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WAO News & Notes - May 2007
Volume 4, Issue 5

Medical Journal Review
WAO Now: What's New in the World of WAO
And In Other News . . .

For Information about WAO Travel Grants to WAC 2007 in Bangkok, click here

バンコクにて12月に開催されるWACのトラベルグラントの案内

Visit the World Allergy Organization Exhibit Booth #28 during the XXVI EAACI Congress in Göteborg, Sweden, from 9-13 June 2007 and enter to win a free registration to the World Allergy Congress (WAC) in Bangkok, Thailand, 2-6 December 2007!


Medical Journal Reviews

Prof. Richard F. Lockey, MD, WAO Web Editor-in-Chief, reviewed premier medical journal articles for practicing allergists. 南フロリダ大学ロッキー教授による実地医家向けの医学雑誌レビュー

1. INVARIANT NATURAL KILLER T CELLS (NK) IN ASTHMA (A) AND CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD)
These authors studied the frequency of NK in the airways of subjects with mild (8 not treated with inhaled corticosteroids) and moderate (16 treated with inhaled corticosteroids) A, 10 subjects with COPD and 10 controls. NK were enumerated with flow cytometry with the use of CD1d tetramers loaded with α-galactosylceramide and antibodies specific to the NK receptor in samples of BAL, induced sputum, and bronchial-biopsy specimens. Real-time PCR analysis was performed on bronchoalveolar-lavage cells for evidence of gene expression of the NK receptor. The authors found that fewer than 2% of the T cells obtained from all subjects were similar and no expression of messenger RNA for the NK-receptor domains Vα24 and Vβ11 were present. NK are found in low numbers in the airways of subjects with asthma, COPD, and controls. Editor’s comment: More studies are needed to determine a possible role for NK in asthma. Vijayanand P, et al. N Engl J Med 2007; 356: 1410. Editorial, Ho LP: 1466.

20064月のWAO News & Notesにて、N Engl J Med 2006; 354: 1117.を紹介し、「Akbariらは喘息患者の気管支洗浄液や肺生検試料をもちいて肺に存在するCD3+CD4+T細胞のうち約60%がこのNKT細胞であることを見いだした。正常試料(T細胞の浸潤はほとんどない)やサルコイドーシス患者肺試料で同様にNKT細 胞の有無を調べたが同定できなかった。」ことを記載した。この論文は、従来の喘息病態の概念を覆す画期的なものであったので、世界中で大きな話題になった ことは記憶に新しい。今回は別なグループが同様な手法をもちいて調査したところ、再現性は得られず、喘息患者においてさえも、NKT細胞の割合はT細胞の2%以下であったとしている。このdiscrepancyに関しては、著者およびNEJMの編集者はNKT細胞に特異的な抗体をもちいる際に十分なブロッキング抗体を使用していなかったと推測している。訳者注:ブロッキング抗体の適切な使用は初歩的な技術であり、もし本当にそうであればこのようなことを見逃したNEJM編集担当者の責任は大きいのではないか。サルコイドーシス患者ではAkbariらもNKTの増加は認めていないが、ブロッキング抗体ではこの説明もつかない。訳者が20064月のWAO News & Notes日本語版で記載した批判的なコメントを以下に引用させていただく。「訳者注:従来の報告では喘息患者において増加しているIL-4IL-13を産生するCD3+CD4+細胞はTh2細胞であると考えられていた。そしてTh2細胞はダニなどの抗原に特異的に反応して活性化されると想像されていた。今回の発表は喘息病態として最も本質的な概念を覆すものでまさに世紀の発見といえる。しかし、もし環境中や生体内に存在することが予測される未発見のNKT活性物質により非特異的に多くのNKT細胞が活性化された場合、大量のIL-4IL-13が分泌されるのでIgE抗体が異常に増加するはずである。だが、この論文に記載されている症例のうち、数例はIgE抗体が低値の非アレルギー性喘息のようにみえる。そのような症例では肺にNKT細 胞が集積しているだけで活性化はおきないのであろうか?もし、そうなら、どのような刺激で肺局所に集積し、生存を維持できるのであろうか?アレルギー性鼻 炎鼻粘膜の炎症病態はアレルギー性喘息における炎症病態と近似していることが知られている。他の炎症細胞と同様に鼻粘膜でもNKT細胞の浸潤が認められるのであろうか?そもそもNKT細胞受容体の同定にもちいた抗体は抗原特異的Th2細胞の受容体と交差反応をおこすことはないと断言できるのであろうか?教科書的に認められるためには今後の厳密な検証が必要とされる。

2. OPIATE THERAPY IN CHRONIC COUGH (CC)
27 patients with CC enrolled into a randomized DBPC study using four weeks of slow-release morphine sulfate (MS) 5 mg 2X/day and a corresponding period of matched placebo. An open-labeled extension of the core study allowed dose escalation to MS 10 mg 2X/day. CC was assessed using the Leicester Cough Questionnaire (LCQ), daily symptom diary and citric acid cough challenge (CACC). A significant improvement of 3.2 points over baseline was noted on the LCQ (p < 0.01). A rapid reduction of 40% in CC scores was noted in subjects on slow-release MS ( p < 0.01). CACC test results did not show any significant changes. Two-thirds of the 18 patients in the extension study opted to increase the MS to 10 mg 2X/day, and at the end of three mo, there was a similar improvement in CC between the 5- and 10-mg groups. MS is an effective antitussive in CC at doses of 5 to 10 mg twice daily. Editor’s comment: The risk (side-effects, dependence and sedation) – benefits (decreased cough) have to be weighed when prescribing MS for CC. Morice AH, et al. Am J Respir Crit Care Med 2007; 175: 312.

モルヒネ等のオピオイドが慢性咳嗽に有効であることを示した論文である。徐放性のモルヒネを慢性患者27名にrandomized DBPCにてプラセボと比較し投与したところ大変有用であることが示された。編集者注:効果と依存症などの副作用と天秤にかけて投与する必要がある。

3. OVERWEIGHT, OBESITY, AND INCIDENT ASTHMA–A META-ANALYSIS OF PROSPECTIVE EPIDEMIOLOGIC STUDIES
This is an online bibliographic database search for studies evaluating body mass index (BMI) and incident asthma in adults. Independent observers extracted data from studies meeting predetermined criteria [defined categories of normal weight (BMI < 25), overweight (BMI, 25-29.9), and obesity (BMI ≥ 30)]. Seven studies of 333,102 subjects met inclusion criteria. Overweight and obesity conferred increased odds of incident asthma, with an OR of 1.51 (95% CI, 1.27 – 1.80). A dose-response effect was observed. The observations were present in both men (OR, 1.46; 95% CI, 1.05 – 2.02) and women (OR, 1.68; 95% CI, 1.45 – 1.94; p = 0.232 for the comparison). The authors conclude that overweight and obesity are a dose-dependent risk in the odds of incident asthma. Editor’s comment: This is the best review available indicating that overweight and obesity are risk factors for asthma. Beuther DA, et al. Am J Resp Crit Care Med 2007; 175: 661.

インターネット上で利用できるデータベースを統計処理して、肥満と喘息との関係を解析したシステムレビューである。7つの研究が対象となりえた。体重過多、肥満は喘息のリスクを1.5倍上昇させ、BMIと喘息リスクには正の相関が認められた。編集者注:体重過多や肥満が喘息のリスク因子であることを示した最良の総説である。

4. SAFETY OF ANTI-IMMUNOGLOBULIN E THERAPY WITH OMALIZUMAB (O) IN ALLERGIC PATIENTS AT RISK OF GEOHELMINTH INFECTION (GI)
137 subjects (12 -30 years) at high risk of GI were included in a randomized DBPC trial. All received pre-study anthelminthic treatment followed by 52 weeks’ treatment with O or placebo (P). 50% (34/68) of the O subjects experienced at least one intestinal GI vs. 41% (28/69) of P subjects [OR 1.47, 95% CI 0.74 – 2.95, one-sided p = 0.14; OR (adjusted for study visit, baseline infection status, gender and age) 2.2 (0.94 – 5.15); one-sided p = 0.035], providing some evidence for a potential increased incidence of this form of infection in subjects on this medication. Infection severity and response to anthelminthics appeared to be unaffected by O therapy. The authors conclude in this exploratory study that O therapy may be associated with a modest increase in the incidence of GI. However, such therapy was safe and well tolerated. Editor’s comment: More information is needed to determine whether anti-IgE therapy is associated with an increased risk of intestinal helminth infections. Cruz AA, et al. Clin Exp Allergy 2007; 37: 197.

抗ヒトIgE抗体Omalizumabは、IgE抗体をほぼゼロにする治療法であり、重症の喘息に対して有効であることから、喘息病態におけるIgE抗体の重要性が再評価されている。この研究においては、Omalizumab治療中における寄生虫感染のリスクについてrandomized DBPCにて検討している。その結果、一年間の投与期間中、Omalizumab投与群では寄生虫感染を一度でもおこしたものは50%であったのに対し、プラセボ投与群では42%であり、基礎感染状態などで補正されたオッズ比は2.2倍、有意差0.035であった。訳者注:つまり、IgEは寄生虫防御に有効である。

5. SHORT-COURSE MONTELUKAST (M) FOR INTERMITTENT ASTHMA (IA) IN CHILDREN–A RANDOMIZED CONTROLLED TRIAL
220 children (aged 2 – 14 yr) with IA were randomized in this multicenter, DBPC clinical trial over 12 months, 107 to M and 113 to placebo (P), to determine whether a short course of M in children with IA would modify the severity of an asthma episode. There were 681 treated episodes (345 M, 336 P) provided by 202 patients. The M group had 163 unscheduled health care resource utilizations for A compared with 228 in the P group (OR, 0.65; 95% CI, 0.47 – 0.89). There was a nonsignificant reduction in specialist attendances and hospitalizations, duration of episode, and ß-agonist and prednisolone use. Symptoms were reduced by 14% and nights awakened by 8.6% (p = 0.043), days off from school or childcare by 37% and parent time off from work by 33% (p < 0.0001 for both). The authors conclude that M introduced at the first signs of an A episode results in a modest reduction in acute health care resource utilization, symptoms, time off from school, and parental time off from work in children with IA. Editor’s comment: More studies are necessary to determine the effects of M on viral respiratory tract infections, particularly when M is used to prevent viral infections. Robertson CF, et al. Am J Respir Crit Care Med 2007; 175: 323.

間歇型の小児喘息患者220名に対して、DBPCにおいてモンテルカストを投与したところ、有効であった。編集者注:モンテルカストのウイルス感染を契機とした喘息発作に対する影響について検討すべきである。

6. PREVALENCE OF VIRAL RESPIRATORY TRACT INFECTIONS IN CHILDREN WITH ASTHMA (A)
Respiratory specimens from children aged 2 to 17 years with A exacerbations (case patients, n = 65) and with well-controlled A (control subjects, n = 77), frequency matched by age and season of enrollment, were tested for rhinoviruses, enteroviruses, respiratory syncytial virus, human metapneumovirus, coronaviruses 229E and OC43, parainfluenza viruses 1 to 3, influenza viruses, adenoviruses, and human bocavirus. Respiratory viruses were associated with A exacerbations (63.1% in case patients vs. 23.4% in control subjects; OR, 5.6; 95% CI, 2.7 – 11.6). Rhinoviruses were the most prevalent viruses (60% among case patients vs. 18.2% among control subjects) and the only ones significantly associated with exacerbations (OR, 6.8; 95% CI, 3.2 – 14.5). The authors conclude that rhinoviruses should be a target for therapies as a means to decrease asthma exacerbations. Editor’s comment: This article confirms that rhinoviruses are the most important viruses associated with asthma exacerbations in children. Khetsuriani N, et al. JACI 2007; 119: 31.

2-17歳の小児喘息患者の発作に関するライノ、コロナ、RS, インフルエンザ、パライフルエンザ、エンテロ等のウイルス感染との関係について調査が行われた。その結果、ライノウイルス感染は喘息発作時の60%に検出されたのに対し、コントロールで20%であり、最も、そしてただ一つ有意に発作頻度を上昇させる因子であることが確認された。

7. CORRELATION BETWEEN BRONCHODILATOR RESPONSIVENESS AND QUALITY OF LIFE (QOL) IN CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD)
63 subjects with COPD, mean age 71.7 yr, were investigated to determine the relationship between reversibility and QOL. Post-bronchodilator FEV1, % predicted, was positively correlated with both the total scores of 2 different QOL questionnaires (p < .0001 and p < 0.006). For the most part, reversibility of FVC was also positively correlated. The reversibility of FEV1 was neither correlated with the total score nor any other items in the scales. The authors conclude that patients who have a FVC that respond to a bronchodilator at rest might result in improvement of QOL after Rx. Editor’s comment: Bronchodilators probably improve the QOL in patients with COPD primarily because of increased respiratory function. Omata M, et al. Allergol Internatinal 2007; 56: 15.

Allergology International 2007年に掲載された木田先生のグループからの「治療に反応しやすいCOPD患者は気管支拡張薬で一秒率ではなく肺活量が変化するとの研究成果が紹介されている!!!!

8. ASYMMETRIC T LYMPHOCYTE DIVISION IN THE INITIATION OF ADAPTIVE IMMUNE RESPONSES
Reviewed by Gary Hellermann, Ph.D.
T cell activation through interaction with MHC-peptide at the immunological synapse is the key feature of adaptive immunity, but it is only part of the picture. Activation also produces memory T cells that generate a rapid response when faced with the same antigen. In this intriguing article, the authors hypothesize that polarization of specific proteins between the synapse and the opposite pole in T cells during prolonged contact with antigen-presenting cells results in an asymmetric cell division producing two daughter cells--one an effector T cell bearing markers from the synapse side and the other a memory T cell with markers from the distal pole. Editor’s comment: The reason for the extended interaction between T cells and antigen-loaded dendritic cells appears to be co-generation of effector and memory T cells by asymmetric cell division. Chang JT et al. Science 2007, 315:1687. Editorial, Littman DR, et al.: 1673.

T細胞は樹状細胞と接触する際にエフェクターT細胞とメモリーT細胞へと非対称性細胞分裂をおこすことを示した画期的な論文である。

9. A POOLED ANALYSIS OF FEV1 DECLINE IN COPD PATIENTS RANDOMIZED TO INHALED CORTICOSTEROIDS (ICS) OR PLACEBO (P)
This is a pooled study of patient-level data from seven long-term randomized controlled trials of ICSs vs. P lasting ≥ 12 mo in patients with moderate-to-severe COPD. 3,911 randomized participants (29.2% female) were included in the analysis. In the first six mo after randomization, ICS use was associated with a significant mean (± SE) relative increase in FEV1 of 2.42 ± 0.19% compared with P (p < 0.01). However, from 6 to 36 months, there was no significant difference between P and ICS therapy in terms of FEV1 decline (-0.01 ± 0.09%; p = 0.86). The authors conclude that ICS therapy is more effective in ex-smokers than in current smokers with COPD and that women have larger responses to ICS than men. However, this effect only lasts for approximately six months, and thereafter, does not modify the decline in FEV1. Editor’s comment: Is it possible there are phenotypes within this cohort with reversible airways disease that responds better and over a longer period than others who have minimal or no reversibility? Soriano JB, et al. Chest 2007; 131: 682.

吸入性ステロイド薬のCOPDに対する効果を検討したところ、プラセボに比し、6ヶ月まではより有効であることが示されたがそれ以降は有意差がみられなかった。編集者注:このコホート調査の対象には可逆的な病態をもつサブグループが存在している可能性があるのではないか?

10. EVIDENCE-BASED SELECTION OF INHALED CORTICOSTEROID (ICS) FOR TREATMENT OF CHRONIC ASTHMA
This is an excellent evidence-based article on the published literature comparing various ICSs. There is considerable heterogeneity in the published results on these medications and their efficacy, and side-effects depend on their formulation, dosing, device used, and the subjects’ age, severity of asthma, and inhaler technique. Each medication is reviewed and the pros and cons of using it elaborated upon. The article is 12 pages with 137 citations. Editor’s comment: This is a nice review on a subject of importance to every physician who treats asthma. Abdullah AK, et al. J Asthma 2007; 44: 1

吸入性ステロイド薬の喘息治療に対するエビデンスについて、137の文献をもとにまとめられている優れた総説である。

11. UPDATE IN ASTHMA 2006
Drs. Moore and Peters update asthma 2006. New concepts discussed include long-acting beta-agonists, risk, and the genetics of the β2-adrenergic receptor. They also review the pros and cons of whether early inhalational corticosteroids prevent development of asthma in transient wheezing infants. Anti-tumor necrosis factor-α is discussed as a potential new asthma medication. In addition, gene-environment interactions, pharmacogenomics, endotoxin and ozone, remodeling in asthma (vascular remodeling and remodeling in children), and ADAM33, the gene that best exemplifies the increasing significance of extracellular matrix proteins and mesenchymal cells in asthma pathogenesis, are discussed. Editor’s comment: Great review for physicians who care for patients with asthma. Moore W et al. Am J Resp Crit Care Med 2007; 175: 649.

喘息病態や治療に関する最新情報を記載した総説(雑誌編集者のImpact factor稼ぎといえなくもない)。LABAの副作用、抗TNF療法、遺伝子と環境との相関等について記載されている。



WAO Now: What's New in the World of WAO

allergic disease resource centerNew Synopsis Available
A new synopsis on Pharmacotherapy for Allergic Diseases has been posted on the WAO Web site.  Authored by Dr. Saha Siddiqui, Prof. Peter Bradding, and Prof, Stephen Holgate from the UK, this synopsis reviews currently available therapies for the treatment of allergic diseases, explaining their mechanisms of action, major side effects, and general comments about their use.  To read the synopsis, click here.

新しいsynopsisの紹介。Bradding, Holgateらの共著によるアレルギー疾患の薬理学。


WAO's Allergen Specific Immunotherapy Document
The World Allergy Organization (WAO) convened a group of experts to provide guidelines for the methodology of future immunotherapy studies to ensure that patients are treated based on sound scientific evidence and to minimize the risk of misusing limited financial resources for scientific studies. The document summarizes the recommendations for study design, patients’ selection, appropriate outcomes and statistical treatment to be used in planning and performing clinical trials with specific immunotherapy.

抗原特異的免疫療法に関するWAOのワーキンググループによる見解が紹介されている。

The document was recently published in the March 2007 Issue of Allergy: European Journal of Allergy and Clinical Immunology and is now available to you free from PubMed.

You may also access the document from WAO’s Allergic Disease Resource Center.


New Interactive Case Review

Take a moment to test your knowledge with the new Interactive Case Review based on a Clinical Case Report - ACE Induced Angioedema by Dr. Byol Shin.

Webにおけるインターアクティヴな症例検討の紹介。


Call for Applications

WAO Short-Term Research Fellowship 2007 Applications
The World Allergy Organization (WAO) offers three Short-Term Research Fellowships, to commence in the latter half of 2007, to support junior allergists to visit a center of their choice to learn a research technique. The expected duration of each attachment is 2-3 weeks. WAO will contribute up to a maximum of $2,500 USD, to include travel and accommodations, for each Short-Term Fellowship.

Priority will be given to junior clinicians within five years of award of the most recent professional degree, who are specializing in allergy and who are affiliated to an academic department or clinical institute. Applicants must be current members of a WAO member society.

The Short-Term Fellowships will be applied to a project which meets one of the WAO Research Priorities:

  • Genetic factors involved in the development of allergic disease and response to treatment
  • Allergen characterization and standardization
  • Clinical and basic studies in allergy and asthma

Application forms may be downloaded here

Applications must be received by WAO head office not later than 31 May 2007

The WAO Henning Løwenstein Research Award 2007
The WAO Henning Løwenstein Research Award is a biennial award given to a young scientist who has shown excellence within the field of allergy.  WAO and ALK-Abelló will present the award at the World Allergy Congress in Bangkok, 2-6 December 2007.

WAO Henning Løwenstein賞、賞金は2万ユーロ(300万円強)。

The winner will receive EURO 20,000 together with a travel grant to attend the World Allergy Congress.

alk-abelloFor application guidelines, visit www.alk.abello.com and click on "The WAO Henning Løwenstein Research Award."

Deadline: 30 June 2007


World Allergy Congress (WAC) Travel Grants
WAO, in partnership with Schering-Plough Corporation (SPC), the European Academy of Allergology and Clinical Immunology (EAACI), and the American Academy of Allergy, Asthma and Immunology (AAAAI), is sponsoring several Travel Grants for young scientists to attend WAO’s World Allergy Congress (WAC) in Bangkok, Thailand, 2-6 December 2007. For further information, click here.

バンコクでのWACのトラベルグラントの紹介。


You are invited to attend…

wafWAF Symposium: Immune Tolerance
XXVI EAACI Congress
Tuesday, 12 June 2007, 8:30 - 10:00 
Göteborg Convention Centre, Room K2-K3
Göteborg, Sweden

Chairs: 
Michael A. Kaliner, United States
Anthony J. Frew, United Kingdom

Concepts in tolerance induction in the lung
Dale Umetsu, United States

Modulation of IgE-related diseases in children: atopic asthma as a paradigm
Patrick Holt, Australia

Can omalizumab synergize immunotherapy?
Thomas Casale, United States

World Allergy Forum is supported through an unrestricted educational grant from

novartis

bangkok logo2007 World Allergy Congress Symposium: Masqueraders of Allergic Disease
XXVI EAACI Congress
Tuesday, 12 June 2007, 15:30 – 17:00
Göteborg Convention Centre, Room K2-K3
Göteborg, Sweden

今年のヨーロッパアレルギー学会の紹介(残念ながら日本アレルギー学会と重複)。

Chair: Michael A. Kaliner, United States

Conjunctivitis
Connie Katelaris, Australia

Asthma
Ronald Dahl, Denmark

Rhinosinusitis
Michael A. Kaliner, United States


June Educational Program Placements

gloriaGLORIA Placements

The Asthma and Allergy Society of Virginia
16-17 June 2007
Virginia Beach, Virginia
US GLORIA Faculty:
Ira Finegold
Presentation:
Module 5: Treatment of Severe Asthma

Louisiana Society of Allergy, Asthma & Immunology
23-24 June 2007
New Orleans, Louisiana
US GLORIA Faculty:
Michael Blaiss
Presentations:
Module 2: Allergic Conjunctivitis
Module 5: Treatment of Severe Asthma

GLORIA is supported through unrestricted educational grants from:
alcon
dey
schering-plough


GLORIA Module 5: Treatment of Severe Asthma Now Available!

WAO is excited to announce the completion of the Treatment of Severe Asthma Module, with is now available for download.

seminars and conferencesSeminars & Conferences Placement

Mexican National Congress on Clinical Immunology and Allergy
27-30 June 2007
Cancun, Mexico
WAO Invited Lecturer:
Jay Portnoy
www.cmica.org


esp latin americaEmerging Societies Meeting - Cancun, Mexico
WAO's first Emerging Societies Meeting (ESM) of 2007 will take place during the LXI National Congress of Clinical Immunology and Allergy, 27-30 June 2007 in Cancun, Mexico. The ESM is intended as a follow-up to the ESM that was held in Latin America in 2006 and will include representatives from Honduras, Guatemala, Cuba, El Salvador, Nicaragua and Martinique. This meeting is jointly funded by the American College of Allergy, Asthma and Immunology, the Mexican College of Allergy, Asthma and Clinical Immunology and the World Allergy Organization.

For more information on the Mexican College of Allergy, Asthma and Clinical Immunology’s meeting 27-30 June 2007, please click here.


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

First name
Last (Family) name
Postal address
City, State/Province and postal code
Country
E-mail address
Name of Member Society


And In Other News

Two Allergy Book Reviews

Bronchial Asthma: A Guide for Practical Understanding and Treatment
Edited by: M Eric Gershwin, MD and Timothy E Albertson, MD, MPH, PhD.
ISBN: 1-58829-604-0

List price: $125.00 USD (hardcover and eBook)
$99.50 USD (paperback)
Available from: Humana Press

Reviewer:
Dr David C Sutherland, FRACP
Nineways Specialist Clinic, Broadmeadow, NSW, Australia

Description:
This is the 5th edition of a comprehensive guide to the diagnosis and management of bronchial asthma. Previous editions have been well reviewed in the medical press. The current edition provides an update of recent developments and relatively new drug therapy, along with a greater use of tables and charts, which are deemed to make the book more "user friendly". The coverage of the topic is encyclopaedic, with each chapter, and indeed sections within chapters, written so that they will stand alone. This is both the strength and the weakness of this volume.

Purpose:
The textbook is designed to provide rapid access to practical information regarding the diagnosis and management of bronchial asthma, gleaned from an enormous number of scientific studies and reviews, published over the last thirty years.

Audience:
This volume is designed to provide practical information for generalists, and for specialists other than chest physicians and allergists/immunologists, as at least all clinicians will be required to manage this common condition, as part of the total care of their patients.

Features:
The scope of the book is very comprehensive, ranging from basic immunology and pulmonary physiology, through management issues and specific clinical problems, to lifestyle issues. The format of the book allows rapid access to information, through the use of “key points”, numerous tables and figures, and summaries. Most of the chapters provide comprehensive, and up-to-date lists of references.

Assessment:
This volume succeeds in its aim of providing practical, readily accessible, information about the diagnosis and management of bronchial asthma for those without a specialist interest in the area. However, this format means that the volume is not designed to be read from cover to cover, and even within single chapters, there is a great deal of repetition. This format does allow for the inclusion of a great deal of detailed information which may be of interest to individual clinicians, or perhaps relevant to the management of specific patients, but not necessarily of interest to the general reader. Much of the information (for example epidemiology, drug information, health delivery issues and the management of asthma in "minorities") is directed to the North American audience, and has less relevance to clinicians elsewhere.

Overall, this is a very useful resource text, and should be included in all institutional libraries. The ease of access to detailed information will make it an attractive resource for undergraduate and postgraduate students outside of the areas of respiratory medicine and allergy/immunology.

米国の実地医家向けの喘息治療についてよくまとめられた案内書である。


Oxford Handbook of Clinical Immunology and Allergy

Edited by: Gavin Spickett
ISBN13: 9780198528661
ISBN10: 0198528663

List Price: $45.00 USD
Available from: Oxford University Press

Reviewer:
Thomas Chacko, MD
Division of Allergy and Immunology
University of South Florida College of Medicine, Tampa, FL, USA

Description:
This handy pocket reference is a practical and clinically relevant guide for the diagnosis and management of diseases in clinical immunology and allergy.

Purpose:
It provides the physician and other healthcare professionals with a quick reference and covers a wide range of clinical topics, basic laboratory tests, and the latest advances in the field.

Audience:
The book is geared toward the novice student, sub-specialty resident in allergy and immunology, and other physicians who want a quick reference book for high yield information.

Features:
The pocket handbook is divided into 2 sections. The first section covers clinical diseases, including primary and secondary immunodeficiencies, allergic diseases, autoimmunity, connective tissue diseases, and vasculitis. There are multiple tables within each chapter but few treatment algorithms. Even rare diseases are highlighted with key clinical points. The second section covers diagnostic tests, and summarizes the methodology and pros and cons of each test.

Assessment:
This is an excellent pocket reference for clinical immunology and allergy. The sections are arranged to allow for quick retrieval of key facts. It is small and convenient to carry. Other sources are necessary for a more in depth review of these topics, but this is a good start.

In summary, the Oxford Handbook of Clinical Immunology and Allergy will be particularly helpful to the student or physician who wants a quick convenient resource to retrieve key facts, in a broad range of topics, related to this field.

この本は学生向けのアレルギーと免疫に関する教科書である。

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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Made possible through an unrestricted educational grant from Novartis.