WAO News and Notes - Medical Reviews
Volume 6, Issue 12 Reviews - December 2009
International Scientific Conference - Dubai, UAE,  6-10 December 2010
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. Identification of asthma phenotypes (AP) using cluster analysis in the severe asthma research program (SARP).

To identify novel AP using an unsupervised hierarchical cluster analysis of the SARP cohort that includes subjects with persistent asthma, the authors reduced an initial 628 variables to 34 core variables by elimination of redundant data and transformation of categorical variables into ranked ordinal composite variables. They performed a cluster analysis on 726 subjects who met the American Thoracic Society (ATS) definition of severe asthma. Five groups were identified. Cluster 1 (n=110) had early onset atopic asthma with normal lung function treated with ≤ 2 controller medications (82%) and minimal health care utilization. Cluster 2 (n=321) were subjects with early onset atopic asthma and preserved lung function but increased medication requirements (29% on ≥ 3) and health care utilization. Cluster 3 (n=59) was a unique group of mostly older obese women with late onset nonatopic asthma, moderate reductions in FEV1 and frequent oral corticosteroid use. Clusters 4 (n=120) and 5 (n=116) had severe airflow obstruction with bronchodilator responsiveness, but they differed with regards to their ability to attain normal lung function, age of asthma onset, atopic status, and use of oral corticosteroids.
Editor's comment: These data support clinical heterogeneity in asthma and the need for new approaches for the classification of disease severity.
Moore WC, Myers DA, Wenzel SE et al. Identification of Asthma Phenotypes using Cluster Analysis in the Severe Asthma Research Program. American Journal of Respiratory and Critical Care Medicine 2009; published ahead of print on November 5.


米国において、喘息の症状や検査所見をコンピュータ解析した結果、5ないし6の独立した疾患群(クラスター)に分かれることが判明した。2群が最も多いIgE-mediated喘息であった。なお、英国やニュージーランドにおいても同様な報告がある(Am J Respir Crit Care Med 2008; 178:218, Eur Respir J 2009; 34:812)

2. The association between allergy skin testing (AST), atopic respiratory conditions (ARC), and stroke mortality in middle-aged and elderly adults.
An analysis was performed of the National Health and Nutrition Examination Survey II Mortality Cohort to determine whether positive AST was associated with an increased risk of fatal stroke and having both positive AST and an ARC was associated with a particularly high risk of stroke-related death. The authors found that patients with positive AST had a hazard ratio for stroke mortality of 1.56 versus those without. Patients with both positive AST and an ARC had a hazard ratio for stroke mortality of 2.31. Individuals with both positive AST and an ARC have more than a 2-fold increased risk of fatal stroke.
Editor's comment: This novel risk factor has substantial implications for a large segment of the population not previously considered at risk.
Matheson EM. Mainous AG, Carnemolla MA. The Association Between Allergy Skin Testing, Atopic Respiratory Conditions, and Stroke Mortality in Middle-Aged and Elderly Adults, The Journal of the American Board of Family Medicine 2009;22(6):604 -609.
Full text


3. Food allergy (FA) among children in the United States.
An analysis of previously published cross-sectional surveys of data on food allergy in children < 18 years of age was performed. Five previously reported surveys were reviewed. In 2007, 3.9% of US children < 18 years of age had reported FA. The prevalence of reported FA increased 18% from 1997 through 2007. In 2005-2006, specific Immunoglobulin E (IgE) to peanut was detectable for 9% of US children. Ambulatory care visits tripled between 1993 and 2006. From 2003 through 2006, there were an estimated average of 317,000 FA-related, ambulatory care visits per year. Hospitalizations with any recorded diagnoses related to FA also increased between 1998-2000 and 2004-2006, from 2,600 to 9,500 discharges per year.
Editor's comment: Food allergy prevalence and/or awareness have increased among US children in recent years.
Branum AM and Lukacs SL. Food Allergy Among Children in the United States, Pediatrics 2009;124(6):1549-1555.



All 12 reviews are posted in the literature review section of the WAO website.

WAO Journal

World Allergy Organization Journal
December 2009, Volume 2, Issue 12
ISSN: 1939-4551

This Month in the Journal


Invited Article
Food Allergy: Present and Future Management
Ananth Thyagarajan, MD; A Wesley Burks, MD

今月のWAOジャーナルでは食物アレルギーの総説の他原著3編、letter to editor1編がある。


Wheezy Child Program: The Experience of the Belo Horizonte Pediatric Asthma Management Program
Laura Lasmar, MD, PhD; Maria Jussara Fontes, MD, PhD; Maria Teresa Mohallen, MD, PhD; Ana Cristina Fonseca, MD; Paulo Camargos, MD, PhD

Alternaria and Cladosporium Fungal Allergen Epitopes Are Denatured by Sodium Hypochlorite
Charles Barnes, PhD; Freddy Pacheco, MS; Minati Dhar, PhD; Jay Portnoy, MD

Barriers to Asthma Treatment in the United States: Results from the Global Asthma Physician and Patient Survey
Michael S. Blaiss, MD; Michael A. Kaliner, MD; Carlos E. Baena-Cagnani, MD; Ronald Dahl, MD; Erkka J. Valovirta, MD; Giorgio W. Canonica, MD


An Allergy to Goldfish? Highlighting Labeling Laws for Food Additives
Ian A. Myles, MD; Douglas Beakes, MD


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


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
  1. The minimal clinically important difference (MCID) in allergic rhinitis (AR).

    アレルギー性鼻炎患者の自覚症状と検査所見を比較した結果、5L/min以上の鼻内気流量の改善があればQOLスコアが改善することなどがわかった。Clin Exp Allergy 2009 Nov. 5 Epub

  2. Glucocorticoid (GC) use and risk of atrial fibrillation (AF) or flutter (F).

    全身性のステロイド投与は心房細動や心房粗動のリスクを2倍高める。Archives of Internal Medicine 2009;169(18)1677

  3. Establishing the sequential progression of multiple allergic diagnoses in a UK birth cohort using the General Practice Research Database.

    アレルギーマーチの実態に関するコホート調査。湿疹から喘息への移行が典型的。Clin Exp Allergy 2009;39(12):1889

  4. Hypersensitivity and oral tolerance in the absence of a secretory immune system.

    分泌型IgA, IgMの欠損マウスは抗原負荷で強い過敏症状がみられた。しかし、代償性のTreg細胞の増加による経口免疫寛容は認められた。Allergy 2009; Nov 3 Epub

  5. Levels of nitric oxide oxidation products are increased in the epithelial lining fluid (ELF) of children with persistent asthma.

    NO関連産物が小児喘息BAL中に増加。J Allergy Clin Immunol. 2009;124(5):990

  6. Variability in the prevalence of premenstrual asthma (PMA).

    月経と喘息。Eur Respir J. 2009; Nov. 6 Epub

  7. Synergistic induction of macrophage inflammatory protein-3α/CCL20 production by IL-17A and TNF-α; in nasal polyp fibroblasts.

    鼻粘膜線維芽細胞はIL-17AとTNFの刺激によりCCL20(TH17の遊走因子)を分泌する。WAO Journal 2009;2(10):218

  8. Sleep actigraphy evidence of improved sleep after treatment of allergic rhinitis (AR).

    睡眠時無呼吸とアレルギー性鼻炎の関係。Annals of Allergy, Asthma and Immunology 2009;103(4):290

  9. The connection between early life wheezing and subsequent asthma: The viral march.

    Martinezによる小児喘息発症に関する総説Allergologia et Immunopathologia (Madr) 2009;37(5):249

World Allergy Congress (WAC) 2011 - Cancun, Mexico, 4-8 December 2011

Medical Book Review

Clinical Management of Chronic Obstructive Pulmonary Disease
Second Edition (Lung Biology in Health and Disease)

Edited by Stephen I. Rennard, Roberto Rodriguez-Rosin, Gerard Huchon, Nicolas Roche
2007 Informa Healthcare
ISBN: 0849375878
$299.95 USD Hardcover
Available at Amazon


Dr. Girish Patel, MBBS, MD (Respiratory Medicine)
Advanced Trainee, Respiratory Medicine
Cambelltown Hospital
Campbelltown, New South Wales

Chronic obstructive pulmonary disease (COPD) is the third leading cause of death in Australia, fourth in the USA and fifth globally. It is a common problem encountered in both primary and secondary care and contributes to the essential workload for medical practitioners in general and teaching hospitals (about 10% of hospital admissions) and the community-at-large. COPD treatment frequently involves a number of multidisciplinary team members. This book is a practical and well-written volume for the primary care physicians, specialists and allied health teams who deal with this common respiratory problem. It is designed for easy use with straightforward sections, individually referenced.

The purpose of the book is to provide easily accessible, reliable information outlining the etiology, natural history, diagnosis, and current evidence-based management of COPD. It also predicts what will be the next advances in understanding and treating COPD.

This book provides a comprehensive review of the pathogenesis, diagnosis, and management of COPD for pulmonologists, allergist/immunologists, research scientists, physiotherapists, clinical nurses and trainees in respiratory medicine.

The book is subdivided into five sections: Understanding the Pathophysiology of COPD, Clinical Assessment, Pharmacological Management, Non-pharmacological Management, and finally, Conclusions.

The first part comprehensively reviews basic mechanisms of COPD including the relationship with tobacco smoking as well as other non-tobacco causes. The reader is treated to a journey from diagnosis through end-of-life care and the opportunity to examine a variety of different areas of interest. The book concludes with an overview section on current and future global strategies for this disease.

A long list of contributors from around the world contributed to this text. Each chapter is well referenced, and numerous tables and illustrations assist the reader by emphasizing and summarizing important information. The presentation follows a logical progression. I recommend this book for all those who have an interest in understanding the pathogenesis and treatment of this global disease.

Find more allergy book reviews on the WAO Website here.

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