WAO News and Notes - Medical Reviews
Volume 6, Issue 4 Reviews - April 2009
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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.

Gary Hellerman博士とRichard Lockey教授による今月の医学雑誌レビュー

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

1. Mepolizumab for prednisone-dependent asthma with sputum eosinophilia.a
These researchers treated a group of severe corticosteroid-resistant asthma patients with the IL-5 antibody, mepolizumab (Mep), which blocks the eosinophil-promoting activity of IL-5. The primary outcome was the % of patients in the test group vs. the placebo group who had exacerbations during the 26-week test period. Secondarily, the reduction in prednisone dose relative to the maximum reduction was determined. Spirometry was performed on the subjects and they were asked to fill out the Juniper Asthma Control Questionnaire. Eosinophils in induced sputum were counted. The placebo group (n = 10) experienced 12 exacerbations while the Mep group (n = 9) had one. Mean prednisone dose was reduced from 11.9 to 3.9 mg in the Mep group compared to the placebo group where the dose went from 10.7 to 6.4 mg. Eosinophilia in sputum and blood was significantly reduced by treatment with Mep and there were no significant alterations in blood chemistry. A second paper in this issue of the Journal, Mepolizumab and exacerbations of refractory eosinophilic asthma,b examined Mep therapy for severe eosinophilic asthma and demonstrated a significant reduction in the number of exacerbations and improvement in quality of life. Editor's comment: Although these are relatively small studies, the results are very promising for helping this group of severe asthmatics.
aNair P et al., New Eng J Med 2009; 360:985-993.
bHaldar P et al., op. cit., 973-984.
Also see editorial by Sally Wenzel, pp. 1026-1028
Both studies were funded by an educational grant from Glaxo-SmithKline

抗IL-5抗体mepolizumabにより喀痰中の好酸球は減少したのに喘息の改善がみられなかったというLancet2000年の報告はよく知られている。今回ステロイド抵抗性重症喘息を対象として、プラセボ比較試験をおこなったところ、抗IL-5抗体投与により、前登録しておいたprimary outcomeである喘息発作回数が有意に(12対1)減少していた。訳者注:やはり喘息は症候群であり、細分類して検討しないと有意差が出にくいと思われる。

2. Do childhood respiratory infections continue to influence adult respiratory morbidity?
Viral bronchiolitis during infancy can increase the risk of asthma in young adults, but there are few studies that monitor the effects of childhood respiratory infections on lung function in adults. This meta-analysis examines data from a prior study in which 9,175 individuals, age 20-44 yr, completed questionnaires to provide a family history and previous allergic and respiratory symptoms and underwent lung function testing. The subjects were reinvestigated an average of 8.9 years later. In the initial study, 9.6% reported a serious respiratory infection (SRI) before the age of 5 and in the second study, 2.4% reported being hospitalized for lung disease (HLD) before the age of 2. SRI was associated with increased risk of wheeze and asthma and reduced lung function. Similar results were found for HDL. An even stronger correlation for risk of adult lung disease was found among children with SRI or HLD from households with maternal smoking. Editor's comment: The implication of this study is that severe respiratory infections during the first 3-4 years of life can cause permanent changes to the airway manifesting in lung disease in adulthood.
Dharmage SC et al., Eur Resp J 2009; 33:237-244.

妊娠中の母親の喫煙や小児期の重症呼吸器感染症は成人後の呼吸機能に影響する。

3. Cell-mediated immunity in recent-onset type I diabetic children.
Type I diabetes mellitus (T1DM) is an autoimmune disease caused by destruction of pancreatic beta-cells by specific T lymphocytes. The exact T cell subset involved is unknown, but since immune tolerance is maintained by regulatory T cells (Tregs), primarily of the CD4+CD25+ phenotype, it is logical to suspect that Tregs may also be associated with the pathogenesis of T1DM. In this study, 20 children (4-12 yr old) with T1DM were evaluated for percentages of CD4+, CD8+, CD4+CD25+ and CD8+CD25+ T cells in peripheral blood and compared to a control group. No difference in % of CD4+ T cells or CD4+CD25+ Tregs was seen between diabetic and control groups. The % of CD8+ T cells and CD8+CD25+ Tregs, however, was significantly lower in the diabetics indicating possibly that CD8+ cells have migrated to the pancreas from the blood at this early stage of diabetes. A loss of blood glucose control (as evidenced by the level of hyperglycosylated hemoglobin) was also found in the early-onset diabetics. Editor's comment: This finding of early changes in T lymphocyte populations in T1DM suggests that intervention at this point might alter progression of the disease.
Ibrahim WE et al., Egypt J Pediatr Allergy Immunol 2009; 6:69-76. (Abstract not available)

自己免疫疾患I型糖尿病のT細胞比率について検討した結果、CD4陽性細胞に関しては有意差を認めなかったが、CD8陽性T細胞、CD8陽性CD25陽性の制御性T細胞数が有意に低下していた。

All 12 reviews are posted here.

WAO Journal

World Allergy Organization Journal
April 2009, Volume 2, Issue 4
ISSN: 1939-4551

Editorial
New Initiatives at the WAO Journal.
Rosenwasser, Lanny J.

Original Articles
Desloratadine Therapy Improves Allergic Rhinitis Symptoms in Latin American Children Aged 6 to 12 years.
Tassinari, Paolo; Suárez, Nelson R.; Centeno, Jorge; Vergara Velásquez, Janina; Aguirre-Mariscal, Héctor; González Díaz, Sandra N.; Fernández de Córdova Jerves, Alfredo; and the Latin American Desloratadine Study Group

Clinical Efficacy and Safety of a Combined Loratadine-Betamethasone Oral Solution in the Treatment of Severe Pediatric Perennial Allergic Rhinitis.
Mendoza de Morales, Teolinda; Sánchez, Francis

Differences in the Asthma Treatment of Children between Europe and Japan - A Questionnaire-based Survey Using Model Cases.
Nambu, Mitsuhiko; Holgate, Stephen

Specific Immunotherapy in a Pollen Allergic Patient with HIV Infection.
Steiner, Urs C.; Furrer, Hansjakob; Helbling, Arthur

Letter to the Editor
Curcumin in Stevens-Johnson Syndrome: Culprit or Bystander.
Irani, Cara; Haddad, Fadi; Maalouly, Georges; Nemnoum, Rita

今月のWAOジャーナルは南部、Holgateらによる日欧の喘息診断比較などが掲載されている。

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Additional Journal Reviews
  1. Comparison of weight-loss diets in fat, protein, carbs 炭水化物や脂肪の比率など様々なダイエット法が推奨されているが、結局重要なのは総カロリーで、方法には関係なかった。New Eng J Med, 2009; 360:859-873.

  2. Respiratory pathogens in children with and without respiratory symptoms法などにより呼吸器ウイルスの同定と症状との関係について調査した。ライノウイルスなどは乳児期には症状と比例するが成長するにつれ無症状でも同定されることが多かった。J Pediatr 2009; 154:396-400.

  3. Increase in inflammatory markers from exposure to oligomeric isocyanates イソシアネートNCOは職業喘息の原因としてよく知られている。著者らはNCOは感作によりアレルゲンとして作用する以外に直接炎症をひきおこすことを見いだした。Eur Resp J 2009; 33:494-501.

  4. Glucocorticoid therapy increases COX-2 gene expression in nasal polyps in vivo ステロイドは鼻ポリープ組織のプロスタグランジン合成酵素COX-2遺伝子の発現を増加させた。Eur Resp J 2009; 33:502-508.

  5. Effect of specific allergen inhalation on serum adiponectin in human asthma 喘息患者では脂肪組織由来の抗炎症性サイトカインであるアディポネクチンが有意に低かった。Chest, 2009; 135:287-294.

  6. Comparison of FFNS and FPNS in Japanese cedar pollinosis treatment スギ花粉症患者に対する一日一回のフルチカゾン点鼻は有用であった。Allergy Asthma Proc, 2009; 30:84-94.

  7. Oral SFN increases phase II antioxidant enzymes in human upper airway 抗酸化作用を有するsulforaphane (SFN)を経口投与すると気道の活性酸素レベルは低下した。Clin Immunol 2009; 130:244-251.

  8. Sequence variants affecting EO numbers associate with A and myocardial infarction 網羅的遺伝子SNP解析の結果、IL-33受容体の遺伝子変異は喘息発症との、IL-33などいくつかの遺伝子SNPは好酸球数との相関が認められた。Nature Genetics, 2009; 41:342-347.

  9. Genetic variation in the promoter region of CHI3L1 associated with atopy の遺伝子変異とアトピー喘息発症が相関していた。Am J Resp Crit Care Med 2009; 179:449-456.

World Allergy Congress (WAC) 2009 - Buenos Aires, Argentina,  6-10 December 2009

Abstract Submission and Early Registration Deadline: 11 May 2009

Medical Book Review

今月の書籍は、自然免疫の最新の話題に関するものである。免疫学者、専攻学生、免疫学に興味をもつ医師などが対象である。イラストはあまり多くない。

Book Title
Contributions to Microbiology vol. 15: Trends in Innate Immunity
2008 S. Karger AG
Editors: Arne Egesten, Axel Schmidt, Heiko Herwald
ISSN: 1420-9519

Available from: S. Karger AG
$188 USD

Reviewer:
James J. Yun, MBBS
Immunology Registrar
Campbelltown Hospital
New South Wales, Australia

Description
This book is the 15th volume in the series of "Contributions to Microbiology". Rather than trying to cover all topics in the rapidly evolving field of innate immunity, it attempts to provide an update on some of the key developments. Hence, it is appropriately titled "Trends in Innate Immunity".

Purpose
The purpose of this book is to provide a wide and updated overview on some of the key components of innate immunity. To achieve this, a number of authors around the world with varying expertise ranging from comparative neurobiology and zoology to immunology and microbiology have contributed to this book.

Audience
This book is suitable for immunology students and clinicians; in particular to immunologists, microbiologists and those with an interest in immunology who endeavor to attain an up-to-date knowledge in this rapidly moving field. However, those with little background knowledge in basic immunology may find this book unsatisfactory as it only touches on certain aspects of innate immunity and it assumes that the reader will be familiar with basic immunology.

Features
The book consists of 11 articles with topics that deal with the innate immune system in mammals and invertebrates, pattern recognition receptors, antimicrobial peptides, complement, antibacterial chemokines, neutrophils and monocytes, airway epithelium and aging and impairment of innate immunity. The articles cover topics well, provide a great overview and are excellent updates. The book focuses on selected key developments and consequently other major components of the innate immune system such as NK cells are not mentioned in detail.

This book has a limited number of illustrations. Descriptions of concepts in words are often adequate but sometimes they are hard to visualize. Overall, there is a little discussion in the way of linking the advances in innate immunity to diseases and therapeutics. The emphasis is on host defence against pathogens and little is mentioned of innate immune system's role in non-infectious diseases such as autoimmunity, allergy or cancer./p>

Assessment
This is not a straightforward textbook that deals comprehensively with innate immunity but as a reference that covers certain key topics, it is an excellent update.

Find more allergy book reviews on the WAO Website here.

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