WAO News and Notes - Medical Reviews
Volume 5, Issue 10 Reviews - October 2008
Announcing the WAO Web Site's new look at www.worldallergy.org
Medical Journal Reviews

Prof. Richard F. Lockey, MD, WAO Web Editor-in-Chief, and Guest Editor Mark Glaum, MD PhD, reviewed premier medical journal articles for practicing allergists. Read their top 3 picks below and for the other 6 reviews, click here.

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

1. INHALED CORTICOSTEROID USE IS ASSOCIATED WITH DECREASED CARDIOVASCULAR AND ALL-CAUSE MORTALITY IN ASTHMATIC WOMEN
Inhaled corticosteroid (ICS) use decreases the risk of asthma exacerbations and may decrease all-cause mortality. In the 1970's the Nurses' Health Study (NHS) enrolled 121,700 registered nurses aged 33-55 years. In 1998, asthmatic participants from NHS were sent supplementary questionnaires on asthma diagnosis and ICS use. Mortality was assessed through 2003 and odds ratios (ORs) for death were adjusted for age, asthma severity, smoking, heart disease, cancer, stroke, aspirin and statin use. Of 2671 eligible women who responded to the 1998 survey, 2270 (85%) met criteria for persistent asthma and 1442 (54%) reported ICS use. Compared to asthmatic women who did not use ICS, those receiving ICS therapy had lower risk for all-cause mortality (OR, 0.58; 95% confidence interval [CI], 0.36-0.92) and cardiovascular death (OR, 0.35; 95% CI, 0.13-0.93) but not death from cancer (OR, 0.66; 95% CI, 0.32-1.38) or other causes (OR, 0.62; 95% CI, 0.30-1.27). Editor's comment: ICS may exert anti-inflammatory benefits beyond the airway. Camargo CA, Barr RG, Chen R, Speizer FE. Chest 2008; 134: 546-51.

1970年代に12万人の看護師を対象に実施された同一の調査対象に1998年喘息に関する調査を行った。吸入ステロイド薬の使用は心血管系疾患を含む全て疾患の死亡率の低下と有意に相関していた。

2. SERIAL RHINOVIRUS INFECTIONS IN INFANTS WITH RECURRENT RESPIRATORY ILLNESSES
Acute viral infections are a major cause of respiratory morbidity and asthma exacerbations in infants and young children. This study examines the viral etiology of respiratory illnesses in a subgroup of infants from the Childhood Origins of ASThma (COAST) study, a prospective birth cohort of 300 newborns at increased risk of developing asthma based on family history. Attention was focused on infants who were frequently ill (27 infants out of 285), with five or more moderate-to-severe respiratory illnesses (MSIs) during the first year of life. In frequently ill infants, rhinoviruses were most commonly detected in nasal washes (detected in 61% of cases of moderate-to-severe respiratory illnesses and in 43% of mild illnesses). Rhinovirus infections occurred early in life, with the mean age of four months at first infection. Extended viral syndromes were usually caused by sequential infections with distinct rhinovirus strains, as opposed to a protracted infection with a single strain. Editor's comment: Human rhinovirus infection occurs early, pervasively and repetitively in infants with increased risk for asthma. Jartti J, Lee W-M, Pappas T, et al. Eur Respir J 2008; 32: 314-20.

300名を対象とした喘息ハイリスク群の出生コホート調査の一環としてウイルス感染の調査が実施された。27名の乳児が頻回の5回以上、中等度以上の呼吸器疾患症状を呈し、そのうち61%の原因がライノウイルスであった。ライノウイルス感染は4<ヶ月の乳児から認められた。遷延する呼吸器症状の多くはライノウイルス感染の反復であった。

3. BACTERIAL INFECTIONS IN HUMANS WITH MyD88 DEFECTS
MyD88 is an essential adapter molecule for many Toll-like receptors (TLR) that provides pivotal protection in innate immune defense. This report describes a series of nine children with autorecessive MyD88 deficiency who suffered from life-threatening recurrent pyogenic bacterial infections. While subjects were susceptible to infection with organisms such as Streptococcus pneumoniae, Staphylococcus aureus, and Pseudomonas aeruginosa, they were otherwise healthy with normal resistance to most common bacteria, viruses, fungi and parasites. Susceptibility to bacterial infections tended to improve with age. Editor's comment: MyD88-dependent TLRs provide important but redundant protection against certain pyogenic bacteria. Von Bernuth H, Picard C, Jin Z, et al. Science 2008; 321: 691-6.

MyD88は自然免疫などでToll様受容体などの情報を伝え炎症や免疫反応をおこすために必須の転写因子である。MyD88を遺伝的に欠損している患者は、化膿性疾患以外、常在菌、ウイルス、真菌に対する抵抗力は正常で健康であることがわかった。

4. NONATOPIC CHILDREN WITH MULTITRIGGER WHEEZING HAVE AIRWAY PATHOLOGY COMPARABLE TO ATOPIC ASTHMA
Epidemiologic studies suggest that wheezing in children with infections is transient, while wheezing in atopic children persists into adolescence. This study examined differences in histopathology of airway biopsies from children with atopic and non-atopic asthma. Bronchial biopsies were obtained from 18 non-atopic asthmatic children, 20 atopic asthmatics and 17 non-asthmatic controls. There were no differences in biopsy specimens between atopic and non-atopic asthmatics in regard to epithelial cell loss, basement membrane thickening, angiogenesis, or number of IL-4 and IL-5 positive cells in the subepithelium. Editor's comment: When subjective symptoms of asthma occur in non-atopic children, the airway pathology is still typical of allergic asthma. Turato G, Barbato A, Barlado S, et al. Am J Respir Crit Care Med 2008; 178:476-82. Please see related editorial: Am J Respir Crit Care Med 2008; 178:437.

小児喘息の中にはアトピー感作を受けずにウイルス感染等で頻回に喘鳴を来たす群が存在する。著者らはIgE抗体によるアトピー感作を認める小児喘息と非アトピー型の喘息小児患者の気道生検を行い、その結果、非アトピー型の喘息でもアトピー型の喘息と同様に気道上皮基底膜の肥厚、IL-4陽性細胞、IL-5陽性細胞などの増加を同様に認めた。IgE抗体感作が証明されない非アトピー型の喘息でもTH2型のアレルギー炎症が存在する。

5. AVIAN IGY BINDS TO A MONOCYTE RECEPTOR WITH IGG-LIKE KINETICS DESPITE AN IGE-LIKE STRUCTURE
IgY is an immunoglobulin produced by birds, reptiles and amphibians that is structurally similar to IgE and is thought to protect against parasitic infections. This study finds that binding characteristics of IgY to its receptor are much weaker those of human IgE despite highly homologous structural motifs. Determining reasons for this discrepancy may provide new therapeutic strategies for blocking IgE binding. Editor's comment: Binding affinity of IgE to its receptor may be an attractive therapeutic target for allergic diseases. Taylor AI, Gould HJ, Calvert RA. J Biol Chem 2008; 24: 16384-90. Please see related editorial: Nature Medicine 2008; 14: 797.

鳥類、爬虫類、両生類などに存在する免疫グロブリンIgYは構造的に哺乳類のIgEに似ている.

鳥類のIgY受容体との親和性を検討したところ、鳥のIgYよりもヒトのIgEに高い親和性を認めた。注:IgYの構造を検討することによりアレルギー疾患治療薬の開発が可能になると期待される。

6. DIFFERENTIATION OF HUMAN TH17 CELLS FROM NAÏVE T CELLS
TH17 cells are a subset of interleukin (IL)-17-producing T helper cells thought to contribute to the pathogenesis of a number of human autoimmune diseases. This study examines cytokines required for the production of IL-17A by memory and naive human CD4 T cells. The data demonstrate that transforming growth factor-beta (TGF-β) and IL-21, through the induction of the transcription factor RORC2, are critical for the differentiation of TH17 cells from highly purified naive (but not memory) CD4+ T cells. Editor's comment: This study helps further delineate human TH17 inflammatory responses associated with infection and autoimmune diseases. Yang L, Anderson D, Baecher-Allan C, et al. Nature 2008;454: 350-2.

TH17細胞はIL-17を選択的に分泌するヘルパーT細胞サブセットで、多くの自己免疫疾患の発症に重要な役割を演じている。マウスのTH17細胞のナイーヴT細胞からの分化はTGFβとIL-6が必須である。著者らはヒトTH17細胞のナイーヴT細胞からの分化に必須の因子を検討したところ、TGFβとIL-21、そして転写因子としてはRORC2が不可欠であることを見いだした。

7. HEREDITARY ANGIOEDEMA
Hereditary angioedema (HA) is an autosomal dominant condition caused by deficiency of functional C1 inhibitor. HA is characterized by recurrent episodes of nonpruritic, nonpitting, subcutaneous or submucosal edema involving the face, tongue, larynx, extremities, trunk, or viscera. This report is an excellent case presentation and review of clinical features, laboratory evaluation and treatment of this unusual but clinically challenging condition. Editor's comment: Outstanding updated review of hereditary angioedema. Zuraw BL. N Engl J Med 2008; 359: 1027-36.

NEJMに掲載された遺伝性血管浮腫(常染色体優性形式をとるC1 inhibitorの機能不全)に関する最新情報を含む優れた総説である。

8. ROLE OF BISPHOSPHONATES IN CLINICAL PRACTICE
This excellent review outlines the mechanism of action and appropriate clinical use of bisphosphonates in osteoporosis. Potential complications of bisphosphonate use and the roles of calcium and vitamin D supplementation are discussed. Editor's comment: Persistent asthmatics are at increased risk for side effects from high-dose inhalational and systemic corticosteroids. Asthma specialists should be familiar with appropriate use of bisphosphonates. Drake MT, Clark BL, Khosla S. Mayo Clin Proc 2008: 83:1032-45.

骨粗酒症に対する燐酸塩の投与方法と役割に関する解説論文。

9. PRACTICE PARAMETER: DIAGNOSIS AND MANAGEMENT OF RHINITIS
This supplement to the Journal of Allergy and Clinical Immunology provides graded quality of evidence recommendations for the diagnosis and management of rhinitis. Editor's comment: A must-read for anyone who treats patients with chronic nasal symptoms. Wallace DV, Dykewicz MS, et al. J Allergy Clin Immunol 2008: 122 (suppl 1):1-84

JACIに掲載された鼻炎の診断と治療に関する解説論文である。

World Allergy Congress (WAC) 2009 - Buenos Aires, Argentina,  6-10 December 2009

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Book Review

Dictionary of Contact Allergens
Authors: Lepoittevin, J.-P., Christophe, L.C.
ISBN: 978-3-540-74164-0

今月の単行本紹介は接触アレルギーに関する本である。アルファベット順に並べられた、接触皮膚炎をひきおこす化学物質の構造・特徴などについて簡潔に記載されている。パッチテストに関する章も設けられている。かさばらず持ち運びに便利である。

Available from: Springer
List Price: 29.95 (about $40.00 USD)

Reviewer:
Dr Veronica A Preda, MB BS BSc (Hons)
Conjoint Associate Lecturer, Faculty of Medicine, University of New South Wales, Australia
Sydney South Western Area Health Service Campbelltown Hospital.
Skin & Cancer Foundation Darlinghurst and St Vincent's Hospital.

Description
The Dictionary of Contact Allergens is a concise pocket sized paperback book on the structures of chemicals implicated in contact dermatitis.

Purpose
The purpose of the Dictionary of Contact Allergens is to familiarize the reader with the structures of the chemicals involved in allergic contact dermatitis.

Audience
The intended audience is for physicians involved with the management of patients with contact dermatitis and allergic skin disease. This includes primary care doctors and specialists such as immunologists and dermatologists. In a broader sense it may be of use to clinicians involved in guidelines and caring for patients in an occupational health and safety as well as public health setting.

Features
This book has alphabetized the chemicals involved in contact dermatitis. Listed under the principal chemical name, it contains a description of each molecule together with the Chemical Abstract Service (CAS) registry number which characterizes the substance and its chemical structure. Suggested reading of pertinent related contact dermatitis articles is included with each culprit molecule. The Dictionary of Contact Allergens also contains a chapter on patch testing with the patient's own products providing clinical relevance.

Assessment
This book has several strengths. Lepoittevin and Le Coz have been extremely thorough in detailing the chemical structures and correct names with CAS number of the molecules. The simple layout and concise content makes for a pleasant read. In particular the suggested reading with a short-list of useful articles is a plus. The size of the book is not cumbersome and is functional for a pocket reference.

The primary weakness of this book is in its alphabetization under chemical name. From a clinical stand point, the alphabetization under the principal chemical name makes this book a difficult read and an impractical reference material. In most clinical contexts the exact chemical name will not be known, only the offending item containing multiple possible contact allergens is usually available. Indexing could be better achieved under the products involved in the contact allergy as well as the chemical name. For example, headings could include cosmetics, hair care products, clothing dyes, chemicals in footwear, topical cutaneous therapies used in the medical field, paints, lacquers, adhesive chemicals, etc.

Find more allergy book reviews on the WAO Website here.

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