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

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

Prof. Richard F. Lockey, MD, WAO Web Editor-in-Chief, reviewed premier August medical journal articles for practicing allergists. 南フロリダ大学Richard F. Lockey助教授による8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. DIRECT DETECTION OF BACTERIAL BIOFILMS ON THE MIDDLE-EAR MUCOSA (MEM) OF CHILDREN WITH CHRONIC OTITIS MEDIA (OM)
This study tested the hypothesis that chronic OM in humans is bacterial biofilm-related. MEM biopsy specimens were obtained from 26 children (mean age, 2.5 [range, 0.5-14] yrs) undergoing tympanostomy tube placement for OM with effusion (OME) and recurrent OM. Control biopsies were obtained from 8 subjects undergoing cochlear implantation. Samples were analyzed using microbiological culture, polymerase chain reaction (PCR) – based diagnostics, direct microscopic examination, fluorescence in situ hybridization and immunostaining. Mucosal biofilms were visualized by confocal laser scanning microscopic images using generic and pathogen-specific probes on 46 (92%) of 50 MEM specimens (vs none from controls) from children with OME and recurrent OM. Editor’s comment: The finding of biofilms on biopsy specimens from children with OME and recurrent OM supports the hypothesis of a cause and effect in the pathophysiology of chronic OM. Hall-Stoodley L, et al. JAMA 2006; 296: 202.

バイオフィルムとは細菌などの微生物がその表面に産生する菌体外多糖 (glycocalyx)などから成る物質のことである。バイオフィルムが形成されると生体の感染防御機構や抗菌薬 の侵入が遮断され、菌の緩やかな増殖が持続する(以上、訳者注)。この論文によると、50例の小児の慢性中耳炎、反復性中耳炎のうち46例(92%)の症例で、中耳粘膜より92%にバイオフィルムが検出されたとのことである。

2. ULTRA-RUSH VENOM IMMUNOTHERAPY (VIT) INDUCES DIFFERENTIAL T CELL ACTIVATION AND REGULATORY PATTERNS ACCORDING TO THE SEVERITY OF ALLERGY
The objectives of this study were to assess the early effects of ultra-rush VIT on T lymphocyte activation and regulatory profile induction in 30 vespid-allergic patients according to the four severity grades of the Mueller classification. The authors found that a T helper type 2 (Th2)-to-Th1 switch occurs during ultra-rush VIT, in parallel with a natural and acquired regulatory T cell increase. These immunologic events occur earlier and at a higher level in less severe subjects, suggesting that VIT tolerance induction is easier to achieve in patients with less severe reactions. Editor’s comment: The immunologic changes induced during ultra-rush venom immunotherapy are impressive and easier to achieve in patients with milder vs more severe reactions. Mamessir E, et al. Clin and Exp Allergy 2006; 36: 704.

ハチ毒アレルギーの患者30名において急速減感作療法中の免疫細胞の変動を検討している。これらの患者では急速減感作注射施行中に血清中のIL-4濃度お よびIL13産生T細胞つまりTh2細胞が減少し、IFNγ産生CD3T細胞、すなわちTh1およびTc1細胞が増加した。また、CD4CD25 (high)細胞つまりnTreg細胞、およびIL-10産生CD4陽性細胞つまりiTreg細胞も増加した。これらのT細胞分画の変動のうち、IFNγ 産生T細胞とnTreg細胞は軽症群においてより早期から増加した。訳者注:本研究におけるT細胞分画の変化はハチ毒抗原特異的なはずであるが、T細胞全体の変化としても捉えることが可能であったということは興味深い。

3. CONTROL OF AIRWAY INFLAMMATION MAINTAINED AT A LOWER STEROID DOSE WITH 100/50 μg OF FLUTICASONE PROPIONATE (FP)/SALMETEROL
Eighty-eight subjects, age > 18 yr, who demonstrated improved asthma control after an increase of FP from 100 μg twice daily to 250 μg twice daily were randomized to receive 100/50 μg of FP/salmeterol twice daily or continued FP 250 μg twice daily both through a Diskus inhaler for 24 weeks. Clinical outcomes, bronchial biopsy results, and bronchoalveolar fluid analysis results were similar. The authors conclude that a lower dose of FP with salmeterol versus a higher dose of FP is equally effective in controlling inflammation and asthma symptoms. Editor’s comment: Salmeterol augments the clinical benefits of FP. Jarjour NN et al. J Allergy Clin Immunol 2006; 118: 44.

フルチカゾン吸入FPを250μg(一日あたり)に増量することでコントロール可能であった成人喘息患者88名を対象に、その後、FP100μgにサルメ テロール50μgを併用する群とFP250μgを継続して群に分けて、喘息発作症状や生検組織による気道炎症の程度を比較した。その結果、両群とも等しく 有効であった。

4. SHORT COURSE OF SYSTEMIC CORTICOSTEROIDS (SC) IN SINONASAL POLYPOSIS (SP): A DOUBLE-BLIND, RANDOMIZED, PLACEBO-CONTROLLED TRIAL WITH EVALUATION OF OUTCOME MEASURES
Subjects with symptomatic endoscopically diagnosed SP received prednisolone (P) 50 mg daily for 14 days or placebo in a double-blind, randomized, placebo-controlled trial. The P-treated group showed significant improvement in nasal symptoms (P<.001); Rhinosinusitis Outcome Measure score (P<.001); and reduction in polyp size, as noted with nasendoscopy (P <.001) and MRI (P <.001). Fourteen days of prednisolone 50 mg daily was both safe and effective therapy for SP. Editor’s comment: Medical treatment for SP is effective. Hissaria P, et al. J Allergy Clin Immunol 2006; 118: 128.

臨床症状があり内視鏡により副鼻腔や鼻腔にポリープが存在することが確認された症例に対し、プレドニゾロン50mgを2週間使用したところ対照偽薬群と比較して有意に鼻症状、臨床スコア、ポリープのサイズ、MRI所見が改善した。

5. ANTI-APOPTOTIC FUNCTION OF A microRNA ENCODED BY THE HSV-1 LATENCY-ASSOCIATED TRANSCRIPT
The herpes simplex virus-1 (HSV-1) lies dormant in the peripheral nervous system until reactivated causing cold sores. Just one viral gene is expressed during the latency phase when no virus is produced. The virus produces a microRNA that protects infected neurons from apoptosis or cell death, so that the infection persists until reactivated. Editor’s comment: MiRNAs are not only major regulators of gene expression in mammalian cells but also in HSV-1, providing a hiding place in neurons for this virus. Gupta A, et al. Nature 2006; 442: 82. Editorial by Sugden B, p 33.

単純ヘルペスウイルスは神経細胞に長期間潜伏することがあることはよく知られている。しかし、そのメカニズムに関しては不明であった。著者らは潜伏期間中 にウイルスが神経細胞内にmicroRNAを放出することで感染した神経細胞の細胞死を防いでいることを発見した。

6. SAFETY AND EFFICACY OF SELF-ADMINISTERED SUBCUTANEOUS IMMUNOGLOBULIN (SCIg) IN PATIENTS WITH PRIMARY IMMUNODEFICIENCY DISEASES (PIDD)
This open-label study investigated the efficacy and safety of SCIg (16% IgG) in patients with PIDD. Sixty-five patients entered a three-month, wash-in/wash-out phase, designed to bring patients to a steady-state with SCIg. This was followed by 12 months of weekly SCIg infusions resulting in a mean weekly dose of 158 mg/kg. Mean trough serum IgG levels increased from 786 to 1,040 mg/dL during the study, a mean increase of 39%. The most frequent treatment-related adverse event was an infusion-site reaction, reported by 91% of patients and tolerated by most. Editor’s comment: SCIg is safe, effective and an alternative to IVIg. It should be more cost effective. Ochs HD, et al. J Clin Immunol 2006; 26: 265

先天性免疫不全症に対する免疫グロブリンの皮下自己注射に関して有効性と安全性を検討した論文である。結果は血清IgGレベルは786 〜 1,040 mg/dLに保持され有効であり、局所の腫脹が見られたもののほとんどは軽度のものであったとのことである。なお、編集者のコメントによればもう少しコストが改善されるべきだとしている。

7. THE UNDERRECOGNIZED BURDEN OF INFLUENZA (INF) IN YOUNG CHILDREN (CH)
This population-based surveillance of medical visits associated with laboratory-confirmed INF demonstrated that the average annual rate of hospitalization associated with INF was 0.9 per 1,000 CH (0-6 yr). The estimated burden was 50 clinic visits (CV) and 6 emergency department (ED) visits per 1000 CH during the 2002-2003 season and 95 CV and 27 ED visits per 1,000 CH during the 2003-2004 season. Few CH who had laboratory-confirmed INF were given a diagnosis of INF in the inpatient (28%) or outpatient (17%) settings. Outpatient INF was 10 to 250 times more common than hospitalized INF. Editor’s comment: INF commonly causes respiratory illness in children < 6 yrs. Perhaps all children < 6 yrs should be vaccinated for INF. Poehling KA, et al. N Engl J Med 2006; 355: 31.

幼児期のインフルエンザ感染は過少評価されていることを示した論文である。6歳以下の小児でインフルエンザが証明された感染の頻度は1000例中0.9回であった。編集者注:6歳以下の小児はインフルエンザワクチンを接種すべきである。

8. APHTHOUS ULCERATION
The author outlines an extensive differential diagnosis for recurring mouth ulcers. The etiology for aphthous ulcers remains unknown, but this condition can be quite bothersome and painful. Recommended treatment based on data available from randomized controlled trails includes topical corticosteroids in a paste, 5% amlexanox paste, or treatment with a mouth rinse such as chlorhexidine gluconate. Editor’s comment: Often times patients believe that aphthous ulcers and other mouth lesions are caused by allergy; therefore, it behooves allergists to understand the differential diagnosis and how to treat this common disorder. Scully C. N Engl J Med 2006; 355: 165.

アフタ性口内炎はしばしばアレルギー性と考えられているが原因はよくわかっていない。この論文では種々の臨床試験の結果、ステロイド薬や抗菌薬のペーストなどの既存の治療法が有効であることを確認している。

9. TREATMENT OF CHRONIC RHINOSINUSITIS (CRS) AND ITS EFFECTS ON ASTHMA
This paper reports on the results of 43 patients with CRS with and without nasal polyps and concomitant asthma. Both medical and surgical treatment were associated with subjective and objective improvements in asthma. However, it was better maintained following medical therapy, where improvement could also be demonstrated in the subgroup of patients with nasal polyps. Medical vs. surgical therapy was also superior with respect to a decrease in exhaled nitric oxide and increase in FEV1 in polyp patients. Editor’s comment: This study demonstrates that medical or surgical treatment of CRS improves asthma. Medical treatment seems to be better. Ragab S, et al. Eur Respir J 2006; 28: 68.

慢性鼻副鼻腔炎で鼻ポリープがあり、喘息を合併している患者に手術を施行すると喘息症状、呼吸機能が改善したことを示している論文である。>

10. TOWARDS SUBTLETY: UNDERSTANDING THE ROLE OF TOLL-LIKE RECEPTOR (TLR) SIGNALING IN SUSCEPTIBILITY TO HUMAN INFECTIONS.
There has been a dramatic improvement in understanding the role of innate immunity, in particular, TLR signaling in human host defense. In six pages, these authors brilliantly outline defects in human TLR signaling which enhance susceptibility to infection. The review highlights the mechanisms of infectious susceptibility that result from complex interactions between the genetically variable host and microbe and explores how this knowledge ultimately will translate into better care for patients. Editor’s comment: Abnormalities of the innate immune system, in this case, TLR signaling, are important in clinical medicine. Turvey SE, Hawn TR. Clin Immunol 2006; 120: 1.

自然免疫システムの主役であるToll様受容体の欠損と易感染を示す疾患との関係について簡潔かつ明快に示した総説である。

11. REVIEWS ON ATOPIC DERMATITIS (AD)
The July JACI has a variety of papers on AD. Subjects discussed include: Epidermal barrier dysfunction in AD and gene-environment interaction, genetics of AD, clinical pearls about this subject, a consensus report on AD from the European and American Academies, the vasculature in AD, sleep disturbance associated with AD and its management, innate immune defects in AD, a Rostrum article challenging three prevailing concepts, an original article about "“Loss of function variations within the filaggrin gene predispose for AD", and patient perspectives about AD. Editor’s comment: Progress is being made in understanding and treating this complex vexing medical problem. J Allergy Clin Immunol, July 2006; 118(1)

アトピー性皮膚炎に関するいくつかの総説、バリアー機能の障害、遺伝子と環境などについて、がJACI7月号に特集されている。

12. UPDATE IN GENERAL INTERNAL MEDICINE (IM)
This paper summarizes the major advancements in IM published in 2005 of interest to general practitioners. For example, the herpes zoster virus vaccine is recommended for all immunocompetent patients > to 60 yrs of age. In addition, vitamin D, 800 IU/d, plus calcium supplements are recommended for women at high risk for fracture. Another recommendation to consider is tiotripium bromide therapy for patients with COPD. Physicians also should stop prescribing high dose vitamin E supplements (no benefit) and bisphosphonate therapy (not cost-effective) to prevent fractures in women with osteopenia (T-score between -1.5 and -2.4). Editor’s comment: A wonderful easily understood review of major innovations in medicine for all physicians. Knight CL, Fihn SD. Ann Intern Med 2006; 145: 52.

一般内科学に関するアップデートの情報が記載された総説である。編集者も大変わかりやすく素晴らしいとほめている。


WAO Member Society Spotlight -The CIS Society of Allergology and Immunology

The CIS (Commonwealth of Independent States) Society of Allergology and Immunology is a non-government organization that co-ordinates the activities of medical scientists and public health specialists in Russia and other CIS countries in the field of allergology, immunology and asthma basic research, prophylaxis and management. The Society unites over 4,500 members from 12 CIS countries as well as 15 national and 7 regional societies of allergologists and immunologists. The CIS Society of Allergology and Immunology publishes four journals: "Allergology and Immunology," "Asthma," "International Journal on Immunorehabilitation," and an Abstract Journal "Immunophysiology, Immunorehabilitology, Clinical Immunology and Allergology" (jointly published with the Russian Academy of Sciences). Our Society is the successor of the Soviet Union Immunological Society that was founded in June 1983 with the first Congress held in 1989.

The CIS Society of Allergology and Immunology is a WAO member alongside international and regional organizations such as EAACI, AAAAI, and ACAAI.

Our Society has a wealth of experience in organizing important international congresses and conferences. In 2001, we hosted the I European Asthma Congress in Moscow; in 2003, the XVII World Asthma Congress was held in Saint-Petersburg, and our events in the Bolshoi Theater in 2001 and in Petershoff in 2003 are engraved in the memory of these congress participants.

On September 11-13, 2006, the VI CIS Congress of Immunology and Allergology took place in Moscow. The Opening Ceremony of the Congress included the official presentation of the Russian Edition of Allergy & Clinical Immunology International ・Journal of the World Allergy Organization. It was a very important event for allergists and immunologists in post-Soviet countries and became a reality due to our cooperation with Professor Allen Kaplan, a former President of WAO, and financial support of the project by the Immunology Research Institute of New England (IRINE). We hope that the publication of such a prominent journal in Russian will contribute to further development of allergology and immunology in the CIS countries and improve educational levels of not only allergologists and immunologists but also specialists involved in related fields. It will also promote higher levels of medical care standards in the CIS countries and the implementation of recent research into clinical practice, which is one of the key tasks of our Society. Another important aim of the CIS Society of Allergology and Immunology is to establish a bridge connecting scientists and health care practitioners.

In April 2007, the VII CIS Congress of Allergology and Immunology will take place in Moscow. From April 21 through April 24, 2007, we will have a great chance to host the V European Asthma Congress and the I World Congress on COPD in Moscow. We would be happy to meet allergologists, immunologists, pulmonologists, pediatricians and other health care practitioners from all over the world. Our guests will have an opportunity to visit the most beautiful and famous sights of Moscow such as the Kremlin, the Red Square, the Manezh Exhibition Hall, the Bolshoi Theater, the Pushkin Fine Arts Museum, Christ the Savior Cathedral, Vassily the Blessed Cathedral, the State Tretyakov Gallery complex, the Panorama museum of the Battle of Borodino, the Novodevichy Convent, and the Memorial museum on Poklonnaya Gora.

Provided by: Professor Revaz Sepiashvili, MD, PhD President, CIS Society of Allergology and Immunology E-mail: mailto:info@wipocis.org

今月のWAOのメンバー紹介は、ロシアなど旧ソビエト 連邦の12カ国で形成された緩やかな国家連合体であるCIS (Commonwealth of Independent States)のアレルギー学会の紹介である。9月11-13日にモスクワで学会が記載された


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

US GLORIA Program

米国のGLORIA関連の団体の紹介である。

WAO, in collaboration with the American College of Allergy, Asthma, and Immunology (ACAAI), is excited to launch our first year of the US GLORIA program, which has been developed to promote the mission of both WAO and ACAAI to optimize allergy care in the United States.

Launching this fall, GLORIA modules will be presented at US Regional, State and Local allergy societies for CME credit. Click here if your society is interested in applying for this new program in 2007; the deadline to apply is November 30.

2006 Placements

Northwest Allergy Forum

September 29 – October 1, 2006
Tacoma, Washington
US GLORIA Faculty:
Dr. Richard Lockey
Presentations:
Module 7: Angioedema
Module 8: Anaphylaxis

Los Angeles Society of Allergy, Asthma, and Clinical Immunology, Inc.
October 21, 2006
Brentwood, California
US GLORIA Faculty:
Dr. Michael Kaliner
Presentation:
Module 8: Anaphylaxis

Broward Palm Beach Allergy Society
November, 2006
Boca Raton, Florida
US GLORIA Faculty:
Dr. Phil Lieberman
Presentation:
Module 8: Anaphylaxis

Mid-South Allergy Forum
December 5, 2006
Memphis, Tennessee
US GLORIA Faculty:
Dr. Bob Lanier
Presentation:
Module 4: Immunotherapy

Greater Washington Asthma, Allergy and Immunology Society
December 6, 2006
Tyson's Corner Area, Virginia
US GLORIA Faculty:
Dr. Michael Kaliner
Presentation:
Module 8: Anaphylaxis

Indiana Allergy and Immunology Society
December 9, 2006
Indianapolis, Indiana
US GLORIA Faculty:
Dr. Ira Finegold
Presentations:
Module 4: Immunotherapy
Module 5: The Symptoms and Treatment of Asthma

Emerging Societies Meeting Held in Latin America

ラテンアメリカの学会の紹介である。

An Emerging Societies Meeting, jointly funded by the American College of Allergy, Asthma and Immunology (ACAAI) and WAO, took place on Friday, August 18, 2006, at the Latin American Congress of Allergy, Asthma and Immunology in Buenos Aires, Argentina. The goals of this meeting were to provide outreach in regions where established allergy societies do not exist, improve standards for existing societies and improve standards for research.

National Allergy Society representatives from Latin America were invited to attend, and Allergy Societies that do not currently belong to WAO were asked to give brief presentations on the practice and structure of allergy services in their countries. They were able to identify the most pressing needs related to allergy education in their countries and also provide WAO with a 'wish list' of services that they would like to receive.

Presenters: Nicaragua Guiselle Urbina Palacios Honduras Claudia Almandarez Flores El Salvador Maria Emilia Castro Mendoza Haiti/French Departments of America Sylvie Lafosse-Marin Guatemala Ann-Michelle Rigalt

New on the WAO Web Site
We are pleased to announce a new Interactive Case Review based on a Clinical Case Report published in the ACII-JWAO. "A patient with yellow nails" is presented by Denise M. Kearney and Richard F Lockey. To read the review, then make your diagnosis and learn if you agree with the experts, click here.

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:

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

発展途上国のメンバーはWAOの機関誌であるAllergy & Clinical Immunology International - Journal of the World Allergy Organizationが無料で購読できる。


And In Other News (その他のニュース)

Allergy Book Reviews

今月のアレルギー関連書籍の紹介は2冊ある。一つはマスト細胞と好塩基球に関する書籍で、もう一つは寄生虫とアレルギーに関する書籍である。後者は好酸球研究で有名なMonique Capron氏が編集者の一人となっている。


Mast Cells and Basophils: Development, Activation and Roles in Allergic/Autoimmune Disease
By: Novartis Foundation

List price: $145.00 USD
Available from: Wiley

Reviewer:
Mark C. Glaum, MD, PhD
University of South Florida College of Medicine, Division of Allergy & Immunology

Description:
This book reviews the most recent research on the role of mast cells and basophils in allergic and autoimmune diseases. Topic reviews are followed by discussion among international experts in mast cell and basophil biology.

Purpose:
The purpose is to provide basic researchers or clinicians with a concise, timely review of the factors and mechanisms regulating the growth, differentiation and function of mast cells and basophils. This is en ever-evolving field, therefore periodic updates in this area are needed. Emphasis is placed on new technologies used to study mast cell and basophil function, and attention is focused on how basic scientific observations can be translated into possible therapeutic applications.

Audience:
Discussion is targeted to researchers and clinicians who have an interest in mast cell and basophil biology. Specialists most likely to use this book include allergists, clinical immunologists, rheumatologists, and dermatologists. Clinical and research fellows will also find it to be an excellent review of basic mechanisms of mast cell and basophil growth, differentiation, and activation.

Features:
Each chapter is presented in the format of a topic review, which is followed by specific discussion of the topic among seminar panelists. A general discussion of the presented material is included every 3 to 5 chapters. The topics include: development of mast cells and basophils, IgE-mediated activation of mast cells and basophils, mechanisms of exocytosis, non-IgE-mediated activation and modulation of mast cells and basophils, description of mediators including those that are lipid-derived, proteases, proteoglycans and cytokines. Each chapter is well referenced and participant and subject indexes are included. The compact size of the book makes transport manageable.

Assessment:
This is an excellent review of current research in mast cell and basophil biology. The discussion sections provide unique insight from world-recognized experts in the field. This is an excellent resource for clinicians or basic scientists with an interest in mast cells and related diseases.

PARASITES & ALLERGY
Editors: Capron, M; Trottein, F

List price: $162.00 USD
Available from: Karger

Reviewer:
PETER DEBUSE FRACP, FRCP (LOND.)
ROYAL CHILDREN’S HOSPITAL, BRISBANE, AUSTRALIA

Description:
Since the 1980's, the "hygiene hypothesis" has held sway in explaining the increase in allergic disease in affluent countries and the lack of increase in underdeveloped communities. The basic concept is that T helper cells are stimulated by infections in childhood and that if they are not, a default mode stimulates the T2 helper cells concerned with the allergic process. The allergic process is often considered to have evolved largely as a measure to counter the gut infestation by protozoan parasites. Where community parasite infestation is high, epidemiologic studies show that the incidence of allergic diseases is lower than in communities with low parasite infestation.

The editors have assembled twelve reviews which address the complicated cellular signaling mechanisms that are involved in the phenomenon, allowing the authors to discuss the anomalies in the basic "hygiene hypothesis" and speculate on the implications for associated T1 disease states such as inflammatory bowel disease and diabetes Type 1. Nearly all the reviews use the example of schistosomiasis in their discussion, probably because of the massive and widespread prevalence in the developing world. The biology of intestinal Helminths is dealt with not only in terms of the life cycle but also in evolutionary significance.

Purpose:
These reviews provide an up-to-date and informative discussion on signaling, proteases, and glycans as promoting molecules, the nature of white cells (natural killer, mast cells, and basophils) and importantly on Regulatory T cells.

Audience:
I found this a fascinating book and anyone interested in biology will enjoy it. Naturally immunologists and allergists are a target audience, but general physicians – both adult and paediatric – will be interested in the speculations on novel methods of controlling inflammatory/allergic diseases.

Features:
The multifaceted approach to unraveling the molecular basis is well organized by the Editors so that there is a layered wealth of detail and a good deal of consensus. The tables and figures are clear and the references numerous.

Assessment:
An excellent book which deals with the very basis of the allergic state. Interestingly, laboratory rodents feature in the experimental data; large domestic animals that are regularly wormed to rid them of intestinal parasites are not mentioned – just wondering?

Find more allergy book reviews on the WAO Website here.

The World Allergy Organization's mission is to build a global alliance of allergy societies to advance excellence in clinical care, research, education and training. 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。

World Allergy Organization (WAO)
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Email: info@worldallergy.org

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Made possible through an unrestricted educational grant from Novartis.