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WAO News & Notes - April

Medical Journal Review
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.
世界アレルギー機構(WAOWeb編集委員長であるRichard Lockey教授によるアレルギー診療に携わる臨床医のための医学ジャーナル論文の紹介


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.

ブデソニドとフォルモテロール(長時間作用型β2受容体刺激薬LABA)の合剤を一日1回使用した群と、一日1回の使用に加え喘息悪化時に発作治療として追加し吸入する群、およびブデソニド高用量使用群の3群について喘息症状の推移について比較した。対象は4歳から11歳までの小児喘息患者でRCTdouble-blind, randomized controlled trial)によった。その結果、定時吸入プラス増悪時の合剤使用は、合剤の定時吸入あるいはブデソニド高用量使用群に比して、無症状期間の延長などの臨床効果において優れており、また、ブデソニド高用量使用群に比べ、成長抑制効果は年間1cm少なかった。編集者注:一日1回定時吸入プラス増悪時のステロイドLABA合剤使用は喘息治療の新しい戦略になりうる。

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歳までの429人の滲出性中耳炎患者において、早期に鼓膜チューブ留置術を施行した群と9ヶ月までの長期間観察して浸出液が持続した場合、留置した群に分け、911歳における読み書き能力、学業成績等の48の発達指標について検討した。その結果、有意差はなかった。

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.

化学物質過敏症に関する、最もエビデンスレベル(疫学研究の信頼度に関する科学的な格付け)が高いとされる体系的レビューである。多種類の化学物質に対する過敏症の報告を全て調査した結果、ほとんどの研究は適切なコントロールがなかった。被験者は、その物質が存在すると知らされた場合のみ反応し、ブラインドでは化学物質に反応しなかった。訳者注:過敏症とは「正常被験者には耐えられる一定量の刺激への曝露により、客観的に再現可能な症状または徴候を引き起こす疾患をいう」と定義されているので、化学物質過敏症は過敏症の定義からはずれてしまう。今後は、過敏症としてアレルギー学者が扱う研究課題ではなく、心理学者、神経学者が扱う研究課題になるであろう。いずれにしても、マスコミなど、これらの症状を訴える方々に対する慎重な配慮が必要である。

4. LONG-TERM COMPARISON OF 3 CONTROLLER REGIMENS FOR MILD-MODERATE PERSISTENT CHILDHOOD ASTHMA (A) : THE PEDIATRIC A CONTROLLER TRIAL
This DB 48-week trial of 285 children (6-14 years) with A compared the efficacy of 3 treatment regimens: fluticasone 100 µg 2x/d (F2X), fluticasone 100 µg/salmeterol 50 µg (FS) in the A.M. and salmeterol 50 µg (S) in the P.M., and montelukast 5 mg (M) in the P.M. F2X and the FS and S were comparable but the F2X was superior for clinic-measured FEV1/FVC (P = .015), maximum bronchodilator response (P = .009), exhaled nitric oxide (P <.001), and methacholine PC20 (P<.001). F2X was superior to M for A control days (64.2% vs. 52.5%; P = .004) and other control outcomes. Growth over 48 weeks was not statistically different among groups. The study confirms the current guideline recommendations favoring inhaled glucocorticoid monotherapy in mild-moderate persistent A. Editor's comment: Inhaled glucocorticosteroids should be the primary treatment for mild-moderate persistent childhood A. Sorkness C, et al. J Allergy Clin Immunol 2007; 119: 64.

軽症から中等症の持続型喘息患児(6歳~14歳)285名に対して、フルチカゾン一日2回、フルチカゾンとサルメテロール合剤を一日一回、そしてサルメテロールとモンテルカストをそれぞれ一日一回ずつの3群に分けて効果を検討した。その結果、フルチカゾン一日2回の群の方がその他の群(小児中等症以下の症例では合剤よりも!!)に比べ、無発作期間など優っていた。編集者注:小児喘息の管理には軽症であっても吸入性ステロイド薬の使用を推奨すべきである。

5. HISTAMINE H4 RECEPTOR (H4R) ANTAGONISTS ARE SUPERIOR TO TRADITIONAL ANTIHISTAMINES IN THE ATTENUATION OF EXPERIMENTAL PRURITUS
The authors demonstrate that scratching responses in mice, induced by histamine and selective H4R agonists, were almost completely attenuated in H4R knockout mice or by pretreatment with a selective H4R antagonist, JNJ 7777120. Pruritus induced by allergic mechanisms was also inhibited by the H4R antagonist or in H4R knockout mice. The inhibitory effect of JNJ7777120 was greater than with a histamine H1 receptor antagonist. The H4R pruritus was shown to be independent of mast cells or other hematopoietic cells and may result from actions on peripheral neurons. The authors conclude that the H4R is involved in pruritic responses in mice more so than the histamine H1 receptor. Editor's comment: Will this new agent provide an alternative and effective therapy for chronic pruritus? I hope so. Dunford PJ, et al. J Allergy Clin Immunol 2007; 119: 176.

ヒスタミンH4受容体拮抗薬は従来の抗ヒスタミン薬(H1受容体拮抗薬)と比べ、痒みの軽減効果に優れていることが、動物(マウス)実験で示された。訳者注:訳者らの研究によるとマウスのマスト細胞はH4受容体を強く発現しているがヒトではそうではなく、今回の結果からすぐにヒトでの有効性を期待することは時期尚早であると考える。

6. IMPACT OF SALMETEROL/FLUTICASONE PROPIONATE VERSUS SALMETEROL ON EXACERBATION IN SEVERE COPD
After a 4-week, run-in period, 994 clinically stable patients were randomized to one of two treatment groups, 507 received the salmeterol/fluticasone combination 50/500 µg 2x/d (SFC) and 487 received salmeterol 50 µg 2x/d (S) for 44 weeks. There were 334 exacerbations in the SFC and 464 in the S (P <0.0001). The annualized rate of moderate and severe exacerbations per patient was 0.92 in the SFC and 1.4 in the S group (35% decrease). Mean time to first exacerbation in SFC was significantly longer versus S (128 vs. 93 d, p<0.0001). QOL, PEF and use of rescue medication were significantly improved in the SFC group. The authors conclude that SFC is better than monotherapy with S for severe COPD. Editor's comment: SFC reduces exacerbation frequency in high risk patients with severe COPD. Kardos P, et al. Am J Respir Crit Care Med 2007; 175: 144.

慢性閉塞性肺疾患(COPD)に対しては喘息に対するほどステロイド薬が効果がないことが知られているが、著者らは吸入ステロイド薬フルチカゾンとLABAサルメテロールの合剤はサルメテロール単独よりも有効であったとしている。

7. ANTIBIOTIC (AB) TREATMENT OF EXACERBATIONS OF COPD; A RANDOMIZED, CONTROLLED TRIAL COMPARING PROCALCITONIN (P)-GUIDANCE WITH STANDARD THERAPY
Serum levels of P increase rapidly in the presence of infection. Two hundred and eight (208) consecutive COPD patients requiring hospitalization for COPD exacerbation were randomized to P-guided or standard AB therapy. Those receiving P-guided therapy were treated with AB according to serum P levels; standard-therapy patients received AB according to the attending physician. The primary outcome was the AB exposure at the index exacerbation and subsequent AB requirements for COPD exacerbation within six months. Secondary outcomes were clinical recovery, symptom scores, length of hospitalization, need for ICU stay, death, lung function, exacerbate rate, and time to the next exacerbation. P-guidance reduced AB prescriptions (P< 0.0001), AB exposure (RR, 0.56; 95% CI, 0.43 to 0.73; P <0.0001), and permitted significant reduction in total AB exposure for up to 6 months (RR, 0.76; 95% CI, 0.64 to 0.92; P = 0.004). Outcomes at 14 days to 6 months did not differ, neither did the exacerbation rate, re-hospitalization rate or the mean time to next exacerbation. The authors conclude that P-guidance reduces AB use for up to 6 months with a number-needed-to-treat of 3. Editor's comment: P levels seem to indicate whether AB will or will not benefit patients with a COPD exacerbation. Stolz D, et al. Chest 2007; 131: 9.

COPDは感冒罹患時に悪化することがよく知られている。著者らは抗生物質のCOPDに対する効果を検討した。CRPよりも鋭敏で迅速な感染マーカーとして最近よく用いられている血清中のprocalcitonin量測定は抗生物質の不必要な投与を明かに抑制した。しかし、抗生物質はCOPDの症状を抑制しなかった。としている。訳者注:若年層の喫煙率が高い日本では今後COPD患者が増えるが、喫煙率を低くするような研究の方が重要であると思う。COPDという漠然とした病名ではなく日本独自で、喫煙性閉塞性肺疾患(タバコ病)などと改名してアピールした方がよいのでは。医療費税込みタバコ一箱千円を早く実現すべきである。

8. FEATURES OF SEVERE ASTHMA IN SCHOOL-AGE CHILDREN: ATOPY AND INCREASED EXHALED NITRIC OXIDE
This study identified features of severe versus mild-to-moderate asthma in school children by assessing lung function, presence of atopy and airway inflammation. A total of 75 children with asthma had lung volume testing, methacholine challenge, allergy evaluation and offline measures of exhaled nitric oxide (FENO). The severe asthma sub-group (N=39) required high doses of inhalational corticosteroids (ICS). These 39 children had more symptoms, greater airway obstruction, more gas trapping, increased methacholine sensitivity, higher concentrations of FENO, and greater sensitization to aeroallergens. Both the reduction of FEV1 and increased FENO persisted in the severe versus mild-to-moderate group throughout the study. Despite adjustments in ICS, the number of exacerbations was significantly higher in subjects with severe (83%) versus the mild-to-moderate group (43%). Editor's comment: Repeated exacerbations, greater allergen sensitization, increased airflow obstruction, and increased FENO all characterized more severe asthma in children. Fitzpatrick AM, et al. JACI 2006;118:1218.

学童期重症喘息の特徴として、アトピー体質の存在と気道炎症(呼気中NOの増加)が重要な因子としている。

9. EGG (E) ORAL IMMUNOTHERAPY (OIT) IN NONANAPHYLACTIC CHILDREN WITH E ALLERGY
E allergic subjects (positive ingestion hx. within 6 months of beginning the study with a + serum CAP of 7 kU/L or greater (2 kU/L or greater for subjects =2 years) or with a + allergic reaction to E within 6 months of beginning the study without a history of anaphylaxis to E underwent a 24-month E OIT involving modified rush, build-up and maintenance phases. DBPC food challenges were performed at study conclusion and E-specific IgE and IgG concentrations measured. E-specific IgG increased significantly, whereas E-specific IgE did not change in the seven subjects who completed the protocol. All tolerated significantly more E protein than at study onset. Two subjects demonstrated oral tolerance. The authors conclude that allergen-specific OIT to protect subjects with food allergy may represent a significant advancement in treatment. Editor's comment: Double-blind control studies with placebo and E oral therapy are now necessary. Buchanan AD, et al. J Allergy Clin Immunol 2007; 119: 199.

アナフィラキシー症状を示さない卵アレルギー患者に対する経口卵負荷による免疫療法が実施された。前後比較で有意に耐性が得られた。卵白特異的なIgG抗体は増加したがIgE抗体の減少はなかった。などとしている。編集者注:RCTによる比較試験が必要である。訳者注:アナジーにより免疫寛容になった訳ではなく一時的な制御性T細胞の誘導ということであればtoleranceという用語は不適切である。

10. REPEATED MEASUREMENTS OF MITE AND PET ALLERGEN LEVELS IN HOUSE DUST OVER A TIME PERIOD OF 8 YEARS
The authors investigated the variability of house dust mites (Der p 1, Der f 1) and cat (Fel d 1) allergens in Dutch homes. Mite allergen concentrations for the child's mattress, the parents' mattress and the living room floor were moderately correlated between time-points. Agreement was better for cat vs. mite allergens. They conclude that over a period of 4 years, mite and cat allergens measured in house dust are sufficiently stable to use single measurements with confidence in epidemiologic studies. The within home variance was larger when samples were taken 8 years apart, so that over a longer period, repetition sampling is recommended. Editor's comment: Dust mite and pet allergen levels in homes vary little for at least 4 years. Antens CJM, et al. Clin Exp Allergy 2006; 36: 1525.

著者らは家の中のダニ抗原量とネコ抗原量を8年間にわたって測定し続けた。その結果、これらの抗原量の変化は非常に安定で、少なくとも4年間はほとんど不変であった。

11. COMPARATIVE PHARMACOLOGY OF THE H1 ANTIHISTAMINES
This supplement begins with a review of the discovery of histamine and antihistamines. It contains chapters on comparative pharmacology, effects on the cardiovascular system, the central nervous system and their interactions. It concludes with a section on H1 antihistamines and their effects on psychomotor performance and driving. Editor's comment: A complete and excellent review of this subject. del Cuvillo A, et al. J Investig Allergol Clin Immunol 2006; 16: Supplement 1.

抗ヒスタミン薬(H1受容体拮抗薬)に関する薬理学の体系的レビューである。


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.

先月開催された米国アレルギー学会においてWAO共催のWorld Allergy Forumが開催された。全てのスライドが上記ウェブからダウンロードすることができる。

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

インタラクティヴな症例報告が掲載されている。

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 Løwenstein Research Award 2007
The WAO Henning Løwenstein 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 Løwenstein 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

今月の書籍紹介は微生物と免疫に関する本とCollegium Internationale Allergologicumの記録集の2冊である。前者は臨床医から学生まで広く対象となりうるが、後者は最先端の研究者の短い研究報告集であり対象は研究者に限られる。としている。

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. Løwenstein, 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.

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。

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