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April Medical Journal Review(医学雑誌レビュー)
WAO Member Society Spotlight(WAO所属学会紹介)
WAO Now: What's New in the World of WAO(WAO最新ニュース)
And In Other News . . .(その他のニュース)

April World Medical Journal Review (医学雑誌レビュー)

Prof. Richard F. Lockey, MD, WAO Web Editor-in-Chief, reviewed premier April medical journal articles for practicing allergists. 南フロリダ大学ロッキー教授による4月の医学雑誌に掲載されたアレルギー関連の文献紹介です。

1. INCREASED GLUCOCORTICOID RECEPTOR ß ALTERS STEROID RESPONSE IN GLUCOCORTICOID-INSENSITIVE ASTHMA
BAL cells of 7 patients with glucocorticoid (GC)-sensitive asthma and 8 patients with GC-insensitive asthma were examined to define the functional role of glucocorticoid receptor (GCR) ß (a splicing variant and dominant negative inhibitor of the classic GCRa) in controlling GCRa nuclear translocation and transactivation at a molecular level. Significantly reduced nuclear translocation of GCRa in response to GC was present in GC-insensitive asthma. These same subjects had significantly increased levels of cytoplasmic and nuclear GCRß. RNA silencing of GCRß mRNA in BAL macrophages from these same subjects enhanced dexamethasone-induced GCRa transactivation. Editor's comment: Measurable differences in GC receptor activity are present in GC-insensitive asthma. Goleva E, et al. Am J Respir Crit Care Med 2006; 173: 607.

グルココルチコイド(GC)による治療に反応する喘息患者とGC治療に反応しにくい喘息患者について、グルココルチコイド受容体(GCR)βの機能について検討した。GCRβは、GCの作用を介在し、シグナルを核に伝えるGCRαのシグナル伝達部位を欠く変異体でGCRαと競合してGCのシグナルを抑制することが知られていた。GC抵抗性喘息症例においては、細胞質内のGCRβの発現が増加し、GCRαの核内移行が減少していることを見いだした。GC抵抗性喘息患者の気管支肺胞洗浄液由来のマクロファージにGCRβ遺伝子mRNAの発現を抑制するRNAiを導入したところ、この細胞のデキサメタゾンに対する反応性が増加した。編集者注:以前からGC抵抗性とGC感受性の患者の違いにGCRβが関与することが報告されていたが、この論文において客観的な評価方法が示された。

2. THE EFFECT OF TELITHROMYCIN IN ACUTE EXACERBATIONS OF ASTHMA
A total of 278 adults with asthma were enrolled within 24 hours after an acute exacerbation requiring short-term medical care. They were randomly assigned to receive 10 days of oral telithromycin 800 mg daily or placebo in addition to usual care. The primary efficacy end points were a change from baseline over the treatment period in symptoms as recorded by the patient and A.M. peak expiratory flow (PEF). Presence of Chlamydophila pneumoniae or Mycoplasma pneumoniae was assed by the polymerase chain reaction and culture. Patients on telithromycin had a significantly greater reduction of symptoms than those on placebo, but no significant difference in A.M. PEF. Sixty-one percent had evidence of infection with C. pneumoniae, M. pneumoniae or both, but there was no relationship between bacteriologic status and response to asthma treatment. Editor's comment: Are C. pneumoniae and, M. pneumoniae important in the pathogenenesis of asthma? Is the effect of telithromycin antibacterial or anti-inflammatory? Is the response to this antibiotic similar to other macrolides? The debate goes on! Johnston SF, et al. N Engl J Med 2006; 354: 1589. Little FF, (editorial), p.1632.

24時間以内に発作を起こした喘息患者278名を10日間telithromycin 投与群、プラセボ投与群に分けて臨床経過やクラミジアやマイコプラズマの存在の有無を観察した。telithromycin 投与群では有意な症状の改善がみられたが、午前中のピークフローの値に有意差はみられなかった。また、61%の患者にクラミジアやマイコプラズマの存在を確認したが喘息症状との関連は認められなかった。編集者注:肺炎マイコプラズマ菌や肺炎クラミジア菌は喘息病態に重要なのか?これらの薬剤は抗菌薬として作用しているのかあるいは抗炎症作用なのか?議論の余地が残る。

3. BUILDING HEALTH: AN EPIDEMIOLOGICAL STUDY OF "SICK BUILDING SYNDROME" (SBS)
SBS was studied in a cross sectional data analysis of the physical environment of a selection of buildings added to individual data from the Whitehall II study -- an ongoing health survey of office-based civil servants. A self-report questionnaire was used to capture 10 symptoms of SBS and psychosocial work stress. In total, 4,052 participants, 42-62 yrs, working in 44 buildings were included in the study. Positive, but non-significant, relations were found with airborne bacteria, inhalable dust, dry bulb temperature, relative humidity, and having some control over the local physical environment. Greater effects were found with features of the psychosocial work environment, including high job demands and low support. Only psychosocial work characteristics and control over the physical environment were independently associated with symptoms in the multivariate analysis. Editor's comment: "Sick Building Syndrome" is a misnomer. This syndrome would be better termed "Building Related Complaints." Marmot AF, et al. Occup Environ Med 2006; 63: 283.

シックハウス(ビルディング)症候群に関する横断的疫学調査全米4052名を対象として実施された。空気中の細菌量や粉塵量、温度、湿度などに正の相関傾向は見られたが有意差は認めなかった。精神的、社会的な特徴に関する身体の健康管理に関する質問事項でのみ有意差が認められた。編集者注:シックハウス(ビルディング)症候群とは間違った命名である。建築物に関する愁訴と命名しなおす方がよい。

4. SAFETY AND IMMUNOGENICITY OF AN INACTIVATED SUBVIRION INFLUENZA A (H5N1) VACCINE.
The authors conducted a multicenter, double-blind, two-stage study involving 451 healthy adults 18-64 yr who were randomly assigned to receive various IM doses of a subvirion influenza A (H5N1) vaccine ("Bird Flu") or placebo. There were no major safety problems and the highest antibody responses were among those subjects who received 45 µg (43 % response) and 90 µg (58% response). Editor's comment: The 58% response is lower than ideal, but good news for a virus which could cause a world-wide flu epidemic. Treanor JJ, et al. N Engl J Med 2006; 345: 1343.

H5N1インフルエンザ(鳥インフルエンザ)不活化ワクチンに関する有効性と安全性についてプラセボとの比較で検討している。その結果、安全性に重大な問題はなく、抗体価の上昇は45μg接種のとき43%に、90μg接種のとき58%に認められた。

5. NEUROPSYCHOLOGICAL AND RENAL EFFECTS OF DENTAL AMALGAM IN CHILDREN and NEUROBEHAVIORAL EFFECTS OF DENTAL AMALGAM IN CHILDREN
Both studies are randomized clinical trials. The first study compares neuropsychological and renal function of children (6 to 10 yrs at baseline) whose dental caries were restored using amalgam or mercury free materials. The second study assesses the safety of dental amalgam vs. resin composite restorations in children, (8 to 10 yrs at baseline). The first study followed patients for 5 yrs and the second for 7 yrs. Both conclude that dental amalgam is safe and does not affect neuropsychological outcomes, renal disease or have any adverse neurobehavioral effects. Editor's comment: This paper concludes that amalgam restorations are safe! Bellinger DC, et al. JAMA 2006; 295: 1775. DeRouen TA, et al. p. 1784.

歯科治療でもちいられるアマルガムの安全性に関する臨床研究である。プラセボと比較して、特に精神的な影響、腎臓病などの巷間での噂のような症状に関しては有意差は見られず、安全であるという結論となった。

6. A META-ANALYSIS OF THE EFFECT OF HIGH WEIGHT ON ASTHMA
A Medline search (1966 to October, 2004), supplemented by a manual search of reference lists and literature, was used for this meta-analysis cohort study that examined high body weight at birth or during childhood and future asthma. The combined results from 4 studies that met inclusion criteria and examined the effect of high body weight during middle childhood on the outcomes of subsequent asthma showed a 50% increase in relative risk (RR 1.5, 95% CI 1.2 to 1.8). The combined results from 9 studies that examined the effect of high birth weight on subsequent asthma had a pooled RR of 1.2 (95% CL 1.1 to 1.3). There was consistency among the studies. Editor's comment: Excessive weight affects many diseases, including asthma. Flaherman V, Rutherford GW. Arch Dis Child 2006; 91: 334.

小児期の肥満(高体重)が喘息の発症と関連するかどうか、過去の文献をメタ解析することにより調査した。その結果、小児期の肥満は、4つの研究成果の総合では1.5倍のリスクが、9つの研究成果を総合した場合は1.2倍のリスクが認められた。編集者注:小児期の肥満は喘息のリスク要因である。

7. DOES ANTIBIOTIC EXPOSURE DURING INFANCY LEAD TO DEVELOPMENT OF ASTHMA? A SYSTEMATIC REVIEW AND META-ANALYSIS?
Eight studies (four prospective and four retrospective) examined the association between exposure to at least one course of antibiotics and development of childhood asthma. The authors conclude that exposure to at least one course of antibiotics during the first year of life seems to be a risk factor for childhood asthma. Likewise, there is a slight dose-response association for each additional course of antibiotics. Editor's comment: Conclusions from this study are consistent with the "hygiene hypothesis." Marra F, et al. Chest 2006; 129: 610.

抗生物質の投与が喘息発症に影響するという8つの論文に関してメタ解析が行われた。その結果、生後一年までの抗生物質の投与は喘息発症のリスク要因であることが確認された。

8. AN EXCELLENT REVIEW ON SEVERE ASTHMA
Asthma is the theme of this issue of the JACI. Articles include: Severe Asthma: An Overview; Understanding the Pathophysiology of Severe Asthma to Generate New Therapeutic Opportunities; Managing Severe Asthma; Severity and Control of Severe Asthma; Update on Glucocorticoid Action and Resistance; Severity, Control, and Responsiveness in Asthma; and Severe asthma. Editor's comment: Although there is some redundancy, these are excellent reviews about the pathophysiology and treatment of severe asthma. Moore WC et al, p-487; Holgate ST et al, p-496; Wenzel S, Szefler SJ, p-508; Bateman ED, p-519; Ito K, et al, p-522; Stoloff SW, Boushey HA, p-544; Foley S, Hamid Q, p-714. J Allergy Clin Immunol 2006; 117:
Severe Asthma: An Overview
Understanding the Pathophysiology of Severe Asthma to Generate New Therapeutic Opportunities
Managing Severe Asthma: No abstract is available.
Severity and Control of Severe Asthma: No abstract is available.
Update on Glucocorticoid Action and Resistance
Severity, Control, and Responsiveness in Asthma
Severe asthma: No abstract is available.

以上のJACIに掲載された論文は重症喘息に関する優れた総説である。

9. INTERESTING COLLECTION OF REVIEW ARTICLES ON DRUG ALLERGY
These articles include: Drug-Induced Hypersensitivity Syndrome (DIHS): A Reaction Induced by a Complex Interplay Among Herpesviruses and Antiviral and Antidrug Immune Responses; Toxic Epidermal Necrolysis and Stevens Johnson Syndrome: Our Current Understanding; Pharmacological Interaction of Drugs with Immune Receptors: The p-i Concept; Immune Mechanisms in Drug Allergy; and Recent Advances in the Development of Anti-allergic Drugs. Editor's comment: Progress is being made to better understand the complexity and pathogenesis of drug allergy. Shiohara T, et al, p-1; French LE, p-9; Pichler WJ, et al, p-17; Roujeau J, p-27; Nagai H, et al, p-35. Allergology International 2006; 55.

訳者注:Allergology Internationalに掲載された薬物アレルギーに関する興味深い総説の特集であると紹介されている。なお、この特集号の編集担当は杏林大学皮膚科の塩原教授である。

10. ANTIINFLAMMATORY EFFECTS OF SALMETEROL/FLUTICASONE PROPIONATE IN COPD
Bronchial biopsies and induced sputum were collected from 140 current and former smokers (mean age, 64 yr) with moderate to severe COPD. They were randomized in a 13-wk, double-blind study to placebo or salmeterol/fluticasone propionate 50/500 µg (n = 67) twice daily. Biopsies were repeated at 12-wk. and sputa at 8- and 13-wk. Combination therapy was associated with a reduction in biopsy CD8+ cells, not CD68+ cells. Sputum differential (but not total) neutrophils reduced progressively. The combination also significantly reduced biopsy CD45+ and CD4+ cells, cells expressing genes for tumor necrosis factor–a and IFN-γ and sputum total eosinophils. Changes were accompanied by a 173-ml improvement in prebronchodilator FEV1. Editor's comment: The combination of salmeterol/fluticasone are anti-inflammatory for COPD. Barnes NC, et al. Am J Respir Crit Care Med 2006; 173: 736.

サルメテロールとフルチカゾンの合剤のCOPDに対する効果について生検材料、喀痰により病理的変化を検討している。対象は平均年齢64歳の喫煙者あるいは以前喫煙していたCOPD患者140名である。プラセボと比較して、CD8陽性細胞、好中球、CD4陽性細胞、IFNγ陽性TNFα陽性細胞が改善し、気管支拡張薬使用前のFEV1も改善した。訳者注:喫煙をやめるべきであろう。

11. REVIEW ARTICLE ON EXTRAPULMONARY EFFECTS OF INHALED NITRIC OXIDE: MECHANISMS AND IMPLICATIONS.
These articles include: The Biological Chemistry of Nitric Oxide as It Pertains to the Extrapulmonary Effects of Inhaled Nitric Oxide; Extrapulmonary Effects of Inhaled Nitric Oxide: Role of Reversible S-Nitrosylation of Erythrocytic Hemoglobin; Immunoregulatory and Antimicrobial Effects of Nitrogen Oxides; Regulation of Respiration and Endothelial Gene Expression by S-Nitrosothiols in Health and Disease; and Summary: Systemic Effects of Inhaled Nitric Oxide. Editor's comment: This is an excellent review on the extrapulmonary effects of inhaled nitric oxide. Gow AJ, p-150; McMahon TJ, Doctor A, p-153; Mannick JB, p-161; Palmer LA, p-166; Gaston B, p-170. Proc Am Thorac Soc 2006; 3.

窒素酸化物NOの吸入が肺以外の病態に与える影響についての興味深い総説である。免疫調節作用や抗菌作用などがあるらしい。


WAO Member Society Spotlight - Latin American Society of Allergy, Asthma and Immunology (SLAAI)

今月のWAOメンバー紹介は中南米アレルギー学会の紹介です。

The Latin American Society of Allergy, Asthma and Immunology (SLAAI) is a non-profit organization that includes 19 National Societies from Latin America and the Iberian Peninsula (Spain and Portugal).

中南米アレルギー学会のメンバーはアメリカ大陸19ヶ国およびスペインとポルトガルにより構成されている。

This year the Latin American Society of Allergy, Asthma and Immunology (LASAAI) will celebrate its 45th anniversary during the XIV Latin American Congress of Allergy, Asthma and Immunology (LACAAI). The LACAAI will be held on 17 – 20 August 2006 in Buenos Aires, Argentina, in collaboration with the XIX Congress of the Argentinean Allergy and Clinical Immunology Association (AACIA). This congress will be the greatest ever scientific meeting in Latin America. The expected attendance is 2,500 participants from not only the region but also from other parts of the world. Spanish is the official language of the congress although many of the sessions will be in English and simultaneous translation into Spanish will be provided.

今年が設立45周年であり、総会がブエノスアイレスにて8月に開催される。

The prevalence of asthma and other allergic disorders is very high in Latin America and is a substantial public health problem; therefore an updated program on allergic disorders for allergy specialists and also for general practictioners, pediatricians, and family doctors is needed. There is a high global burden of allergy and other related disorders, however, regional aspects will be also addressed.

The Scientific Program Committee chaired by Prof. Carlos E. Baena-Cagnani has developed an excellent scientific program that includes discussion on sensitization to universal and regional allergens and specific genetic and environmental factors associated with asthma and atopy in Latin American populations. The following programs will take place during the congress:

  • WAO/ACAAI ESP: World Allergy Organization - Emerging Societies Program
  • WAO GLORIA Symposium (Global Resources in Allergy) 
  • Global Asthma Patients and Physician survey (GAPP)
  • American College of Allergy Asthma and Immunology
  • 1st Argentinean and Latin American Meeting of Pediatric Allergy, Asthma & Immunology

Buenos Aires is the cultural capital of South America. There are many exciting places to visit while you are in Buenos Aires, and the official travel agency has prepared optional tours before and after the congress to unforgettable places such as Iguazu falls, Tierra del Fuego or Perito Moreno Glacier. The incomparably competitive prices for international luxury hotels, restaurants and shopping centers offer an additional attraction to make plans to attend the 14th LACAAI in August 2006.

Additional Information:
LACAI Congress web site: http://www.slaai.org/congreso/
AACIA: www.alergia.org.ar/jornadas
E-mail: latamcong@alergia.org.ar
Moreno 909 (C1091AAS)
Ciudad de Buenos Aires, Argentina
Tel. / Fax: (54-11) 4334-7680 / 4331-7356


WAO Now: What's New in the World of WAO (最新ニュース)

A new synopsis on the Asprin Triad, authored by an international expert in this area, is posted on the WAO Web site this month. To read the latest views on this complex clinical problem, click here.

World Allergy Forum

WAO主催のシンポジウムがヨーロッパアレルギー学会開催期間中の6月11日13:30より開催されます。演者は以下の通りです。

The diagnosis and management of anaphylaxis is a major concern for allergists worldwide. Anaphylaxis has been selected as the topic for the next World Allergy Forum Symposium scheduled for Sunday, 11 June 2006 - 13:30 – 15:15, during the European Academy of Allergology and Clinical Immunology (EAACI), Annual Scientific Meeting, Vienna, Austria.

Michael A. Kaliner, President, WAO and Anthony J. Frew, EAACI President, will chair the program of renowned international speakers.

Life-Threatening Allergy – An Homage to Von Pirquet

Epidemiology of Anaphylaxis
Aziz Sheikh, The University of Edinburgh
Edinburgh, Scotland

Mechanisms of Anaphylaxis
Richard F. Lockey, University of South Florida College of Medicine
Tampa, Florida, U.S.A.

Management of Anaphylaxis
F. Estelle R. Simons, University of Manitoba

Sign up for On-Line Journal Subscription –

WAO and Hogrefe & Huber Publishers are offering a limited number of free on-line 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, on-line subscription, please send an e-mail to info@worldallergy.org, noting "Free Journal Subscription" in the subject line, with the following details:

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And In Other News (その他のニュース)

Allergy Book Review

Applying Genomic and Proteomic Microarray Technology in Drug Discovery
Robert S. Matson
CRC Press, ISBN 0-8493-1469-0

マイクロアレイによる創薬標的の探索に関する本の紹介です。

List price: $119.95
Available from: CRC Press

Reviewer: Gary Hellermann
University of South Florida College of Medicine, Tampa, Florida

Description:
We hear a lot about microarrays as research and diagnostic tools, but they are also utilized in the search for new drugs. Microarrays generate a picture of the molecular processes in a specific cell or tissue and this unique window allows drug researchers to directly see the effects of a test agent. Microarrays are one of those enabling technologies, like the polymerase chain reaction, that open a vast realm of possibilities in medical diagnostics and drug development, and this book provides a comprehensive and practical text for this exciting new field.

内容:マイクロアレイは研究や診断にもちいられる以外に、薬剤開発にも利用され、その可能性が拡がっている。

Purpose:
The purpose of this book is to provide a thorough understanding of the technology of microarrays and to evaluate their usefulness in developing new approaches to biomedical problem-solving.

目的:この本の出版目的はマイクロアレイ技術の理解である。

Audience:
Scientists and pharmaceutical researchers, bioinformaticians and technologists, students and teachers will all find this book a helpful source of information about a field that is rapidly becoming one of the mainstays of medicine now and in the future.

対象:研究者、薬剤開発研究者、バイオインフォーマティクスの専門家、技術者、学生などである。

Features:
The book's 243 pages are divided into six chapters that cover the history, technology and application of DNA and protein microarrays. Each chapter has pertinent references for additional study in specific areas. The chapters are especially well illustrated with diagrams, photos, tables and graphs that highlight the important points and enhance understanding of the text. DNA microarrays are the best-studied system, but protein-based arrays are strong contenders for new uses along with other array types employing antibodies, carbohydrates, small molecules and even cells and tissues. Uses in clinical trials, prediction, diagnosis, prognosis and treatment are practically limitless.

将来展望:マイクロアレイ技術は今後いろいろな分野に広まっていくことが予想される。

Find more allergy book reviews on the WAO Website here.

WAO's mission is to be a global resource and advocate in the field of allergy, advancing excellence in clinical care through education, research and training as a world-wide alliance of allergy and clinical immunology societies. 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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