WAO News and Notes - Medical Reviews
Volume 6, Issue 3 Reviews - March 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 Editor-in-Chief, 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.

今月の臨床実地医家のための医学雑誌レビューの紹介はHellerman博士とLockey教授が担当です。

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

過去の医学雑誌レビューは上記リンクをクリックして下さい。

1. Gene therapy for immunodeficiency due to adenosine deaminase (ADA) deficiency.
Lack of the enzyme ADA causes a fatal severe combined immunodeficiency (SCID). This report presents successful results of transplant of autologous CD34+ cells transfected with a viral vector containing the human ADA gene into ADA-deficient patients pretreated with busulfan as a nonmyeloablative conditioner. The ADA vector (GIADAI) is based on the Moloney murine leukemia virus. The 10 patients were diagnosed with ADA deficiency at a median age of 2 months and underwent gene therapy at a median age of 1.7 years (range, 0.6 to 5.6 yr). The follow-up is 1.8 to 8.0 years and all 10 subjects are alive and pursuing a normal lifestyle. In 8 patients, the blood cells produce ADA normally and there are no signs of toxic purine metabolites. Numbers of T and B lymphocytes increased and immune responses improved. Editor's Comment: This gene therapy involves 10 subjects and the lack of adverse events is encouraging. Aiuti A, et al. New Eng J Med 2009; 360:447-458. (also see the accompanying editorial by DB Kohn and F Candotti, pp. 518-521)

アデノシンデアミナーゼADA酵素欠損は重症複合型免疫不全症SCIDを引き起こすことはよくしられている。著者らは10例のSCID患者に対し、ADAをモロニーマウス白血病ベクターをもちいて遺伝子治療をおこなった結果、副作用もなく有効であったとしている。

2. Long-acting beta agonists (LABAs): a review of formoterol (F) safety data from asthma (A) clinical trials.
Questions about the safety of salmeterol in treating A in combination with other A drugs have precipitated a widespread reexamination of the data from clinical trials of LABAs. This study examines the results of all AstraZeneca trials for deaths involving F categorized as A-related, cardiac-related or other. Comparing patients (n = 49,906) taking F to non-LABA patients (n = 18,098), there were 8 A-related deaths in the former versus 2 in the latter group, but the difference is not significant because the sample size is too small to provide the necessary statistical power. There was no increased risk of cardiac-related death in patients taking F compared to non-LABA patients. There was, however, a significant reduction in severe adverse events in the F group. Editor's comment: There are problems with combining and analyzing data from multiple studies and the jury is still out on the issue of LABA safety. Sears MR et al., Eur Resp J 2009; 33:21-32. (also see the accompanying editorial by Beasley R et al, pp. 3-5)

長時間作動型β2刺激薬フォルモテロールの有効性、安全性に関する検討をAstraZeneca主導の治験例約5万例と他のβ2刺激薬使用例を比較することにより調査した。その結果、喘息死や心症状に関する安全性に関しては有意差がみられなかったが、副作用の発生件数はフォルモテロール群の方が有意に低かった。

3. Pre-emptive use of high-dose fluticasone (FP) for virus-induced wheezing in young children.
The optimal treatment of viral infections in young children to prevent wheezing is not satisfactorily defined. A group of 129 children, age 1 to 6 years, were given a high dose of inhaled FP, 750 µg, or placebo twice a day at the beginning of a respiratory virus infection and continued up to 10 days. Use of rescue oral corticosteroids was the primary outcome with symptom scores, use of beta agonists, hospitalization and change in growth and bone mineral density as some of the secondary metrics. Of the children taking FP, only 8% needed rescue medication in comparison to 18% of the placebo group. Their symptoms were less severe and of shorter duration, and they used less beta agonist and had fewer hospitalizations than in the placebo group; however, the FP group showed a small but significantly reduced height and weight. Editor's comment: The inhibition of growth in the FP group is cause for concern and longer term studies are necessary. Ducharme FM et al., New Engl J Med 2009; 360:339-353.

高用量のフルチカゾンをウイルス感染に伴う喘鳴を来した1-6歳の患児に投与したところ、有意に症状を改善した。しかし、わずかながら身長の伸びの抑制が認められた。

All 10 reviews are posted here.

WAO Journal

March 2009

Review Articles
Asthma and allergic diseases in pregnancy. A review.
Isabella Pali-Schŏll, Erika Jensen-Jarocim, Cassim Motala

Nonallergic Rhinitis, with a Focus on Vasomotor Rhinitis: Clinical importance, differential diagnosis and effective treatment recommendations
Michael Kaliner, Mark D. Scarupa

Letter to the Editor
12-hour-ultrarush-immunotherapy in a patient with mastocytosis and Hymenoptera sting
Doris Jäeger, Barth Jürgen

今月のWAO journalの紹介およびWAO journalへのアクセスの方法(下)。簡単です。

How to Access the
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Additional Journal Reviews

そのほかの今月の医学雑誌レビュー。下線をクリックすると雑誌のページにとびます。

  1. Oral P for preschool children with acute VIW

    経口プレドニゾロンは乳幼児のウイルス喘鳴に対し、無効であったというNEJMからの報告。Lehtinen et al. JACI2007なども一緒に読むと良い。

  2. Adaptive immune features of natural killer (NK) cells

    NK細胞が自然免疫のみならず、メモリー機能を有し獲得免疫にも働くことを示したScienceからの報告。

  3. Childhood asthma and increased airway responsiveness (AR)

    生後何ヶ月の気道過敏性検査により小児喘息の発症を予知できるかに関して調査した結果、12ヶ月以降であった(AJRCCMより)。

  4. HLX1 gene variants influence the development of childhood asthma (A)

    Th1細胞の分化に必須な転写因子T-betと強調する因子HLX1の遺伝子多型の違いが小児喘息の発症と関連していることを示したJACI の論文である。

  5. ICSs vs LABAs in asthma: an observational study

    高用量の吸入ステロイドとLABAとICSの併用を比較した結果、症状の改善にはLABAとの併用がよかった。しかし、大発作による入院回数の減少は高用量ICSの方がよい可能性がある。

  6. Causal direction in association between RSV hospitalization and A

    RSVとその後の喘息発症に関する報告。喘息発症のリスクの高い宿主がRSVによる喘鳴を来しやすいのでは、と推測している。

  7. Special topics on lipid mediators

    浅野浩一郎先生が編集しAllergology Internationalの脂質メディエーターの特集の紹介。

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

WACの演題締め切りは5月11日

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

WACの割引前登録締め切りは月11日(もうすぐ掲載)

Medical Book Review

Handbook of Human Immunology, Second Edition
2008 CRC Press
Editors: Maurice R.G. O'Gorman (The Children's Memorial Hospital, Chicago, Illinois, USA) and Albert D. Donnenberg (Hillman Cancer Center, Pittsburgh, Pennsylvania, USA)
ISBN: 9780849319846

今月の書籍紹介はHandbook of Human Immunology。ハンドブックとはいえ、内容は深く専門的である。一般学生向きではなく、免疫学を専攻する臨床医や学生のための本。

Available from: CRC Press
$189.95 (US)

Reviewer:
Salvador Gala, MB BS PhD

Description
Handbook of Human Immunology provides a useful, up-to-date collection of detailed reviews on specific subjects relating to basic science and clinical laboratory immunology. Individual chapters read as a "state of the art" overview of a particular topic. Altogether, there are 20 chapters dealing with select topics in immunology.

This is a multi-authored text. Most contributors have affiliations to university pathology departments, or else, to university medical departments. Hence, there is a palpable clinical flavor to the subject matter, but predominantly from the point of view of laboratory diagnosis of immunological disease. Even within chapters dealing with basic science, there is often mention of relevance to immunological disease (e.g., clinical applications of cytokine detection or therapy following a review of cytokine function).

Purpose
Handbook of Human Immunology provides the advanced reader with a detailed overview of specific topics in immunological science and clinical diagnosis. The focus is on basic science and laboratory diagnosis.

Audience
Due to the detailed in-depth information provided, this is a book for the advanced level trainee or specialist clinical immunologist wishing to learn about recent advances in basic immunology and laboratory diagnosis. However, readers will still need to consult other sources for specific laboratory protocols. A considerable degree of understanding of basic and clinical immunology is assumed. Basic level trainees and non-specialists will likely struggle with this text.

Not all subjects within the discipline of immunology are equally dealt with, and so the potential reader would do well to consult the table of contents carefully before ordering this volume.

Features
Although there is an adequate index to guide the reader, the text is more a collection of 20 high quality but individual monographs rather than a systemic treatment of the discipline of immunology. References within individual chapters are plentiful and mostly from prior to 2006. One chapter worthy of special praise is that on the Statistics of Immunology Testing, where statistical analysis is considered from an immunological perspective and examples are provided using immunological assays. On the other hand, the editors might wish to reconsider the usefulness of a 49 page chapter on human leukocyte differentiation antigens in future editions: this "current" list of CD molecules will be quickly outdated, and readers could have accessed the information elsewhere. All tables, diagrams and photomicrographs are provided in black and white - whilst this is not a grave impediment to the text, its readability could have been improved by the use of color illustrations (particularly considering this book's cost).

Handbook of Human Immunology is not an introductory textbook on human immunology. As far as basic science is concerned, the focus is generally on recent advances rather than a systematic description of the immune system. Chapters include those on cellular immunology, immunoglobulins, complement and cytokines. There is a special emphasis on flow cytometry, with chapters relating to its utility in hematological malignancy, immunodeficiency and immunosuppression. Also included are chapters on serological and molecular diagnosis of infectious disease, as well as transplantation medicine. Given its importance in routine clinical practice, diagnosis of autoimmune disease appears relatively under-represented in this book. Allergic disease does not feature at all in this volume.

Assessment
Handbook of Human Immunology will be most useful to clinical immunologists and advanced level trainees with a specific interest in laboratory diagnosis. Individual chapters will provide a detailed and up-to-date review of a specific area to specialist physicians already familiar with the subject matter being discussed. Non-specialist physicians or more junior trainees in clinical immunology will likely find the information to be overly detailed and difficult to follow. As a supplement to other standard texts and journals, Handbook of Human Immunology will be of interest to experienced immunologists wishing to extend their understanding of the discipline.

Find more allergy book reviews on the WAO Website here.

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