (4-11 years) with A, uncontrolled with inhaled corticosteroids (ICS), were included in a 12-month, double-blind, randomized study to determine whether budesonide/formoterol (B/F) 80/4.5 µg qd maintenance plus prn inhalations versus B/F 80/4.5 µg qd maintenance or budesonide 320 µg qd reduced A exacerbations. The B/F qd plus prn use prolonged the time from first exacerbation versus fixed dose B (P = 0.02) and fixed dose combination (P< 0.001). Mild exacerbation days and awakenings were significantly lower with B/F qd plus prn use, and yearly growth improved by one centimeter versus B 320 µg qd (P< 0.01). B/F used daily plus prn use versus fixed dose B and fixed dose combination reduces exacerbation rates (both P<0.001). Editor's comments: Daily use of combination therapy plus prn use may become a new accepted treatment for A. Bisgaard H, et al. Chest 2006; 130: 1733.

2. TYMPANOSTOMY TUBES AND DEVELOPMENTAL OUTCOMES AT 9 TO 11 YEARS OF AGE
Four hundred and twenty-nine (429) children, before 3 years, with persistent effusion were randomly assigned to undergo the insertion of tympanostomy tubes either promptly or up to nine months later if effusion persisted. In a previous report, the authors concluded that prompt versus delayed insertion did not result in improved cognitive language, speech or psychosocial development at 3, 4 or 6 years. They now assess literacy, attention, social skills and academic achievement in 391 of these children at 9 to 11 years and conclude that mean scores of 48 developmental measures in children who underwent early insertion of tympanostomy tubes did not differ significantly from the scores in the group that was assigned to undergo delayed insertion at the later age.Editor's comment: The authors suggest that watchful waiting for at least six additional months with bilateral infusions and for an additional nine months with unilateral infusions is the preferred management option in most cases. Recommendations should be individualized. Paradise JL, et al. N Engl J Med 2007; 356: 248. Editorial, Berman S. N Engl J Med 2007; 356: 300.

3. MULTIPLE CHEMICAL SENSITIVITIES (MCS): A SYSTEMATIC REVIEW OF PROVOCATION STUDIES
This is a review of provocation studies of persons reporting MCS from a database search from inception to May 2006. Most studies were insufficiently controlled. The authors conclude that persons with MCS react to chemical challenges; however, responses only occur when they can discern differences between active and sham substances. This suggests that the mechanism of action is related to expectations and prior beliefs rather than to the chemical itself. Editor's comment: Fortunately, humans are not as sensitive to a variety of different environmental agents as believed by some individuals and physicians. Das-Munshi J, et al. JACI 2006; 118: 1257.

To read the additional reviews, click here.



WAO Now: What's New in the World of WAO


World Allergy Forum World Allergy Forum Held at the 2007 AAAAI Annual Scientific Meeting, San Diego, CA, USA, 26 February 2007

"A Global Perspective on Genetics, the Environment and Allergy"


Our international expert faculty was chaired by Thomas A.E. Platts-Mills and Michael A. Kaliner, and provided a worldwide update on genetics, the environment and allergy to almost 300 attendees. The first speaker, Adnan Custovic (United Kingdom), discussed whether or not early exposure to allergen is protective, and the presentation by Robert F. Lemanske Jr. (United States) focused on the environment's influence on genetic responses. The successful symposium was concluded by Erika Von Mutius (Germany), who discussed environmental intervention in the management of allergic diseases.

Presenter slides and audio recordings will soon be available for download on the WAF web page.

World Allergy Forum is funded through an unrestricted educational grant from



Updated GLORIA Module Now Available

An updated version of GLORIA Module 2: Allergic Conjunctivitis, authored by Prof. Connie H. Katelaris and Dr. Allen P. Kaplan, is now available for downloading on the US GLORIA web site

2007 April GLORIA Placements

V European Asthma Congress and I World Congress on COPD
21-24 April 2007
Moscow, Russia
International GLORIA Faculty:
Allen P. Kaplan
Presentations:
Module 5: The Symptoms and Treatment of Asthma
Module 7: Agioedema

Romanian National Congress of Allergy and Clinical Immunology
26-27 April 2007
Tirgu Mures, Romania
International GLORIA Faculty:
Jean Bousquet
Presentations:
Module 1: Allergic Rhinitis
Module 4: Immunotherapy

GLORIA is supported through unrestricted educational grants from:

nutricia  shs
dey
dyax & genzyme


New Interactive Case Review

Take a moment to test your knowledge with the new Interactive Case Review based on a Clinical Case Report published in the ACII-JWAO - Trouble in Your Own Backyard: Case Report and Review of Imported Fire Ant Sensitivity. Link

Call for Applications

  • WAO Short-Term Research Fellowship 2007 Applications

  • The World Allergy Organization (WAO) offers three Short-Term Research Fellowships, to commence in the latter half of 2007, to support junior allergists to visit a center of their choice to learn a research technique. The expected duration of each attachment is 2-3 weeks. WAO will contribute up to a maximum of $2,500 USD, to include travel and accommodations, for each Short-Term Fellowship.

    Priority will be given to junior clinicians within five years of award of the most recent professional degree, who are specializing in allergy and who are affiliated to an academic department or clinical institute. Applicants must be current members of a WAO member society.

    The Short-Term Fellowships will be applied to a project which meets one of the WAO Research Priorities:
    *Genetic factors involved in the development of allergic disease and response to treatment
    *Allergen characterization and standardization
    *Clinical and basic studies in allergy and asthma
    Application forms may be downloaded here: Link

    Applications must be received by WAO head office not later than 31 May 2007

  • The WAO Henning Lųwenstein Research Award 2007
The WAO Henning Lųwenstein Research Award is a biennial award given to a young scientist who has shown excellence within the field of allergy. WAO and ALK-Abelló will present the award at the World Allergy Congress in Bangkok, 2-6 December 2007.

The winner will receive EURO 20,000 together with a travel grant to attend the World Allergy Congress.

For application guidelines, visit www.alk-abello.com and click on "The WAO Henning Lųwenstein Research Award."

Deadline: 30 June 2007

Sign up for Online Journal Subscription -

WAO and Hogrefe & Huber Publishers are offering a limited number of free online 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, online 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 (Family) name
Postal address
City, State/Province and postal code
Country
E-mail address
Name of Member Society


And In Other News


Allergy Book Reviews


Microbial Subversion of Immunity: Current Topics
Editors: Peter J. Lachmann, M.B.A. Oldstone
ISBN #: 1904455050

List price: $230.00 USD
Available from: Caister Academic Press

Reviewer: Gary Hellermann PhD
University of South Florida, Tampa, Florida

Description:
This is a collection of nine reviews focusing on the strategies used by bacteria, viruses and parasites to avoid detection or destruction by the host's immune system. It begins with an overview of the subversion process and its effects on complement, natural killer cells and other parts of the mucosal innate immune system. This is followed by general reviews of the subversive techniques of viruses, bacteria and helminths. Lastly, there are three papers dealing more specifically with the humoral immune response and dendritic cell reaction to viruses, and a description of the measles virus serving as a model for the mechanisms of inhibition of human antiviral defenses.

Purpose:
The editors point out that all human pathogens by definition have achieved some degree of success in blocking attacks by the immune system and that this review of their methods 'on the battleground' should yield valuable insights into the workings of the immune system. Considering that humans are under constant threat by these highly adaptive organisms, this book fills an important need by bringing together the current findings on microbial subversion of the immune system. The difficulty of the task is matched by the high level of expertise of the contributing authors.

Audience:
The book's subject, how some viruses, bacteria and parasites manage to avoid our immune defenses, is one of interest to a wide audience teachers, students, researchers and clinicians. The language and concepts are not dauntingly technical, and the current findings are brought out within a logical framework that makes them easy to understand. The contributors to the work all seem to be highly competent and knowledgeable.

Features:
While the book's main emphasis is on the various ways that microbes circumvent the innate immune response, there is an excellent review chapter on the innate immune system itself that highlights the host's defense mechanisms and sets the stage for a better understanding of microbial subversion.

The authors of the reviews have done an excellent job combing the literature for the latest information and condensing and summarizing it into a comprehensive report on the state of knowledge about microbial evasion of the human immune system. Each review has an extensive bibliography providing a complete cross section of the current literature.

Chapter 4 on Viral Immune Evasion is especially well written, comprehensive and illustrated with numerous figures showing the pathways blocked by specific viruses. The chapter on immune system subversion by helminths at 70 pages (35 pages of references!) may well be the definitive work on this subject.

Together with chapters on viral inhibition of the humoral immune response, viral effects on dendritic cells and a detailed discussion of the measles virus, the book affords a virtually complete overview of the current research findings. These recent advances in virology demonstrate the great variety of mechanisms employed by these consummate pathogens, and this improved knowledge should provide us with insights to design better vaccines and antiviral drugs.

The subjects are covered in good detail and with competent explanations, but the text seems to suffer in places from a lack of editing that could have improved the clarity and readability.

Assessment:
After reading this book, one comes away with a new appreciation of the value of a healthy and well prepared immune system. The immunocompromized individual is at far greater risk of infection and may even die as a result of an illness that would otherwise be just an inconvenience. By gathering together and evaluating the latest research in this important area of immunology, the authors and editors deserve much credit for producing a work that should be the reference standard in the field for some time.

From Genes to Phenotypes - The Basis of Future Allergy Management
Proceedings of the 25th Symposium of the Collegium Internationale Allergologicum (Supplement 2, 2005 of Allergy & Clinical Immunology International - Journal of the World Allergy Organization)
Editors: H. Lųwenstein, J.B. Bienenstock, J. Ring

List Price: $64.95 USD
Available from: Hogrefe & Huber

Reviewer: John B. Ziegler, MB BS, FRACP, MD, DipHEd, FAAAAI Head, Department of Immunology & Infectious Diseases Sydney Children's Hospital, RANDWICK NSW, Australia

Description:
The Collegium Internationale Allergologicum holds biennial meetings and invites about 200 allergy investigators for an informal gathering to discuss recent allergy research and future therapeutic options. This hard cover volume of 252 pages collects papers presented at the 2004 meeting held in Denmark, covering topics such as gene-environment interaction, T cell regulation, basic mechanisms of effector cell function, mast cells, psychoneuroallergology, asthma, food allergy, eczema, drug reactions, diagnostics and progress in pharmacotherapy, as well as nonspecific and specific immunotherapy.

Purpose:
The stated purpose, implied by the title, is to bridge the gap between genetics and mechanisms of allergic responses and office allergy practice. Evolving from the proceedings of a conference, however, the content is clearly determined by the interests and research programs of the participants with no clear themes emerging. The purpose is perhaps better described to allow allergy research groups to present recent findings and interests. The book does not present discussion of genotype-phenotype correlations, which the title seems to promise, but of course, none could really be expected for allergic diseases, which appear to be multigenic disorders.

Audience:
This is not a reader-centered book. It does not provide a revue of any broad areas of allergy research, theory or practice. It does not describe current knowledge about genetic factors leading to allergic phenotypes. It does not describe allergic phenotypes. Its audience is not students, trainees or physicians in other disciplines seeking an update on current thinking. Rather, its audience is academic allergists, researchers working in allergy and practicing allergists and immunologists seeking a window on current research trends.

Features:
The book comprises about 70 papers of about 3-4 pages mostly presented in the format of journal articles with abstracts, methods, results, discussion and a short reference list. Some are short reviews presenting published work, though even this type of paper generally has fewer than 20 references. Unusual for a bound volume, it does not have a subject index. There is an author list and an index based on keywords (which are not necessarily standard terms) provided by authors. This has some unusual effects. An Australian contribution on latex immunotherapy is indexed under "latex allergy," "basophils," and "Hev b 6.01" but not "immunotherapy." Many of the terms are abbreviated names, for example, of cell surface molecules. Although its role is of great interest, few readers would search for IRp60 (a recently described inhibitory receptor on mast cells).

Assessment:
This book, published in 2006, presents papers presented in August 2004, so the reader does not benefit from the immediacy afforded to the delegates. The content is largely in the form of short scientific papers but is apparently not peer reviewed. In fact, there is usually insufficient methodological detail to allow critical appraisal. This, at first glance may be a weakness, but it is also a strength since it affords the opportunity, for example, to publish methods which, though not necessarily new technology, are novel approaches to problems in allergy research (basophil histamine release assay to detect circulating dietary allergens; CD63 expression as a marker for basophil activation). It allows for short reviews to encourage readers to enquire further into emerging areas (epitope diversity as a correlate of severity of food allergic reactions). It provides an opportunity to put forward hypotheses which remain largely untested but may prove to be very important (antibodies against membrane bound IgE spacer sequences to modulate IgE synthesis). All those wishing to keep abreast of current thinking in allergy will enjoy thumbing through this book. Many might prefer to spend that time on recent issues of peer-reviewed journals.

Find more allergy book reviews on the WAO Website here.

WAO's mission is to be a global resource and advocate in the field of allergy, advancing excellence in clinical care through education, research and training as a world-wide alliance of allergy and clinical immunology societies. Visit us on the Web at www.worldallergy.org

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