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WAO News & Notes - June 2007
Volume 4, Issue 6

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

Visit the World Allergy Organization Exhibit Booth #9 Exterior during the LXI National Congress of Clinical Immunology and Allergy, 27-30 June 2007 in Cancun, Mexico 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, and Guest Reviewer Gary Hellermann, PhD, reviewed premier medical journal articles for practicing allergists. 今月の医学雑誌レビューは南フロリダ大学Richard F. Lockey教授の他にGary Hellermann先生が担当している。

Guest Reviewer: Gary Hellermann, PhD

Type 1 diabetes mellitus (DM) is one of the most common autoimmune diseases and researchers have been attempting to circumvent the immune system’s destruction of pancreatic beta cells that characterizes the disease. One promising method is by AHST. This paper reports the results of a clinical trial in which 15 newly diagnosed DM patients, age 14-31 years, were given AHST and the progress of their disease followed for up to 36 months. All but one showed marked improvement as reflected by elevated C-peptide levels and freedom from insulin use. Side effects were neutropenia, alopecia, nausea and, in one case, pneumonia that resolved with treatment. Editor’s comment: Immunointervention in type 1 DM at a young age while there is still a substantial number of beta cells appears to provide significant advantages, but long term side-effects still need to be examined. Voltarelli, JC et al. JAMA 2007; 297:1568.


The April 2007 JACI has multiple reviews and featured articles on allergen immunotherapy. The articles entitled are "Allergen Immunotherapy: Where Is It Now?," "Mechanisms of Allergen-Specific Immunotherapy," "Tradition and Innovation: Finding the Right Balance," and "Sublingual Immunotherapy: The Optimism and the Issues." In addition, there are articles entitled, "Recombinant Allergens For Immunotherapy," "Advances In Upper Airway Diseases and Allergen Immunotherapy," and "Allergic Rhinitis and Its Impact on Asthma Update: Allergen Immunotherapy." Likewise, there are three original articles on immunotherapy which include "Sublingual Immunotherapy With Grass Pollen Is Not Effective In Symptomatic Youngsters In Primary Care," "Update On the Current Status Of Peptide Immunotherapy," and "Successful Sublingual Immunotherapy With Birch Pollen Has Limited Effects On Concomitant Food Allergy To Apple and the Immune Response To the Bet v 1 homolog Mal d 1." Editor’s comment: This issue contains a multitude of articles on allergen immunotherapy and is must reading for the practicing allergist/immunologist. Nelson HS; Akdis M, et al; Durham SR; Pajno GB; Valenta R, et al; Nelson HS; Passalacqua G, et al; Röder E, et al; Larché M; Kinaciyan T, et al. JACI 2007; 119(4).


42 patients were randomized to receive single doses of I (50, 100, 200 and 400 μg) or placebo (P) via a hydrofluoroalkane pressurized metered-dose inhaler in a double-blind crossover study. Using primary efficacy comparisons, the mean percentage increases in FEV1 from placebo (P) and I, 200 and 400 μg, were 7.6 and 14.9%, respectively, at 30 min and 7.5% and 10.4%, respectively, at 21 h post-dose. At these doses, changes in mean FEV1 of I vs. P were significant from 5 min to 24 h, inclusive. I at 400 μg was statistically superior (P < 0.05) to other I doses at most time points. The highest mean differences in FEV1 of I from P were reached at 2-3 h post-dose. Once daily I (200 and 400 μg) provides 24-h bronchodilation, rapid onset, and good tolerability and safety.Editor’s comment: 24-h long-acting bronchodilators are on their way. Beeh KM, et al. Eur Respir J 2007; 29:871.


57 children, 41 allergic mild asthmatics and 16 healthy controls, underwent exhaled air temperature and lung function measurements. The asthmatic children also underwent exhaled nitric oxide (NO) measurement and hypertonic saline sputum induction for eosinophils. Exhaled temperatures were significantly higher in asthmatics than controls (30.18 ± 0.14 ºC vs. 27.47 ± 0.24 ºC (P < 0.001). There was a positive relationship between exhaled air temperature and both NO (r = 0.39; P = 0.01) and % EOS (r = 0.53; P = 0.04). The authors conclude that exhaled breath temperature is related to airway inflammation in asthma. Editor’s comment: Another article indicating that there is correlation between exhaled breath temperature and inflammation in asthma. Piacentini GL, et al. Clin Exp Allergy 2007; 37: 415.

喘息患者の呼気温度は対照と比較し有意に高いことがわかった(30.18 ± 0.14 ºC vs. 27.47 ± 0.24 ºC (P < 0.001)。呼気温度は呼気のNOや好酸球数と相関していた。

23 subjects with asthma and 18 controls had RHML measured in a cross-sectional study using a device that combines temperature and humidity measurements during inspiration and expiration and allows precise control over inspiratory conditions and ventilatory pattern. They also underwent parallel measurements of exhaled NO (eNO), % sputum eosinophilia and exhaled breath condensate pH. Mean ±SD RHML was elevated in asthma (98.1±7.3 J·L-1) vs controls (91.9±4.5 J·L-1). The results correlated with % sputum eosinophilia (r = 0.73, P<0.0001) but not with eNO, EBC pH, FEV1 or FEV1 % predicted. Editor’s comment: Respiratory heat and moisture loss are elevated in patients with asthma. Noble DD, et al. Eur Respir J 2007; 29:676.


This is a randomized, double-blind, placebo-controlled trial of 449 patients with moderate to severe COPD. They were treated for 1 year with T plus placebo (P), T + S, or T + FS. The primary end point was the number who experienced COPD exacerbations that required treatment with systemic steroids or antibiotics. The proportion of patients who experienced exacerbations did not differ in the 3 groups. T + FS improved lung function (P = 0.049) and disease-specific QOL (P = 0.01) and reduced the number of hospitalizations for COPD exacerbation and all-cause hospitalizations [incidence rate ratio, 0.67 (CI, 0.45 to 0.99)] compared with T + P. In contrast, T + S did not statistically improve lung function or hospitalization rates compared with T + P. The authors conclude that FS + T did not influence COPD exacerbation rates but did improve lung function, QOL, and hospitalization rates in patients with moderate to severe COPD. Editor’s comment: The jury is still out as to the best treatment for moderate to severe COPD. Physicians have to individualize treatment of COPD and what is appropriate and cost-effective for one patient may not be so for another. Aaron SD, et al. Ann Intern Med 2007; 146:545. Editorial, Criner GJ: 606.

慢性閉塞性肺疾患COPD治療に対する抗コリン薬の有効性は証明されているが、この研究では、サツメテロールやサルメテロールとフルチカゾン合剤の併用効果について検討している。その結果、喘息とは異なり、COPD治療にはフルチカゾンは有効でないことが示された。編集者注:COPDに対するステロイド薬の効果に関しては審議中(Jury is still out)といえる。医師は患者をよく観察し、COPDの症状により個別化していくことが必要と思われる。

Guest Reviewer: Gary Hellermann, PhD
When T lymphocytes are activated by antigen-presenting cells, they also receive instructions where to go. From the lymphoid tissue, they migrate to the exact area of the body under attack to play their part in the immune response. What are the signals that tell them this and where do they come from? Dendritic cells are the key because they identify the molecular address of the tissue in which the antigen was acquired and pass this information along to the T cell in the form of a pattern of chemokine receptors and cell-adhesion molecules. Editor’s comment: This clearly written review tells the story of how T cells are "educated" to home to a specific tissue address. Ferber, D. Science 2007; 316:191.


Guest Reviewer: Gary Hellermann, PhD
The key molecule that distinguishes a regulatory T cell is the transcription factor, Foxp3, which acts to maintain self-tolerance and suppress an overactive immune response. The molecular basis of Foxp3 function is a hot area of research, and the pieces of the puzzle are quickly falling into place. Suppression of IL-2 production by regulatory T cells is one aspect of Foxp3 control, and this article demonstrates by a masterful series of experiments that control is exerted directly through inhibition of the IL-2 transcription activator, AML1/Runx1 (acute myeloid leukaemia 1/Runt-related transcription factor. Editor’s comment: Foxp3 is the heavy hitter in regulatory T cells and this article adds one more to its list—suppression of IL-2 gene expression. Ono, M et al. Nature 2007; 446:685.


This multi-authored paper reviews airways smooth muscle (ASM) dysfunction and its contribution to the pathophysiology of asthma. It indicates that there is a central role for ASM in the pathogenesis of airway hyperresponsiveness. Editor’s comment: This American Thoracic Society Workshop Report is extremely interesting and an in-depth discussion of the complex issues surrounding ASM and asthma. An SS, et al. Eur Respir J 2007; 29:834.


Osteoimmunology is an interdisciplinary research involving osteology (the branch of anatomy that deals with the structure and function of bones) and immunology. Receptor activator of nuclear factor κB ligand (RANKL), the main regulator of osteoclastogenesis, is the primary culprit responsible for the enhanced activation of osteoclasts and inflammatory diseases, such as occurs in rheumatoid arthritis. Activated T cells directly and indirectly increase the expression of RANKL thereby promoting osteoclastic activity and excessive bone loss in inflammatory and autoimmune diseases and cancer. Indeed, there is more and more evidence that osteoporosis is associated with alterations of the immune system. Other connections have been discovered in osteoimmunology and include the importance of osteoblasts in maintenance of the hematopoietic stem cell niche, lymphocyte development, and the functions of immune cells participating in osteoblast and osteoclast development. Cytokines, chemokines, transcription factors and co-stimulatory molecules are shared by both systems. Editor’s comment: Osteoimmunology is an innovative field and more research is needed to prevent and treat the bone loss which accompanies inflammatory and autoimmune diseases. Rauner M, et al. Int Arch Allergy Immunol 2007; 143:31.

骨免疫学という新たな概念に関する総説である。Receptor activator of nuclear factor κB ligand (RANKL)は破骨を促進し、樹状細胞を介して制御性T細胞を増加させる。骨密度の低下は炎症の増大や自己免疫疾患の増加を招く。

The AAAAI has tracked the U.S. Allergy/Immunology Physician Workforce (AIPW) for the past 30 years. The current report concludes that there is an increase in diversity, training, and that 91% of AIP are board certified. Training programs are slowly increasing and the number of graduates has increased. Patients seen are more complex and less allergen immunotherapy administered. Personal, professional and economic satisfaction of the physician has increased. Even though the number of trainees is increasing, they are not expected to replace the diminishing practitioner supply amid growing U.S. population demand. Editor’s comment: The numbers of trainees are increasing, however, they are not sufficient to meet the increased needs for future care. Marshall GD. JACI 2007; 119:802.


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

allergic disease resource centerNew Synopsis Available - Vasculitis
Vasculitis syndromes are a clinical concern for allergists and clinical immunologists who are likely to be involved in managing hypersensitivity vasculitis; ANCA associated vasculitis, including Wegener’s granulomatosis and Churg-Strauss vasculitis (allergic angitis and granulomatosis); and temporal arteritis. To read an update about the diagnosis and management of these difficult conditions in a new synopsis authored by international expert Dr. Dennis Ledford of Tampa, USA, click here.


WAO’s 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, patient selection, appropriate outcomes and statistical treatment to be used in planning and performing clinical trials with specific immunotherapy.

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.


WAO Conversations
We have the pleasure of announcing two new interviews with well-respected allergists. Take a moment to listen to them share their extensive knowledge.


Ask the Expert – Exclusive Benefit to WAO Members
Ask the Expert
is a new online tool available exclusively to WAO Members. Directed by Professors Cassim Motala and Ruby Pawankar, this online service provides the opportunity to pose educational, scientific and medical questions about allergy, asthma, and clinical immunology to one of the many WAO volunteer experts located throughout the world. We invite all WAO Members to become a part of this online service. To Ask the Expert, click here.

「専門家に聴く」コーナー。Cassim Motala先生とRuby Pawankar先生がon-lineで答えます。

Call for Applications

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 Secretariat no later than 29 June 2007

Long-Term Research Fellowship
The World Allergy Organization (WAO) offers one Long-Term Research Fellowship, to commence in 2008. The Fellowship will support a junior allergist following an approved research program at a WAO proposed host center for up to two years. WAO will contribute a monthly stipend of $1,700 US and once-yearly travel expenses between the home country and the host center.

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 with an academic department or clinical institute. Applicants must be active members of a WAO member society.

The Long-Term Fellowship 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 including a list of host centers may be downloaded here

Applications must be received by WAO Secretariat no later than 30 September 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.

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

WAO Henning Løwenstein研究奨励賞の募集。締め切りは6月30日。

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 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.
Deadline: 5 July 2007


You are invited to attend…

gloriaGLORIA Placements
British Society for Allergy and Clinical Immunology
2-4 July 2007
Loughborough, United Kingdom
International GLORIA Faculty:
Allen P. Kaplan
Module 7: Angioedema

XV Mexican National Congress of Pediatric Allergy and Asthma
21-25 July 2007
Merida, Yuc., Mexico
International GLORIA Faculty:
Bob Q. Lanier
Module 6: Food Allergy
Module 8: Anaphylaxis

International GLORIA is supported through unrestricted educational grants from:
dyax & genzyme
nutricia shs international

seminars and conferencesSeminars & Conferences Placement
Mexican National Congress on Clinical Immunology and Allergy
27-30 June 2007
Cancun, Mexico
WAO Invited Lecturer: Jay Portnoy

esp latin america
Emerging 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 a follow-up to the ESM 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
E-mail address
Name of Member Society

And In Other News

Two Allergy Book Reviews

Mayo Clinic Atlas of Immunofluorescence in Dermatology: Patterns and Target Antigens
By: Amer N Kalaaji

Price: $98.95 USD
Available from: Mayo Clinic Scientific Press

Andrew Bagg, MD
Division of Allergy and Immunology
University of South Florida College of Medicine, Tampa Florida

This Atlas reviews immunofluorescence patterns found in many dermatologic conditions. The direct and indirect immunofluorescence findings and the target antigens are summarized in bullet point format.

The purpose is to provide information to aid in the understanding of the patterns found in immunodermatology. It is designed to present the reader with a review of clinical dermatological diseases and a summary of immunofluorescence findings to facilitate learning and memory recall. It is a valuable resource for those preparing for boards and anyone interpreting immunofluorescence results.

The Atlas targets dermatologists, pathologists, residents, and fellows. It should be used by those preparing for boards and physicians who need to interpret immunofluorescence results to diagnose and treat patients.

The 75 pages cover the major diseases in immunodermatology. Particular attention is given to staining patterns with numerous color photographs on every other page. For each disease there are clinical and direct and indirect immunofluorescence findings and target antigens summarized in an easy-to-follow bullet point format.

The color photographs and informative summaries found in the Atlas provide the student with an understanding of dermatologic immunofluorescence. This book is an excellent resource for review and a convenient visual guide for diseases in immunodermatology.


The Year in Allergy, Volume 3

Editors: S. Hasan Arshad, Stephen T. Holgate

ISBN:1 904392 60 1

List Price: $99.95 USD
Available from: Atlas Medical Publishing

Steven L. Cole, DO
Division of Allergy and Immunology
University of South Florida College of Medicine

This is the third installment of The Year in Allergy series and reviews the most recent research findings over the last two years. Each study reviewed is followed by a discussion of the scientific and clinical relevance of the findings.

The purpose of this book is to provide an overview of the major discoveries in the preceding two years relating to the mechanism, diagnosis, and treatment of allergic disorders. The book is divided into three parts, Epidemiology and Genetics (Part I), Pathophysiology and Diseases (Part II), and Treatment Modalities for Allergic Diseases (Part III).

The target audience includes researchers and clinicians from a wide array of interests in allergic disorders including specialists in allergy and immunology, dermatology, and pulmonology. Experts in these subjects will glean valuable insight into not only their own interests, but also develop potential links to related topics as well.

Each chapter includes an introduction which highlights the salient issues of the subject matter. The original publication reference is provided, and a summary of the methods is included for each paper. All studies reviewed contain an interpretation by the authors that focus on key findings and point out potential weaknesses of the information. Future directions are also discussed within the comments and conclusions section of each chapter.

This is an ever-evolving discipline with numerous papers published each month from a wide array of journals, making it difficult for clinicians and researchers to read and digest all of them in a timely manner. This book succeeds in raising awareness of recent developments in the field of allergy, and it is organized in a manner that holds interest to a diverse group of readers. Clinicians can quickly review subject material directly pertaining to patient care, and researchers have access to critical reviews of the major findings in their field of interest. Although it is impossible to analyze every publication the world has to offer in allergic disorders, the authors of this book have done a tremendous job in the emphasis of papers with the most potential to impact the field.

アレルギーのトピックが記載されたYear in Allergyの紹介。

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


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