WAO News and Notes - Medical Reviews
Volume 6, Issue 11 Reviews - November 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 Phil Lieberman, MD, 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. Acetaminophen use and the risk of asthma in children and adults: a systematic review and metaanalysis.
The authors searched databases including MEDLINE (1966-2008) and EMBASE (1980-2008) to identify studies of acetaminophen use and its relation to a diagnosis of asthma. Thirteen cross-sectional, four cohort and two case-control studies of 425,140 subjects were included. The pooled odds ratio (OR) for asthma among acetaminophen users was 1.63 (95% CI, 1.46-1.77). The risk of asthma in children among acetaminophen users in the year prior to a diagnosis of asthma and in the first year of life was elevated (1.60 [95% CI, 1.48-1.74], 1.47 [95% CI, 1.36-1.56] respectively). Only one study reported the association between high acetaminophen dose and asthma in children (3.23 [95%CI, 2.9-3.6]). There was an increased risk of asthma and wheezing with prenatal use of acetaminophen by mothers (1.28 [95% CI, 1.16-41], 1.50 [95% CI, 1.10-2.05] respectively).
Editor's comment: The results are consistent with an increase in the risk of asthma and wheezing in both children and adults exposed to acetaminophen.
Etminan M et al. Acetaminophen use and the risk of asthma in children and adults: a systematic review and metaanalysis, Chest 2009;136(5):1316-1323, November 2009.

アセトアミノフェンの使用と小児喘息の発症についての体系的レビュー。全体的なオッズ比は1.63, 喘息発症前年使用では1.6, 周産期の母親の使用と児の喘息、喘鳴発症はそれぞれ1.28, 1.5であった。

2. GA²LEN skin test study III: Minimum battery of test inhalent allergens needed in epidemiological studies in patients.
The authors defined the minimal number and the necessary allergens required to identify a sensitized patient in the Pan-European GA²LEN skin prick test study (17 centers in 14 countries). A standardized panel of 18 allergens was employed to evaluate 3034 subjects. 1996 (68.2%) were sensitized to at least one allergen. Overall, eight allergens (grass pollen, D. pteronyssinus, birch pollen, cat dander, Artemisia, olive pollen, Blatella and Alternaria) identified more than 95% of sensitized subjects. Depending on the country, up to 13 allergens were needed to identify all sensitized subjects. The authors concluded that a panel of eight to ten allergens was sufficient to identify the majority of sensitized subjects. For clinical care, the whole battery of 18 allergens is needed.
Editor's comment: Knowing the number of allergens necessary to identify a sensitized patient is important for a cost-effective approach in epidemiological studies.
Bousquet P et al. GA²LEN skin test study III: Minimum battery of test inhalent allergens needed in epidemiological studies in patients. Allergy 2009;64(11):1656-1662.


3. Adrenergic β2-receptor(ADRB2) genotype predisposes to exacerbations in steroid-treated asthmatic patients taking frequent albuterol or salmeterol.
The researchers studied the role of the Arg16 allele on asthma exacerbations requiring the use of albuterol and salmeterol. Arg/Gly status at position 16 of ADRB2 was assessed in 1182 young asthmatic patients (age, 3-22 years). An increased risk of exacerbations per copy of the Arg16 allele was observed, regardless of treatment regimen (OR, 1.30; 95% CI, 1.09-1.55; P = .003). The risk of exacerbations in patients with the Arg16 allele was only observed in those receiving daily inhaled long- or short-acting β2-agonists (OR, 1.64; 95% CI, 1.22-2.20; P = .001). There was no genotypic risk in patients using inhaled β2-agonists less than once a day (OR, 1.08; 95% CI, 0.85-1.36; P = .525). The Arg16 genotype-associated risk for exacerbations was significantly different in those exposed to β2-agonists daily versus those that were not (test for interaction, P = .022)
Editor's comment: The Arg16 genotype of ADRB2 is associated with exacerbations in asthmatic children and young adults exposed daily to β2-agonists.
Basu K et al. Adrenergic β2-receptor(ADRB2) genotype predisposes to exacerbations in steroid-treated asthmatic patients taking frequent albuterol or salmeterol, J Clin Allergy Immun 2009: Article in press, published online 05 October 2009.



All 14 reviews are posted in the literature review section of the WAO website.

WAO Journal

World Allergy Organization Journal
November 2009, Volume 2, Issue 11
ISSN: 1939-4551

This Month in the Journal


Sub-Lingual Immunotherapy, World Allergy Organization Position Paper
G. Walter Canonica, Jean Bousquet, Thomas Casale, Richard F. Lockey, Carlos E. Baena-Cagnani, Ruby Pawankar, Paul C. Potter, Philippe J. Bousquet, Linda S. Cox, Stephen R. Durham, Harold S. Nelson, Giovanni Passalaqua, Dermot P. Ryan, Jan L. Brozek, Enrico Campalati, Ronald Dahl, Luis Delgado, Roy Gerth van Wijk, Richard G. Gower, Dennis K. Ledford, Nelson Rosario Filho, Erkka J. Valovirta, Osman M. Yusef, Torsten Zuberbier, Wahiduzzaman Akhanda, Raul Castro Almarales, Ignacio Ansotegui, Floriano Bonifazi, Jan Ceuppens, Tomás Chivato, Darina Dimova, Diana Dumitrascu, Luigi Fontana, Constance H. Katelaris, Ranbir Kaulsay, Piotr Kuna, Désirée Larenas-Linnemann, Manolis Manoussakis, Kristof Nekam, Carlos Nunes, Robyn O'Hehir, José M. Olaguibel, Nerin Bahceciler Onder, Jung Won Park, Alfred Priftanji, Robert Puy, Luis Sarmiento, Glenis Scadding, Peter Schmid-Grendelmeier, Ester Seberova, Revaz Sepiashvili, Dirceu Solé, Alkis Togias, Carlo Tomino, Elina Toskala, Hugo Van Beever, Stefan Vieths



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Additional Journal Reviews
  1. Multicentre trial evaluating alveolar NO fraction as a marker of asthma control and severity.

    喘息での肺胞NO分画測定についての多施設共同研究。有用性に疑問を呈した。Allergy, 20 October 2009 Epub

  2. BCG vaccination and protection against development of childhood asthma - epi studies review and meta analysis.

    出生早期のBCGは喘息発症リスクを下げる。体系的レビュー。Int J Epidemiol. 2009 Oct 12 Epub

  3. Phenotypic determinants of uncontrolled asthma.

    治療に抵抗する喘息に関して表現型サブタイプを決定するとよいJ Allergy Clin Immunol, 2009;124(4):681

  4. Critical Role of IL-17RA in immunopathology of Influenza Infection.

    IL-17A欠損マウスはインフルエンザ感染での死亡率が高い。J Immunol, 2009;183:5301

  5. Inhaled house dust mite induces pulmonary T helper 2 cytokine production

    ダニ抽出エキス抗原の吸入はマウス肺のTH2サイトカイン産生を増強する。Clin Exp Allergy, 2009;39(10):1597

  6. Leukotriene E4-induced pulmonary inflammation is mediated by the P2Y12 (purinergic) receptor.

    P2Y12受容体(danger signal ATPの受容体)を欠損したマウスではロイコトリエンE4による肺炎症が生じない。J. Exp. Med, 2009;26(11):2543

  7. Effect of natural seasonal pollen exposure and repeated nasal allergen provocations on elevation of exhaled nitric oxide (FENO).

    アレルギー鼻炎患者鼻粘膜にアレルゲンを負荷すると呼気中NOが増加する。Allergy 2009;64(11):1629

  8. The prevalence of food hypersensitivity (FHS) in young adults.

    デンマークの青年の負荷試験で確定した、OASを除く、食物アレルギーの頻度は1.7%。Pediatr Allergy Immunol. 2009;20(7):686

  9. The Longest Wheal Diameter Is the Optimal Measurement for the Evaluation of Skin Prick Tests (SPT).

    プリックテストにおいて膨疹長径をもちいるとよい。Int Arch Allergy Immunol, 2010;151(4):343

  10. Quadrupling the dose of inhaled corticosteroid to prevent asthma exacerbations: a randomized, double-blind, placebo-controlled, parallel-group clinical trial.

    吸入ステロイドを4倍に増量した場合、経口ステロイドの必要使用量が減少する。Am J Respir Crit Care Med, 2009:180(7):598

  11. Oral Allergy Syndrome.

    Kondo Y and Urisu A. によるOral Allergy Syndrome. の総説。定義や歴史について、わかりやすく書かれている。Allergol Int. 2009 Oct 25;58(4) [Epub ahead of print]

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

Medical Book Review

The Immune System, Third Edition
By Peter Parham
2009 Garland Science, Taylor & Francis Group, LLC
ISBN: 9780815344292
$60.00 USD
Available at Garland Science

Dr. Frederick J. Lee, BSc MBBS (Hons I)
Senior Registrar, Clinical Immunology and Allergy
Campbelltown Hospital
Campbelltown, New South Wales

The Immune System, 3rd Edition is an up to date, if very conventional text outlining the structure and function of the human immune system spread out over 16 chapters. It starts with the basic science of immunology before moving onto the clinical implications of immune dysfunction.

Those familiar with Janeway's Immunobiology will notice an immediate resemblance. Indeed, The Immune System is wholly adapted from its Garland Science stable-mate.

The Immune System is designed as an introductory text. There is a focus on first principles and basic concepts.

This text is squarely aimed at the medical student level. Many features present in its contemporaries - such as an introduction to laboratory immunology - have been eschewed in favour of a redundancy of information.

What this text sets out to do, it does quite well. The flow and detail provided in covering the major topics is logical and systematic. Especially pleasing was the (relatively) greater space dedicated to innate immunity, an increasingly important area of study. The prose is clear and sticks to the 'one paragraph-one concept' rule.

Each chapter is concluded by a succinct summary, and is accompanied by a set of questions for self-revision. The provision of an answer section makes this a very useful study tool.

However, it is in the diagrams and illustrations that this book excels. Garland Science have built up a substantial expertise in this area and use this to full effect.

There is no CD-ROM/multimedia resource provided with this book. Rather, this is sold separately.

The challenge in the successful teaching of immunology lies in imparting the concepts without becoming entangled in the detail. The Immune System attempts to do this by paraphrasing information in as many different forms as a conventional textbook can allow. The absence of a bundled multimedia CD-ROM, common with current textbooks, is a disappointing omission however, particularly considering the book's target audience.

In spite of this, The Immune System succeeds in its purpose, and considered alone, is a very competent text for the medical student level. Nevertheless, it resembles its immediate forbear - Janeway's Immunobiology - much too closely to present a genuine alternative to that text's broader appeal.

Find more allergy book reviews on the WAO Website here.

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