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.