WAO Email News and Notes

Volume 6, Issue 10 Reviews - October 2009

Your global community of learning and practice for allergy, asthma and immunology! www.worldallergy.org

Medical Journal Reviews

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 three picks 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. EAACI/GA²LEN/EDF/WAO guideline: definition, classification and diagnosis of urticaria
This guideline, together with its sister guideline on the classification of urticaria, is the result of a consensus reached during a panel discussion at the Third International Consensus Meeting on Urticaria, a joint initiative of the European Academy of Allergy Asthma and Immunology (EAACI), the EU-funded network of excellence, GA²LEN, the European Dermatology Forum (EDF) and the World Allergy Organization (WAO). Urticaria has a profound impact on the quality of life; therefore, effective treatment is required. The recommended first line treatment is new generation, non-sedating H1-antihistamines. If standard dosing is not effective, increasing the dosage up to four-fold is recommended. For patients who do not respond to a four-fold increase, second-line therapies, such as corticosteroids, cyclosporin, omalizumab or phototherapy, should be added to the antihistamine regimen. For second-line therapy, costs and risk/benefit are important to consider. Corticosteroids are not recommended for long-term treatment due to their serious adverse effects.
Editor's comment: This guideline is a review of the available literature on the subject of urticaria.
Zuberbier T et al., EAACI/GA²LEN/EDF/WAO guideline: definition, classification and diagnosis of urticaria. Allergy. 2009;64(10):1417-1426. Abstract

ヨーロッパアレルギー学会、WAOなど共同による蕁麻疹のガイドラインに関する総説。鎮静作用のないH1受容体拮抗薬を第一選択として無効な場合、ステロイド薬など次の薬剤を選択するとしている。

2. Recommendations for appropriate sublingual immunotherapy (SLIT) clinical trials
Sublingual Immunotherapy (SLIT) is gaining widespread attention as an alternative to subcutaneous immunotherapy the treatment of allergic rhinoconjunctivitis. In addition, SLIT has been studied in other allergic disorders including asthma. However, a review of published studies indicates that there are deficiencies and considerable heterogeneity in both design and data interpretation of SLIT studies. These have made it difficult to assess the appropriate place of SLIT in guidelines for the therapy of allergic diseases. Moreover, several unpublished SLIT studies in the United States failed to meet primary endpoints. This article reviews data from SLIT trials and makes recommendations about appropriate designs of future SLIT studies. It is hoped that these recommendations will result in more adequately designed SLIT trials to facilitate the appropriate placement of this therapy to treat patients with other allergic diseases.
Editor's comment: This article should help design optimal studies to assess efficacy and safety of SLIT.
Casale TB et al., Recommendations for appropriate sublingual immunotherapy clinical trials. J Allergy Clin Immunol. 2009;124(4):665-670. Abstract

舌下免疫療法に関する総説である。舌下免疫療法の臨床研究の中には、あらかじめ公表したプライマリーエンドポイントに達せず公表されていないものがある。適切な研究デザインのもと実施すべきとしている。

3. Budesonide/formoterol (B/F) maintenance and reliever (M-R) therapy versus conventional best practice
Budesonide/formoterol (B/F) maintenance and reliever (M-R) therapy reduces asthma exacerbations and symptoms versus fixed-dose regimens plus short-acting β2-agonists (SABA) in double-blind trials. Information is lacking regarding its effectiveness versus conventional best practice (CBP). The authors conducted a pooled analysis of six, 6-month, randomized, open-label studies examining asthma control and exacerbation risk in asthmatics (aged≥12 years). Patients (N = 7855) symptomatic on inhaled corticosteroids (ICS) or stable/symptomatic on ICS/long-acting β2-agonists (LABA) received B/F M-R therapy (160/4.5 µg bid and as needed) or CBP (ICS or ICS/LABA ± other agents at an approved dose plus as-needed SABA). Overall asthma control was assessed comparing the incidence of exacerbations and levels of asthma control using the asthma control questionnaire (ACQ). B/F M-R therapy did not significantly reduce time to first severe exacerbation (primary variable) versus CBP. However, patients experienced 15% fewer exacerbations and used 27% less ICS.
Editor's comment: B/F M-R therapy can improve key aspects of asthma control versus physicians' choice of CBP.
Demoly P et al., Budesonide/formoterol maintenance and reliever therapy versus conventional best practice, Respiratory Medicine. 2009;103(11):1623-1632. Abstract

ブデソニド・フォルモテロール合剤を喘息の維持療法および発作時に使用し、現在の最良の治療法（フルチカゾン・サルメテロール合剤等による維持＋発作時SABAの使用）と比較した。その結果、発作は15%減少し、吸入ステロイドの使用量も27%減少した。

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

World Allergy Organization Journal
October 2009, Volume 2, Issue 10
ISSN: 1939-4551

This Month in the Journal

ORIGINAL ARTICLES

Synergistic Induction of Macrophage Inflammatory Protein-3α/CCL20 Production by Interleukin-17A and Tumor Necrosis Factor-α in Nasal Polyp Fibroblasts
Manabu Nonaka, MD, PhD; Nozomu Ogihara, MD; Akira Fukumoto, MD, PhD; Atsuko Sakanushi, MD; Kaoru Kusama, MD; Ruby Pawankar, MD, PhD; and Toshiaki Yagi, MD, PhD
JAPAN

REVIEW ARTICLE

Mast Cell Regulation of the Immune Response
John J. Ryan, MD; Johanna K. Morales, MD; Yves T. Falanga, MD; Josephine F.A. Fernando, MD; and Matthew R. Macey
USA

HOW TO ACCESS THE WAO JOURNAL

If you are a current member of a WAO Member Society:

Go to the WAO Web site (www.worldallergy.org). Click "Members Only" and you will be provided with instructions on how to access the full text of all articles published in the WAO Journal. To enjoy continual access, return to www.WorldAllergy.org and Members Only each time to newly access the full text.

Not a member? Sign up for the WAO Journal at: www.waojournal.org

PUBLISH YOUR WORK TO A WORLDWIDE AUDIENCE!

The World Allergy Journal accepts original scientific and clinically relevant information concerned with the practice of allergy and clinical immunology including state-of-the-art review articles and editorials on translational and clinical medicine. Note that the Journal will be retroactively indexed. If you have an original contribution not previously published, visit www.WAOJournal.org and click on "Instructions for Authors".

Additional Journal Reviews

Caudri D et al., Early daycare is associated with an increase in airway symptoms in early childhood but is no protection against asthma or atopy at 8 years, Am J Respir Crit Care Med. 2009;180(6):491-498. 　 Abstract 　早期保育は気道炎症症状を増加させ、 8 歳児の喘息やアトピー感作の率も減少させなかった。
Calabria CW et al., The LOCAL Study: Local reactions do not predict local reactions in allergen immunotherapy, J Allergy Clin Immunol, 2009;124(4):739-744. Abstract 　免疫療法の際の局所反応は次の反応を予測するものでない。
Bernard A et al., Impact of chlorinated swimming pool attendance on the respiratory health of adolescents, Pediatrics, 2009;124(4);1110-1118. 　 Abstract 　塩素消毒されたプールでの水泳は喘息・呼吸器症状を悪化させる。
Çelik GE et al., Effect of in vitro aspirin stimulation on basophils in patients with aspirin-exacerbated respiratory disease, Clin Exp Allergy, 2009;39(10):1522-1531. Abstract 　アスピリン喘息の診断に好塩基球活性化試験は有用ではなかった。
Guilemany JM et al., United airways: the impact of chronic rhinosinusitis and nasal polyps in bronchiectasic patient's quality of life, Allergy, 2009:64(10);1524-1529.　 Abstract 　上気道炎症と下気道炎症の密接な関係について再認識している論文。
Erlewyn-Lajeunesse M et al., Recommendations for the administration of influenza vaccine in children allergic to egg, BMJ, 2009;339:b3680. 　 Abstract 鶏卵アレルギーの子どもに対するインフルエンザワクチン接種の基準に関する論文。最大限 0.6 µg per dose としている。
10.Gros E et al., Expression of chemokines and chemokine receptors in lesional and nonlesional upper skin of patients with atopic dermatitis, J Allergy Clin Immunol, 2009;124(4):753-760. 　 Abstract 　アトピー性皮膚炎患者急性期皮膚では CCR5 や CCR6 陽性、 CD207 陰性、 CD1a 陽性の樹状細胞が多い。

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

Medical Book Review

Chronic Obstructive Pulmonary Disease Exacerbations
Series: Lung Biology in Health and Disease, Volume 228
Jadwiga A. Wedzicha and Fernando J. Martinez (Editors)
2009 Informa Healthcare
ISBN-10: 142007086X
ISBN-13: 978-1420070866
List Price: $ 249.95 USD; £ 125.00 GBP
Available from Informa Healthcare

Reviewer:
Dr. Graeme A. Thompson, M.B.B.S. (Hons1), FRACP
Respiratory Physician and Conjoint Lecturer
Campbelltown Hospital and University of Western Sydney
Australia

Description
Chronic Obstructive Pulmonary Disease (COPD) is a disorder that is rising in prevalence, adding an ever increasing burden on health care systems and is a disease characterized by exacerbations that ultimately accelerate the progression of the disease. Increasingly, COPD is being thought of as an inflammatory disorder with systemic features far reaching beyond the lung, driven by the immunology of the disease. It is hoped that the immuno-pathogenesis of COPD will provide novel agents for targeting the slow but relentless disease progression. This text book reviews the most up to date physiological, environmental and biological causes and effects of COPD exacerbations.

Purpose
The textbook provides an extremely comprehensive review of COPD exacerbations including addressing the clinical, immunobiology and health economics of the disease. The text book also provides consideration for the way forward, both clinically and in terms of research.

Audience
The textbook is undoubtedly beneficial for all clinicians and trainees in the area of pulmonary medicine and related disciplines. In addition, the book handsomely provides for researchers in the area with extensive sections dedicated to animal models of COPD, trial design, unique statistical considerations in COPD trials and future and novel areas for exploration.

Features
The text book is subdivided into five main areas: Introduction, Mechanisms and Pathophysiology, Impact of Exacerbations, Management of Exacerbations, Prevention of COPD exacerbations, and Issues for Studies of COPD Exacerbations.

The initial chapters comprehensively review the clinical, epidemiological and the airway immunobiology of COPD exacerbations. The roles of bacterial, viral, environmental and co-morbid factors are extensively analysed in the subsequent chapters. The impact of the disease on the individual and the health economics of the disease are then reviewed. Appraisal of the therapeutic modalities including physical therapy and rehabilitation follow. The clinical recommendations are based on the best available evidence based medicine and adequately referenced for further analysis.

Assessment
The comprehensive nature of the clinical and immunobiology content ensure that the text will be a valuable resource for both clinicians and researchers at all levels of expertise. The book adds a certain amount of optimism for clinicians and researchers involved with a disease that has previously been shrouded in nihilism.

COPDに関する教科書の紹介。全ての臨床医向けである。

Find more allergy book reviews on the WAO Website here.

The World Allergy Organization'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

World Allergy Organization (WAO)
Secretariat
555 E. Wells Street, Suite 1100
Milwaukee, WI 53202-3823
Email: info@worldallergy.org

You have received this message because you are a member of a WAO Member Society; you have subscribed for the monthly e-letter or had previous contact with the World Allergy Organization. If you would prefer not to receive further messages from WAO, please reply to this message with REMOVE in the subject line.

Made possible through an unrestricted educational grant from Novartis.

And with support through an unrestricted education grant from EAMG.

Volume 6, Issue 10 Reviews - October 2009

Medical Journal Reviews 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 three picks 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. EAACI/GA²LEN/EDF/WAO guideline: definition, classification and diagnosis of urticaria This guideline, together with its sister guideline on the classification of urticaria, is the result of a consensus reached during a panel discussion at the Third International Consensus Meeting on Urticaria, a joint initiative of the European Academy of Allergy Asthma and Immunology (EAACI), the EU-funded network of excellence, GA²LEN, the European Dermatology Forum (EDF) and the World Allergy Organization (WAO). Urticaria has a profound impact on the quality of life; therefore, effective treatment is required. The recommended first line treatment is new generation, non-sedating H1-antihistamines. If standard dosing is not effective, increasing the dosage up to four-fold is recommended. For patients who do not respond to a four-fold increase, second-line therapies, such as corticosteroids, cyclosporin, omalizumab or phototherapy, should be added to the antihistamine regimen. For second-line therapy, costs and risk/benefit are important to consider. Corticosteroids are not recommended for long-term treatment due to their serious adverse effects. Editor's comment: This guideline is a review of the available literature on the subject of urticaria. Zuberbier T et al., EAACI/GA²LEN/EDF/WAO guideline: definition, classification and diagnosis of urticaria. Allergy. 2009;64(10):1417-1426. Abstract ヨーロッパアレルギー学会、WAOなど共同による蕁麻疹のガイドラインに関する総説。鎮静作用のないH1受容体拮抗薬を第一選択として無効な場合、ステロイド薬など次の薬剤を選択するとしている。 2. Recommendations for appropriate sublingual immunotherapy (SLIT) clinical trials Sublingual Immunotherapy (SLIT) is gaining widespread attention as an alternative to subcutaneous immunotherapy the treatment of allergic rhinoconjunctivitis. In addition, SLIT has been studied in other allergic disorders including asthma. However, a review of published studies indicates that there are deficiencies and considerable heterogeneity in both design and data interpretation of SLIT studies. These have made it difficult to assess the appropriate place of SLIT in guidelines for the therapy of allergic diseases. Moreover, several unpublished SLIT studies in the United States failed to meet primary endpoints. This article reviews data from SLIT trials and makes recommendations about appropriate designs of future SLIT studies. It is hoped that these recommendations will result in more adequately designed SLIT trials to facilitate the appropriate placement of this therapy to treat patients with other allergic diseases. Editor's comment: This article should help design optimal studies to assess efficacy and safety of SLIT. Casale TB et al., Recommendations for appropriate sublingual immunotherapy clinical trials. J Allergy Clin Immunol. 2009;124(4):665-670. Abstract 舌下免疫療法に関する総説である。舌下免疫療法の臨床研究の中には、あらかじめ公表したプライマリーエンドポイントに達せず公表されていないものがある。適切な研究デザインのもと実施すべきとしている。 3. Budesonide/formoterol (B/F) maintenance and reliever (M-R) therapy versus conventional best practice Budesonide/formoterol (B/F) maintenance and reliever (M-R) therapy reduces asthma exacerbations and symptoms versus fixed-dose regimens plus short-acting β2-agonists (SABA) in double-blind trials. Information is lacking regarding its effectiveness versus conventional best practice (CBP). The authors conducted a pooled analysis of six, 6-month, randomized, open-label studies examining asthma control and exacerbation risk in asthmatics (aged≥12 years). Patients (N = 7855) symptomatic on inhaled corticosteroids (ICS) or stable/symptomatic on ICS/long-acting β2-agonists (LABA) received B/F M-R therapy (160/4.5 µg bid and as needed) or CBP (ICS or ICS/LABA ± other agents at an approved dose plus as-needed SABA). Overall asthma control was assessed comparing the incidence of exacerbations and levels of asthma control using the asthma control questionnaire (ACQ). B/F M-R therapy did not significantly reduce time to first severe exacerbation (primary variable) versus CBP. However, patients experienced 15% fewer exacerbations and used 27% less ICS. Editor's comment: B/F M-R therapy can improve key aspects of asthma control versus physicians' choice of CBP. Demoly P et al., Budesonide/formoterol maintenance and reliever therapy versus conventional best practice, Respiratory Medicine. 2009;103(11):1623-1632. Abstract ブデソニド・フォルモテロール合剤を喘息の維持療法および発作時に使用し、現在の最良の治療法（フルチカゾン・サルメテロール合剤等による維持＋発作時SABAの使用）と比較した。その結果、発作は15%減少し、吸入ステロイドの使用量も27%減少した。 All 10 reviews are posted in the literature review section of the WAO website.	World Allergy Organization Journal October 2009, Volume 2, Issue 10 ISSN: 1939-4551 This Month in the Journal ORIGINAL ARTICLES Synergistic Induction of Macrophage Inflammatory Protein-3α/CCL20 Production by Interleukin-17A and Tumor Necrosis Factor-α in Nasal Polyp Fibroblasts Manabu Nonaka, MD, PhD; Nozomu Ogihara, MD; Akira Fukumoto, MD, PhD; Atsuko Sakanushi, MD; Kaoru Kusama, MD; Ruby Pawankar, MD, PhD; and Toshiaki Yagi, MD, PhD JAPAN REVIEW ARTICLE Mast Cell Regulation of the Immune Response John J. Ryan, MD; Johanna K. Morales, MD; Yves T. Falanga, MD; Josephine F.A. Fernando, MD; and Matthew R. Macey USA HOW TO ACCESS THE WAO JOURNAL If you are a current member of a WAO Member Society: Go to the WAO Web site (www.worldallergy.org). Click "Members Only" and you will be provided with instructions on how to access the full text of all articles published in the *WAO Journal. To enjoy continual access, return to www.WorldAllergy.org and Members Only each time to newly access the full text. Not a member? Sign up for the WAO Journal* at: www.waojournal.org PUBLISH YOUR WORK TO A WORLDWIDE AUDIENCE! The World Allergy Journal accepts original scientific and clinically relevant information concerned with the practice of allergy and clinical immunology including state-of-the-art review articles and editorials on translational and clinical medicine. Note that the Journal will be retroactively indexed. If you have an original contribution not previously published, visit www.WAOJournal.org and click on "Instructions for Authors". Additional Journal Reviews Caudri D et al., Early daycare is associated with an increase in airway symptoms in early childhood but is no protection against asthma or atopy at 8 years, Am J Respir Crit Care Med. 2009;180(6):491-498. 　 Abstract 　早期保育は気道炎症症状を増加させ、 8 歳児の喘息やアトピー感作の率も減少させなかった。 Calabria CW et al., The LOCAL Study: Local reactions do not predict local reactions in allergen immunotherapy, J Allergy Clin Immunol, 2009;124(4):739-744. Abstract 　免疫療法の際の局所反応は次の反応を予測するものでない。 Bernard A et al., Impact of chlorinated swimming pool attendance on the respiratory health of adolescents, Pediatrics, 2009;124(4);1110-1118. 　 Abstract 　塩素消毒されたプールでの水泳は喘息・呼吸器症状を悪化させる。 Çelik GE et al., Effect of in vitro aspirin stimulation on basophils in patients with aspirin-exacerbated respiratory disease, Clin Exp Allergy, 2009;39(10):1522-1531. Abstract 　アスピリン喘息の診断に好塩基球活性化試験は有用ではなかった。 Guilemany JM et al., United airways: the impact of chronic rhinosinusitis and nasal polyps in bronchiectasic patient's quality of life, Allergy, 2009:64(10);1524-1529.　 Abstract 　上気道炎症と下気道炎症の密接な関係について再認識している論文。 Erlewyn-Lajeunesse M et al., Recommendations for the administration of influenza vaccine in children allergic to egg, BMJ, 2009;339:b3680. 　 Abstract 鶏卵アレルギーの子どもに対するインフルエンザワクチン接種の基準に関する論文。最大限 0.6 µg per dose としている。 10.Gros E et al., Expression of chemokines and chemokine receptors in lesional and nonlesional upper skin of patients with atopic dermatitis, J Allergy Clin Immunol, 2009;124(4):753-760. 　 Abstract 　アトピー性皮膚炎患者急性期皮膚では CCR5 や CCR6 陽性、 CD207 陰性、 CD1a 陽性の樹状細胞が多い。

Medical Book Review Chronic Obstructive Pulmonary Disease Exacerbations Series: Lung Biology in Health and Disease, Volume 228 Jadwiga A. Wedzicha and Fernando J. Martinez (Editors) 2009 Informa Healthcare ISBN-10: 142007086X ISBN-13: 978-1420070866 List Price: $ 249.95 USD; £ 125.00 GBP Available from Informa Healthcare Reviewer: Dr. Graeme A. Thompson, M.B.B.S. (Hons1), FRACP Respiratory Physician and Conjoint Lecturer Campbelltown Hospital and University of Western Sydney Australia Description Chronic Obstructive Pulmonary Disease (COPD) is a disorder that is rising in prevalence, adding an ever increasing burden on health care systems and is a disease characterized by exacerbations that ultimately accelerate the progression of the disease. Increasingly, COPD is being thought of as an inflammatory disorder with systemic features far reaching beyond the lung, driven by the immunology of the disease. It is hoped that the immuno-pathogenesis of COPD will provide novel agents for targeting the slow but relentless disease progression. This text book reviews the most up to date physiological, environmental and biological causes and effects of COPD exacerbations. Purpose The textbook provides an extremely comprehensive review of COPD exacerbations including addressing the clinical, immunobiology and health economics of the disease. The text book also provides consideration for the way forward, both clinically and in terms of research. Audience The textbook is undoubtedly beneficial for all clinicians and trainees in the area of pulmonary medicine and related disciplines. In addition, the book handsomely provides for researchers in the area with extensive sections dedicated to animal models of COPD, trial design, unique statistical considerations in COPD trials and future and novel areas for exploration. Features The text book is subdivided into five main areas: Introduction, Mechanisms and Pathophysiology, Impact of Exacerbations, Management of Exacerbations, Prevention of COPD exacerbations, and Issues for Studies of COPD Exacerbations. The initial chapters comprehensively review the clinical, epidemiological and the airway immunobiology of COPD exacerbations. The roles of bacterial, viral, environmental and co-morbid factors are extensively analysed in the subsequent chapters. The impact of the disease on the individual and the health economics of the disease are then reviewed. Appraisal of the therapeutic modalities including physical therapy and rehabilitation follow. The clinical recommendations are based on the best available evidence based medicine and adequately referenced for further analysis. Assessment The comprehensive nature of the clinical and immunobiology content ensure that the text will be a valuable resource for both clinicians and researchers at all levels of expertise. The book adds a certain amount of optimism for clinicians and researchers involved with a disease that has previously been shrouded in nihilism. COPDに関する教科書の紹介。全ての臨床医向けである。 Find more allergy book reviews on the WAO Website here.
The World Allergy Organization'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 World Allergy Organization (WAO) Secretariat 555 E. Wells Street, Suite 1100 Milwaukee, WI 53202-3823 Email: info@worldallergy.org You have received this message because you are a member of a WAO Member Society; you have subscribed for the monthly e-letter or had previous contact with the World Allergy Organization. If you would prefer not to receive further messages from WAO, please reply to this message with REMOVE in the subject line. Made possible through an unrestricted educational grant from Novartis. And with support through an unrestricted education grant from EAMG.