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. Clinical and laboratory characteristics of allergic rhinitis and nonallergic rhinitis.
Allergic rhinitis (AR) and nonallergic rhinitis (NAR) are distinguished from one another by the presence of skin test reactivity or allergen specific IgE present in AR, but may have other overlapping clinical and laboratory characteristics. To find additional variables predictive of AR, the authors investigated 1,511 consecutive patients (ages 18-81 years, 56% female) diagnosed with rhinitis. The patients underwent a complete allergic evaluation including skin prick test, blood and nasal eosinophil counts, peak nasal inspiratory flow (PNIF) measurement and evaluation of nasal symptoms using a visual analog scale (VAS). The majority (n = 1,107, 73%) had AR as diagnosed by skin prick test, and 404 (27%) had NAR. AR was associated with higher blood and nasal eosinophil counts, higher PNIF, higher VAS symptoms scores, more sneezing and nasal pruritus, more severe symptoms and recurrent conjunctivitis. Patients with NAR were older and predominantly female and more frequently had nasal obstruction and rhinorrhea, as well as slightly more frequent episodes of recurring headaches and olfactory dysfunction. In a final logistic regression model, 10 variables distinguished AR from NAR: age (odds ratio [OR] 0.97), sneezing (OR 4.09), nasal pruritus (OR 3.84), mild symptoms (OR 0.21), intermittent/severe nasal symptoms (OR 3.66), VAS (OR 1.06), clinical response to antihistamines (OR 22.59), conjunctivitis (OR 4.49), PNIF (OR 1.01) and nasal eosinophil counts (OR 1.14). Receiver operating characteristic analysis showed high predictive accuracy for a model including these variables with a cutoff >0.74, independent of the diagnosis of AR/NAR. These clinical and laboratory parameters may help to reinforce or exclude the diagnosis of AR obtained by skin prick testing.
Editor's comment: Demographic and clinical characteristics in addition to the result of skin prick testing can help distinguish allergic rhinitis from its nonallergic counterpart.
Di Lorenzo G, Pacord ML, Amodioc E et al. Differences and Similarities between Allergic and Nonallergic Rhinitis in a Large Sample of Adult Patients with Rhinitis Symptoms. International Archives of Allergy and Immunology 2011; 155(3):263-270.
Abstract

2. Bacillus Calmette-Guérin (BCG) vaccination and allergy prevention.
Childhood vaccinations can exert an important early influence on the development of the immune system. BCG induces a T-helper 1 stimulatory effect, which alters cytokine response patterns in such a way that the T-helper 2 immunologic response is inhibited, thus antagonizing atopy. This phenomenon has been demonstrated in both animal models and human subjects. On this basis, it has been postulated that BCG vaccination administered in infancy might have a protective effect against the development of atopic diseases. To investigate this hypothesis, the authors performed a systematic review and meta-analysis of the published studies, assessing the association between BCG vaccination in childhood and the risk of developing allergic sensitization, asthma, eczema/atopic dermatitis, allergic rhinoconjunctivitis, and other allergic conditions. In total, 17 published studies met criteria for inclusion in the final analysis. These included 16 epidemiologic investigations and one randomized controlled trial. Analysis of the pooled data revealed no significant evidence for a protective effect of BCG vaccination against the risk of sensitization, as assessed by serum allergen specific IgE or skin prick tests. Furthermore, there was no significant evidence for a protective effect of BCG vaccination against atopic eczema/dermatitis or allergic rhinoconjunctivitis. However, the team did find evidence for a modest protective effect of BCG vaccination against the risk for developing asthma, but they noted that this was unlikely to be due to the prevention of allergic sensitization and could be explained by publication bias. The authors concluded that preschool BCG vaccination does not reduce the risk of allergic sensitization, atopic eczema, or allergic rhinoconjunctivitis. However, its possible role in reducing the risk of some cases of childhood asthma warrants further investigation.
Editor's comment: There is little evidence to indicate that Bacillus Calmette-Guérin (BCG) vaccination against tuberculosis also protects children against the development of allergic disease.
Arnoldussen DL, Linehan M, Sheikh A. BCG vaccination and allergy: A systematic review and meta-analysis. The Journal of Allergy and Clinical Immunology. 2011; 127(1): 246-253.e21.
Abstract

3. Antibiotic exposure before 6 months of age and risk of childhood asthma.
Although an association has been reported between antibiotic use and an increased risk of childhood asthma, respiratory tract infections in small children may be difficult to distinguish from early symptoms of asthma. Some studies may therefore have been confounded by ''protopathic'' bias if antibiotics were used to treat respiratory conditions that were in fact early symptoms of asthma. To clarify these issues, the authors examined the association between antibiotic use within the ?rst 6 months of life and asthma and allergy at 6 years of age. Pregnant women were recruited at 71 clinics from 1997 to 2000; the cohort was designed so that 40% of mothers had asthma. Interviews were conducted within 1 month of delivery and again at the child's sixth birthday (±3 months). Children diagnosed with asthma before 6 months of age were excluded from all analyses with asthma as the outcome. Antibiotic exposure before 6 months of age was associated with an increased risk of asthma after 6 months (adjusted odds ratio [OR] 1.52, 95% con?dence interval [CI]: 1.07, 2.16) or 3 years (OR 1.66, 95% CI: 0.99, 2.79) of age, and increased exposure increased the risk. In children with no history of lower respiratory infection in the ?rst year of life, the OR was 1.66 (95% CI: 1.12, 3.46), supporting the absence of protopathic bias. The adverse effect of antibiotics was most evident in children with no family history of asthma (OR 1.89, 95% CI: 1.00, 3.58). Early antibiotic use was also associated with positive allergy tests.
Editor's comment: The association of antibiotics with asthma risk should encourage physicians to avoid prescribing antibiotics unnecessarily, particularly in children with no genetic predisposition to asthma.
Risnes KR, Belanger K, Murk W et al. Antibiotic Exposure by 6 Months and Asthma and Allergy at 6 Years: Findings in a Cohort of 1,401 US Children. American Journal of Epidemiology 2011; 173(3): 310-318.
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.

This Month in the Journal

World Allergy Organization Journal
March 2011
Volume 4, Issue 3
ISSN: 1939-4551

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

REVIEW ARTICLE

Interleukin-13 Signaling and Its Role in Asthma
Efren L. Rael; Richard F. Lockey

LETTER TO THE EDITOR

Oxymetazoline Hydrochloride Combined With Mometasone Nasal Spray for Persistent Nasal Congestion (Pilot Study)
Efren L Rael; John Ramey; Richard F. Lockey

SYMPOSIUM REPORT SUPPLEMENT

Pharmacology of Antihistamines
Diana S. Church; Martin K. Church
United Kingdom

Challenges in the Management of Chronic Urticaria
Todor A. Popov
Bulgaria

Persistent Allergic Rhinitis and the XPERT Study
Anthi Rogkakou; Elisa Villa; Valentina Garelli; G. Walter Canonica
Italy

Additional Journal Reviews

4. Intranasal corticosteroids for the ocular symptoms of allergic rhinitis.
5. Autoinactivation of human 5-lipoxygenase.
6. Link between skin integrity and the susceptibility to asthma.
7. Diagnosing hypersensitivity to quinolones.
8. The role of osteopontin (OPN) in human asthma.
9. Mechanisms of Streptococcus pneumoniae resistance.
10. MeDALL (Mechanisms of the Development of ALLergy)
11. Asthma endotypes.

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

WAO News & Reviews content is now searchable.

Medical Book Review

Primary Immunodeficiency Diseases: A Molecular and Genetic Approach (Second Edition)
Editors: Hans D. Ochs, C. I. Edvard Smith, Jennifer M. Puck
2007 Oxford University Press
ISBN: 978-0-19-514774-2

List Price: $125.00
Available at Oxford University Press

Reviewer:
Catherine Toong, BMed FRACP FRACP
Department of Immunology
Liverpool Hospital
Liverpool, New South Wales
Australia

Description
This is an excellent reference book encompassing all aspects of primary immunodeficiency diseases (PIDs). The single-volume text contains 48 chapters (726 pages in total), providing a comprehensive update to the first edition published in 1999.

Purpose
This is a book that provides a well-rounded and detailed description of the relevant molecular, genetic and clinical features; together with the diagnosis and treatment of PIDs.

Audience
Clinicians with an interest in PIDs, such as adult and pediatric immunologists and allergists, will find this book valuable. The book would also be invaluable to researchers investigating PID.

Features
The text begins with a perspective of genetically determined immunodeficiency diseases. Subsequent introductory chapters cover the genetic principles and technologies used in the study of PIDs, and the development and function of various facets of the immune system. Thirty-four chapters are devoted to detailed descriptions of each of PIDs (or groups thereof). The chapters are logically presented, containing information on historical aspects, clinical features, laboratory findings, molecular basis, pathophysiology, diagnosis, and treatment. Relevant animal models are discussed. Each chapter concludes with a summary and discussion about future directions. The last five chapters are devoted to general approaches to assessment and treatment of PID.

This is a well-written reference. The contributions are from clinicians and researchers who are pre-eminent in their field. These experts provide descriptions of, and insight into, the features of PIDs that are hard to glean from other sources. Their experience infuses the text, from their explanations of molecular pathogenesis to clinical approaches. Each chapter has a few black-and-white figures and tables, and is fully referenced.

Assessment
This is an excellent reference, a must-read for any clinician treating primary immunodeficiencies. Despite being four years old now, it remains the best and most comprehensive source of information on PID.

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