Juan Carlos Ivancevich, MD, in collaboration with Richard Lockey, MD, the WAO Web Editor-in-Chief, conducted these reviews of premier medical journal articles for practicing allergists. Read their top selections here, and link to the remaining reviews from the menu. You may also visit the Medical Journal Review section of the WAO Web site.

To read translations of past Medical Journal Reviews, click here.

1. Dose-response relationship of inhaled corticosteroids (ICS) and cataracts
A systematic review and meta-analysis is reported of four case-control studies of cataracts and ICS use, with a total of 46,638 cases and 146,378 controls. The primary outcome was risk of cataracts. There was a significant relationship between risk of cataracts and ICS dose, with a random effects pooled odds ratio for risk of cataracts per 1000 µg increase in daily beclomethasone dose of 1.25 (95% CI: 1.14-1.37). The risk of cataracts was increased by approximately 25% for each 1000 µg per day increase in the dose of beclomethasone or equivalent.
Editor's comment: These findings reinforce the importance of prescribing the least amount of an ICS to control asthma and screening for the presence of cataracts in older subjects with asthma and COPD.
Weatherall, M. et al., Dose-response relationship of inhaled corticosteroids and cataracts: A systematic review and meta-analysis, Respirology, 983-990, Published Online August 2, 2009. Abstract

ステロイド吸入薬と白内障との関連について調査した体系的レビューである。結論として一日1000μg使用した場合、リスクが25%増加するとのことであった。訳者注：筆者は以前白内障を患い手術を受けたが、手術は15分で終了し、その後の経過も順調である。白内障のリスクと喘息重症化リスクのバランスをよく考えるべきであろう。

2. Probiotic effects on incidence and duration of cold and influenza-like symptoms (ILS) in children
This DBPC (double-blind, placebo-controlled) study on 326 healthy children (3-5 years) reports on the effects of probiotic consumption during the winter season. Subjects were assigned randomly to receive placebo (N = 104), Lactobacillus acidophilus NCFM (North Carolina Food Microbiology) (N = 110), or L acidophilus NCFM in combination with Bifidobacterium animalis subsp lactis Bi-07 (N = 112), treated twice daily for 6 months. Single and combination probiotics relative to placebo significantly reduced the incidence and duration of fever, cough and rhinorrhea, antibiotic use and days absent from child care.
Editor's comment: Daily dietary probiotic supplementation may be a safe and effective way to reduce cold and ILS symptoms in children 3 to 5 years of age.
Leyer G. et al., Probiotic Effects on Cold and Influenza-Like Symptom Incidence and Duration in Children, Pediatrics, 124(2):e172-e179. Abstract

アレルギー疾患に対するプロバイオティクスの効果に関しての報告は一致しないことも多いが、この報告ではインフルエンザ様症状に対して乳酸菌などのプロバイオティクス製剤が有効であったとしている。メカニズムに関しては検討されていない。

3. Unmet needs in severe chronic upper airway disease (SCUAD)
SCUAD defines patients whose symptoms are inadequately controlled despite optimal, i.e., effective, safe, and acceptable, pharmacologic treatment based on guidelines. These patients have an impaired quality-of-life, social function, sleep, and school/work performance. Severe uncontrolled allergic rhinitis, nonallergic rhinitis, chronic rhinosinusitis, aspirin exacerbated respiratory disease, and occupational airway diseases are defined as SCUADs. The group of experts who wrote this paper believes that SCUADs should be considered differently from mild chronic upper airway diseases. It reviews the state-of- the-art literature, highlighting gaps in knowledge, and proposes several areas for the better understanding, prevention, and management of SCUADs.
Editor's comment: This paper hopefully will prompt the pharmaceutical industry to increase research for SCUAD.
Bousquet J. et al., Unmet needs in severe chronic upper airway disease (SCUAD), JACI 24(3): 428-433. Abstract

喘息などの致死的な下気道疾患に比べ、慢性副鼻腔炎などの慢性重症上気道疾患は軽視されがちである。この総説に関しては慢性重症上気道疾患の治療の必要性について議論している。

All 10 reviews are posted in the literature review section of the WAO website.