Medical Journal Reviews
Prof. Richard F. Lockey, MD, WAO Web Editor-in-Chief, reviewed premier medical journal articles for practicing allergists. Read his top 4 picks below and for the other 10 reviews, click here.
1a. RESCUE USE OF BECLOMETHASONE (B) AND ALBUTEROL (A) IN A SINGLE INHALER FOR MILD ASTHMA
This is a 6-mo double-blind, double-dummy, randomized, parallel-group trial of 455 patients (18 to 65 yrs) with mild asthma [FEV1 of 2.96 liters (88.36% of the predicted value)]. After a 4-week run-in, patients were randomly assigned to one of four regimens: placebo (P) 2X/day plus B, 250 μg, and A, 100 μg, in a single inhaler prn; P 2X/day plus A, 100 μg, prn; B, 250 μg, 2X/day, and A, 100 μg, prn; or B, 250 μg, and A, 100 μg, in a single inhaler 2X/day plus A, 100 μg, prn. Morning PEF during the last two weeks of the 6-mo treatment was higher (P = 0.04) and the number of exacerbations during the 6-mo treatment lower (P = 0.002) in the as-needed combination therapy than in the prn A therapy group. However, the values in the prn combination therapy were not significantly different from regular B therapy or regular combination therapy. The authors conclude that the symptom driven use of prn inhaled B, 250 μg and A, 100 μg, in a single inhaler, is effective treatment and is associated with a lower 6-mo cumulation dose of inhaled corticosteroids. Papi A, et al. N Engl J Med 2007; 356: 2040.
1b. RANDOMIZED COMPARISON OF STRATEGIES FOR REDUCING TREATMENT IN MILD PERSISTENT ASTHMA
500 patients (six yrs or older) with mild asthma, well-controlled with inhaled fluticasone (F), 100 μg 2X/day, were randomly assigned to receive continued F, 100 μg 2X/day, montelukast (M), 5 or 10 mg each night, or F, 100 μg, plus salmeterol (S),50 μg, each night for 16 weeks in a DB study. Treatment failure was the primary outcome. 20% of patients assigned to receive F or F + S failed compared to 30.3% of those on M. The hazard ratio for both comparisons was 1.6 (95% CI, 1.1 to 2.6; P = 0.03). The % of asthma free days was similar across the three groups. The authors conclude that patients controlled with 2X/daily F can be switched to 1X/daily F + S without increased treatment failure. However, a switch to M results in an increased treatment failure and decreased asthma control, even though M treated patients remained free of symptoms on 78.7% of treatment days. Editor’s comment: Three physicians’ comments on various treatment options for mild, persistent asthma are included. One of the experts would use prn B and A in a combined inhaler, another, a leukotriene antagonist plus a prn rescue β-agonist, and the third, once daily inhaled corticosteroid plus a long-acting β-agonist in a single inhaler. William Osler, the Father of American Medicine, stated, “The practice of medicine is an art, based on science”. No single treatment may be absolutely correct to treat mild, persistent asthma. The American Lung Association Asthma Clinical Research Centers. N Engl J Med 2007; 356: 2027.
Clinical Decisions. Kraft M: 2096. Israel E: 2097. O’Connor GT: 2098.
2. REMODELING AND AIRWAY HYPERRESPONSIVENESS (AHR) BUT NOT CELLULAR INFLAMMATION PERSIST AFTER ALLERGEN CHALLENGE IN ASTHMA (A)
Fiberoptic bronchoscopy was performed at baseline, 24 hrs and seven days after allergen inhalational challenge of dual responders with mild-moderate asthma. At each time point, AHR, spirometry, and expression of tenascin (extracellular matrix protein), procollagen I, procollagen III, and heat shock protein (HSP)-47 (markers of collagen synthesis), and α-smooth muscle actin (myofibroblasts) were evaluated as markers of activation of airway remodeling. Likewise, numbers of mucosal major basic protein-positive eosinophils, CD68+ macrophages, CD3+, CD4+, CD8+ T cells, elastase-positive neutrophils, and tryptase-positive mast cells were assayed. AHR was increased from baseline at 24 hrs and seven days after allergen challenge. However, reticular basement membrane tenascin expression, elevated at 24 hrs, returned to baseline levels at seven days. Reticular basement membrane procollagen III expression was significantly elevated at seven days, and procollagen 1, HSP-47, and α-smooth muscle actin were all higher at seven days vs. 24 hrs. Eosinophil, macrophage, neutrophil, and CD3+ T cells increased at 24 hrs but returned to baseline by seven days. The authors conclude that the 24-hr increase after allergen challenge in dual responders with asthma in airway wall cellular inflammation resolves by seven days, whereas increases in AHR and markers of remodeling persist. Editor’s comment: AHR is associated with remodeling and not cellular inflammation. Kariyawasam HH, et al. Am J Respir Crit Care Med 2007; 175: 896.
3. A COMPREHENSIVE ANALYSIS OF ADVERSE OBSTETRIC AND PEDIATRIC COMPLICATIONS IN WOMEN WITH ASTHMA (A)
Outcomes for 37,585 pregnancies of women with A were compared to 243,434 without A. Risks of stillbirth and therapeutic abortion were similar; however, the risk of miscarriage was slightly higher (OR 1.10; 95% CI, 1.06 – 1.13). Risk of placental abruption, placental insufficiency, placenta previa, preeclampsia, hypertension, gestational diabetes, thyroid disorders in pregnancy, and assisted delivery were similar with the exception of increases in antepartum (OR, 1.20; 95% CI, 1.08-1.34) or postpartum (OR, 1.38; 95% CI, 1.21-1.57) hemorrhage, anemia (OR, 1.06; 95% CI, 1.01-1.12), depression (OR, 1.52; 95% CI, 1.36-1.69), and C-section (OR, 1.11; 95% CI, 1.07-1.16). Editor’s comment: Asthma is not a major risk factor in pregnancy. Tata LJ, et al. Am J Respir Crit Care Med 2007; 175: 991.
To read the additional reviews, click here.
WAO Now: What's New in the World of WAO
World Allergy Congress (WAC) 2007 – Bangkok, Thailand
Immunotherapy and Food Allergy Symposiums
Immunotherapy and Food Allergy are two major concerns for the practicing Allergist. To address these important topics in depth, World Allergy Congress in Bangkokwill start, 2 December 2007, with a full day symposium on Immunotherapy, co-sponsored by ALK, Dynavax (in partnership with UCB Pharma), Greer and Stallergens and the final day, 6 December 2007, will be a full day symposium on Food Allergy co-sponsored by Dey LP and Heinz. Our faculty will comprise world experts on each topic, bringing exciting updates on latest developments and debating new therapies. To see the programs for the symposia click here (Immunotherapy) or here (Food Allergy).
WAO – Nycomed International Fellows for 2007-2008
WAO, in partnership with Nycomed, is sponsoring 9 international fellows in order to identify and support up-coming key opinion leaders in asthma and/ or allergic rhinitis. WAO is delighted to announce the nine winners of the WAO-Nycomed International Short-Term Fellowship for 2007-2008. Each fellowship includes a 2-week stay at a research host center, as well as inclusion in the World Allergy Congress (WAC) in Bangkok, Thailand where fellows will have a chance to present posters on their research project at the Fellowship Luncheon. Please join us in congratulating:
Zuzana Rennerová, Slovakia
Damian Tworek, Poland
Mirjana Turkalj, Croatia
Corina Ureche, Romania
Mariana Malucelli, Brazil
Anne Ellis, Canada
Katja Adamic, Slovenia
Paraskevi Xepapadaki, Greece
Thaneshvari Moodley, South Africa
New Educational Postings on the WAO Website
We have the pleasure of announcing a new interview with the President of WAO, Michael Kaliner, MD. Please take a moment to listen to Dr. Kaliner share his extensive knowledge in the 2007 Annual WAO Update.
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.
New Interactive Case Review
Take a moment to test your knowledge with the new Interactive Case Review based on a Clinical Case Report – Acute Parotitis by Dr. Andrew Bagg.
Interactive Case Reviews give you the chance to test your knowledge and make a diagnosis on an unusual case history. The case study is pictorially presented, along with questions and possible diagnoses. Once you select your diagnosis, you immediately learn whether or not your diagnosis corresponds to that of the experts who posted the case, and are able to read the rationale for the diagnosis and suggested treatment provided by the expert.
WAF Materials Available
WAF presenter materials from the recent XXVI Congress of the EAACI are now available for download on the WAF web page.
World Allergy Forum is supported through an unrestricted educational grant from
Call for Applications
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
Upcoming Allergy Meetings
US GLORIA Placement
Alabama Society of Allergy, Asthma and Immunology
August 10-12, 2007
US GLORIA Faculty:
Module 5: Treatment of Severe Asthma
Module 10: Chronic Rhinosinusitis and Nasal Polyposis
GLORIA is supported through unrestricted educational grants from:
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And In Other News
Allergy Book Reviews
Handbook of Atopic Eczema: 2nd edition.
Editors: J Ring, B Przybilla, T Ruzicka
List price: $169.00 USD
Available from: Springer-Verlag
Dr Janet Rimmer, MBBS, MD (UNSW), FRACP
St. Vincent Clinic
Darlinghurst, NSW, Australia
The first edition of this book was printed 15 years ago and this 2nd edition has been extensively revised with the addition of new topics. As atopic eczema affects up to 25% of the population in many countries it is appropriate to have an up to date, in depth textbook on this topic. The title is somewhat misleading in that it provides a very comprehensive review of the topic rather than acting as a “handbook”.
The purpose of the book is to provide an in depth approach to atopic eczema.
Both the usual aspects of atopic eczema are covered as well as some very interesting sections such as ‘Complications and diseases associated with atopic eczema’ as well as ‘diseases rarely associated with eczema’; there is a comprehensive coverage of different therapy approaches eg. music therapy, eczema schools and alternative therapies.
This textbook is targeted primarily to clinicians who have a special interest in this condition, i.e., dermatologist and allergists. While there is a paediatric chapter in the clinical aspect section, this is not repeated in the management section which is an omission as it is an important disease in childhood and there are always specific treatment considerations for this age group.
The format is divided into 3 sections: clinical aspects, pathophysiology and management. There is a synopsis at the end of each section. There are 107 contributors most of whom are based in Europe, with only 3 contributors from the USA. The book is 613 pages and there are 66 chapters divided evenly between the 3 sections. Each chapter is divided into sections, which allows for clear organization of the material, there are reasonable numbers of illustrations and copious references.
This book provides a comprehensive review of a common disease. It brings together many aspects of this disease into one compact source. It is highly recommended for any clinician who has an interest in or treats this condition.
Current Problems in Dermatology, Vol. 33: Biofunctional Textiles and the Skin
Series Editor: G. Burg
Volume Editors: U.-C. Hipler, P. Elsner
List Price: $180.00 USD
Available From: Karger Publishers
James Young Joon Choi, MBBS FRACP
Allergist and Clinical Immunologist
Westmead Hospital Dermatology Registrar
Biofunctional textiles are a new and exciting scientific field established to create fabrics which have the potential to treat or prevent diseases. Much of this update focuses on the area of antimicrobial silver textiles – the biological properties of silver, the new methods of incorporating it into resilient seaweed based fibers, and its anticipated uses in the medical field – from preventing nosocomial infections to treating atopic dermatitis.
This book effectively combines and presents the current state of knowledge on silver antimicrobial fabrics from the perspectives of three disciplines – the microbiologist, the textile engineer, and the dermatologist.
Researchers and clinicians interested in infection control, atopic dermatitis, chronic wounds and burns will find this book a very useful introduction and summary of what is currently possible in antimicrobial textiles.
Each chapter begins with a succinct abstract. Although most figures are in black and white, they are of high quality. Charts and tables are well designed and clearly presented. All chapters conclude with a list of references. The index is detailed and useful. Overall, I felt that although the book could be read from front to cover, each chapter was in its own right self contained and could be read alone or out of order.
This book is an exciting introduction into the rapidly evolving science of antimicrobial textiles. It is a very useful and up-to-date synopsis for any practitioner dealing with atopic dermatitis, and emphasizes what can be possible when there is collaboration between a medical discipline (Clinic for Dermatology and Dermatological Allergology at the Clinic of the Friedrich Schiller University at Jena) and a non-medical industry (the German Textile Research Centre North-West, Krefeld).
Find more allergy book reviews on the WAO Website here.