Medical Journal Reviews

Prof. Richard F. Lockey, MD, WAO Web Editor-in-Chief, and Guest Reviewer Mark C. Glaum, MD, PhD, reviewed premier medical journal articles for practicing allergists. Read their top 3 picks below and for the other 8 reviews, click here.

1. Risk Factors Associated with Utilization of Acute Asthma Care
The aim of this study is to identify modifiable risk factors that predispose asthma patients' use of acute care. Adult asthmatics (n = 554) were recruited from a large HMO network. At their initial visit, subjects underwent skin prick allergy testing, spirometry and completed a questionnaire related to modifiable asthma risk factors. Acute care utilization data was recorded for the following 30 months. The most significant risk factors for seeking acute asthma care use were low FEV1 (RR, 4.33), current cigarette smoke exposure (RR, 1.6), and skin prick reactivity and ownership of a cat or dog (RR, 1.5). Editor's comment: Decreased FEV1 is a strong predictor of increased asthma morbidity. Osborne ML et al. Chest 2007; 132 (4): 1151-68

2. Leukotriene Modifiers Prevent Viral URI Symptoms in Asthmatics
Viral upper respiratory tract infections (URI) are common causes of asthma exacerbations. Reports suggest that leukotriene antagonists (LTRA) may decrease rates of rhinovirus infection through down-regulation of receptors expressed on nasal epithelial cells. Adult asthmatics (n = 279) who presented to an emergency department were retrospectively categorized into LTRA treated and untreated groups. Outcomes examined included frequency of exacerbations, emergency room visits and hospitalizations over the prior 12 months. In the LTRA treated group, number of infections (p < 0.05), exacerbations, emergency room visits and hospitalizations (p < 0.01) were all lower than the untreated group. Editor's comment: Leukotriene receptor antagonists may provide protection against viral-induced asthma exacerbations. Horiguchi T et al. Allergol Int 2007; 56: 263-7

3. The Importance of Vaccines in Disease Prevention
Vaccines are among the greatest success stories in U.S. public health over the past century. National recommendations provide guidelines for use of vaccines to prevent or eliminate 17 vaccine-preventable diseases. This study compares morbidity and mortality before and after widespread implementation of national vaccine recommendations in place up to 2005. Primary outcomes include numbers of cases, hospitalizations and deaths for 13 vaccine-preventable diseases. A 92% decline in cases and 99% decline in deaths were shown for diphtheria, mumps, pertussis and tetanus, while an overall 80% or greater reduction in cases and deaths were observed for most other vaccine-preventable diseases. Editor's comment: Appropriate influenza, pneumonia, and pertussis vaccinations make sense in all patients with asthma and other chronic respiratory diseases. Roush SW et al. JAMA 2007; 18: 2155-63

To read the additional reviews, click here.

Allergy Book Review

Superantigens and Superallergens, Vol. 93 in Chemical Immunology and Allergy
Editor: Gianni Marone
ISBN 978-3-8055-8266-7
ISSN: 1660-2242

Available from: Karger
List Price: $160.00 USD

Description:
Bacteria such as Streptococci and Staphylococci have evolved to produce a number of virulence factors that enhance their invasiveness and may suppress the host's immune response to insure their survival. Bacterial superantigens are proteins that are able to crosslink the major histocompatibility complex on an antigen-presenting cell to the T cell receptor at the immune synapse. This non-conventional association can activate up to one in five T cells compared to the usual one in 10,000 for normal antigen recognition. Streptococcal superantigens are the most powerful known T cell activators. Toxic shock syndrome is the classic illness associated with these agents, but bacterial superantigens are only a part of the class of immune system modulators affecting human pathology. As this collection of reviews on the subject clearly illustrates, there are proteins produced within the body itself that act as superantigens while a type of protein known as a superallergen is able to bind to immunoglobulins and activate mast cells, basophils and B lymphocytes. This volume in the series on Chemical Immunology and Allergy provides a comprehensive description of the current research and conclusions about the structure of the superantigens and superallergens, the signaling pathways triggered by their association with T and B cells, the role of mobile pathogenicity islands in the transfer of drug resistance and virulence factors between bacterial strains and much more. It is hoped that this knowledge can direct drug development in new ways to overcome these often fatal bacterial attacks.

Purpose:
This collection of reviews on the subject of superantigens and superallergens in human pathology is intended to gather together the current knowledge from research and to highlight the areas most promising for new drug development in the continuing war on bacterial disease.

Audience:
Researchers will find an excellent historical overview of the subject, up-to-date findings and clearly reasoned suggestions for application and future study. Physicians treating patients with bacterial disease can profit through enhanced understanding of the immune response to superantigens to develop more successful therapies. Students interested in careers in infectious disease will read this book and come away with a profound sense of the urgency to understand and counteract these bacterial agents to relieve human suffering and death.

Features:
The book consists of 12 reviews by noted researchers and clinicians in their respective areas. Each review includes historical introduction and background, detailed characteristics of the pathology, current research status and a careful analysis and interpretation of the data in terms of its potential for new therapies. Illustrations are used where appropriate and there is a complete index.

Assessment:
The book's purpose of describing current research and therapeutic potential is well-served by the astutely selected collection of reviews that cover the entire field. The tight focus of the subject material provides the researcher, clinician and student with just the knowledge they need for designing new research studies and drug trials.

Find more allergy book reviews on the WAO Website here.