November World Medical Journal Review
Prof. Richard F. Lockey, MD, WAO Web Editor-in-Chief, reviewed premier November medical journal articles for practicing allergists. Read his top 3 picks below and for the other nine reviews, click here.
1. THE NATURAL HISTORY OF ASTHMA IN CHILDREN AND ADULTS BY DRS CHARLES REED & GAIL SHAPIRO
Dr. Reed lists six predictors of persistence and severity of adult asthma to include continued exposure to allergens, including occupational agents, older age onset, aspirin sensitivity, socioeconomic status, smoking and coexisting disease (COPD, bronchiectasis, etc.). For children, both Drs. Reed and Shapiro include a family history of atopy, early sensitization, and airway hyper-responsiveness. Dr. Shapiro also includes early onset; low lung function; female sex; smoking, passive smoking and smoking during pregnancy; and maternal asthma. Dr. Reed, for children, covers more frequent and severe asthma, onset during school age, increased serum IgE, increased URIs, lack of contact with other children, parenting problems and childhood psychological problems. Dr. Shapiro concludes, regardless of the prognosis of childhood wheezing, that parents of children with both low and high risk for persistent disease can be comforted and reassured if they follow an action plan for daily maintenance treatment and for acute exacerbations of asthma. Editor’s comment: Two outstanding articles discuss the vexing problem of who will and who will not have persistent childhood and adult asthma. Reed CE, J Allergy Clin Immunol 2006; 118: 543; the late Dr. Shapiro GG: 562.
2. THE EFFECTS OF A MONOCLONAL ANTIBODY DIRECTED AGAINST TUMOR NECROSIS FACTOR-α IN ASTHMA
Infliximab (I) (Remicade), a recombinant human-murine chimeric monoclonal antibody that specifically and potently binds and neutralizes the soluble TNF-α homotrimer and its membrane-bound precursor, was used in a DBPC, parallel-group study in 38 patients with moderate asthma treated with inhaled corticosteroids who were symptomatic during a run-in-phase. Lung function, symptoms and inhaled β2-agonist usage were monitored. There was no change in morning PEF, however, it was associated with a decrease in mean diurnal variation in PEF at wk 8 (p = 0.02). Likewise there was a decrease in exacerbations in the treatment group (p = 0.01) and an increased probability of freedom from exacerbation with time (p = 0.03). I decreases levels of TNF-α and other cytokines in sputum supernatants. No serious adverse events occurred. Editor’s comment: I looks like a promising therapy for moderate asthma. Erin EM, et al. Am J Respir Crit Care Med 2006; 174: 753.
3. URINE LEUKOTRIENE E4 LEVELS ARE ASSOCIATED WITH DECREASED PULMONARY FUNCTION IN CHILDREN WITH PERSISTENT AIRWAY OBSTRUCTION
This study was designed to assess the relationship between daily variability in urinary leukotriene E4 (LTE4) levels and daily lung function in 50 children with moderate to severe asthma primarily taking an inhaled corticosteroid (ICS) and long-acting β-agonist (LABA). Urinary LTE4, monitoring of FEV1, and albuterol use were measured. Daily variability in LTE4 levels is associated with clinically significant decreases in pulmonary function. In children who demonstrate a response associated with an increase in urinary LTE4 levels, leukotriene receptor antagonists protect against daily FEV1 decreases, which may be greatest in those with persistent airway obstruction despite the use of combined ICS and LABA therapy. Editor’s comment: Asthma is a complex disease and what is good for the goose may not be good for the gander. Rabinovitch N, et al. J Allergy Clin Immunol 2006; 118: 635.
To read the additional reviews, click here.
WAO Now: What's New in the World of WAO
WAO Secretariat Staff Change
Stanley Mandarich, WAO’s Executive Director, will be leaving the organization this month to return to Toronto, Ontario, Canada, where he will assume the position of Executive Director of the Canadian Anesthesiologists’ Society. We wish Stan well and thank him for serving WAO so ably since 2004.
We are delighted to welcome Charu Malik, PhD, as our new Executive Director of WAO from mid-January 2007. Charu, a native of India, brings considerable experience in association management; her international knowledge will be a great asset to the organization.
WAO Long-Term Research Fellowship
Congratulations to Dr. Andrea Vereda-Ortiz, who has been awarded the first WAO Long-Term Research Fellowship, to commence in 2007. Dr. Vereda will undertake a fellowship with Dr. Hugh Sampson at Mount Sinai Hospital, New York, to study "Comparative characterization of legume reactivity between patients of Spain and the United States." WAO received a number of excellent applications, and we thank all those who applied for their interest in this program.
WAO Short-Term research fellowship
Dr. Eleonara Dehlink has completed her WAO Short-Term Research Fellowship at the laboratory of Dr. Edda Fiebiger, Boston’s Children’s Hospital. The fellowship funding was used to help Dr. Dehlink learn new techniques for her research project “Is Fc-epsilon-RI an antigen uptake/presentation receptor in the intestinal mucosa involved in the initiation of allergic immune responses in the gastro-intestinal tract? an in vitro approach". To read a report on Dr. Dehlink’s work, click here.
WAO Educational Needs Survey
The World Allergy Organization’s educational programs are designed to assist Member Societies by providing educational materials that bring together the expertise and experience of allergists worldwide. We are currently surveying our members, and would value the comments of the readers of WAO News and Notes about their own educational needs and preferences. Please click here to complete the short, on-line survey.
Future World Allergy Congresses
For all future WAO Congresses, the WAO Congress Council has recently recommended that WAO solicit proposals from specific world regions on a rotational basis. This will ensure a fair, worldwide representation over the years. The WAO Board of Directors met recently and determined that Europe would be the preferred site of our 2013 Congress. The final decision on a location within Europe will be made at the WAO House of Delegates meeting during the 2007 WAC in Bangkok.
2-6 December 2007 - Bangkok, Thailand (http://www.congrex.com/wac2007/ )
2009 - Buenos Aires, Argentina
2011 - Cancun, Mexico
World Allergy Forum Held at the 2007 ACAAI Annual Scientific Meeting:
World Allergy Congress 2007 Symposium
"Global Issues in Allergy: Answers for a Worldwide Problem"
Our international faculty was chaired by Michael A. Kaliner and provided a worldwide update on allergic emergencies. The first speaker, Bob Q. Lanier (Fort Worth, TX, USA), presented an update on acute and severe asthma, and the presentation by Ruby Pawankar (Tokyo, Japan) focused on anaphylaxis. The symposium was concluded by Michael A. Kaliner (Wheaton, MD, USA), who discussed angioedema.
Click here to view abstracts and presentation slides.
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 email@example.com, noting “Free Journal Subscription” in the subject line, with the following details:
City, State/Province and postal code
Name of Member Society
And In Other News
Allergy Book Reviews
Ultrastructure of Mast Cells and Basophils
Ann M Dvorak
List price: $135.50 USD
Available from: Karger
Institute of Clinical Pathology and Medical Research and Westmead Millennium Institute, Westmead, NSW, Australia
This monograph reviews the work undertaken in the laboratories of the author and her collaborators between 1991 and 2001. It follows upon an earlier (1991) monograph and begins by reinforcing the ultrastructural definitions that allow differentiation of the (closely related) mast cell and basophil, in mouse, guinea pig and human.
The well ordered text explores the ultrastructural localization of cytokines, proteases, histamine, Charcot-Leyden crystal protein and other factors in the organelles of mast cells and basophils. The scope of this text then broadens to include the role of vesiculo-vacuolar organelles and their role in the trans endothelial secretory pathway.
While this book will prove to be of broad based interest to medical professionals, its most significant value should be to those researching the basic science of immunology and allergy and the interaction of mast cells in tissue based systems.
There is a balanced blend of both well established electron microscopy methodology (including immuno-gold labeling), together with enzyme affinity gold techniques and ultrastructural in situ hybridization. Techniques are adequately described and effectively referenced. The 185 illustrations are of consistently good quality.
For these specialized individuals, the book will find its way into personal libraries. This text should also reside on the shelves of the libraries of those institutions where basic ultrastructural cell research is undertaken.
Asthma in the Workplace, 3rd Edition
David I. Bernstein, et al.
List price: $249.95
Available from: CRC Press
University of South Florida College of Medicine, Tampa, FL, USA
This is the third edition of a reference text that reviews the key components of work‑related asthma. The book is organized into four main sections, including: General Considerations, Assessment and Management, Specific Agents Causing Occupational Asthma with a Latency Period, and Specific Disease Entities and Variants.
The purpose is to provide the clinician with a detailed reference covering all relevant aspects of occupational asthma, especially those relating to disease mechanisms, causative agents, clinical diagnosis and treatment.
Discussion is targeted to clinicians and clinical researchers who have an interest in occupational lung disease. Specialists most likely to utilize this resource include pulmonologists, allergists, clinical immunologists, and any physician with an interest in work‑related illnesses. Fellows in training will find this book to be an excellent reference text for the evaluation of occupational airway complaints.
Each chapter is logically organized, well‑written and concludes with an extensive bibliography. Over 100 tables and figures are clearly presented serving to illustrate relevant points. An excellent appendix is included that lists known causative agents in occupational asthma along with key references. A complete index concludes the text.
This book provides a comprehensive review of clinically relevant topics in occupational asthma written by nationally and internationally recognized experts in the field. This text is an outstanding reference resource for the clinician, clinical scientist or clinical fellow with an interest in work‑related asthma.
Find more allergy book reviews on the WAO Website here.