August 2010

1. Recommendations for the assessment in allergic rhinitis and asthma: a GA²LEN taskforce position paper.
The expression, "Patient-Reported Outcomes" (PROs), which came into frequent use only in the last decade, refers to "any report coming from patients about a health condition and its treatment", as opposed to data provided by other sources (clinical and instrumental tests, providers and caregivers). PROs are gaining increasing awareness and emphasis in clinical research and by regulatory bodies because of their relevance in the overall treatment efficacy assessment. Among PROs, Health-Related Quality of Life (HRQoL) and patient-reported symptoms have been extensively evaluated in rhinitis and asthma, but unexplored areas and methodological limits have recently been identified and discussed. This approach enables us to better understand patient-related factors influencing clinical trials and real-life management outcomes, to identify patients subgroups that can benefit from specific treatment and management plans and to tailor treatment to address PROs (not only physician-defined targets) to improve asthma and rhinitis management.
Editor's comment: PROs are gaining increasing awareness and emphasis because of their relevance in the overall treatment efficacy assessment.
Braido F, Bousquet PJ, Brzoza Z et al. Specific recommendations for PROs and HRQoL assessment in allergic rhinitis and/or asthma: A GA²LEN taskforce position paper. Allergy 2010; 65(8): 959-968.
Abstract

2. Efficacy of allergen-specific immunotherapy as a steroid-sparing agent in children with allergic asthma.
The aim of this study was to investigate the efficacy of an allergen-specific immunotherapy with a high-dose hypoallergenic mite preparation (allergoid) as a steroid-sparing agent in children with allergic asthma. Sixty-five children with asthma (Global Initiative for Asthma treatment levels II and III; 6-17 years old), after reaching asthma control with inhaled steroids during a 5-month baseline period, were randomized to receive subcutaneous mite allergoid immunotherapy (SCIT) plus fluticasone propionate (FP), or FP therapy alone for 2 years. During 2 subsequent 5-month winter periods, steroid therapy was adjusted according to predefined dose steps, determining and comparing the changes in FP dosages and the lowest FP dose sufficient to maintain asthma control. Immunologic and functional investigations were also carried out. Children treated with house dust mite SCIT plus FP were able to significantly reduce the FP dose by more steps (P < .05), compared to the group on FP alone. The mean daily dose in the immunotherapy group decreased from 330.3 µg in the baseline period to 151.5 µg after 2 treatment years, whereas in the control group the dose decreased from 290.6 µg to 206.3 µg. Compared with the control group, significant improvement was also observed in morning peak expiratory flow (P = .0315). Significantly increased levels of specific IgG(1) (P = .0001) and IgG(4) (P < .0001) were also observed. The authors concluded that adding mite allergoid SCIT to pharmacologic treatment is an effective and safe strategy to reduce corticosteroid doses while maintaining disease control in children with mite-induced allergic asthma.
Editor's comment: Specific immunotherapy in allergy induced asthma should not be an alternative but a complementary treatment to drug treatment.
Zielen S, Kardos P, and Madonini E. Steroid-sparing effects with allergen-specific immunotherapy in children with asthma: A randomized controlled trial. Journal of Allergy and Clinical Immunology 2010; in press [published online ahead of print 12 July 2010]
Abstract

3. Cigarette smoke induced inflammation in upper and lower airways.
Cigarette smoke (CS) is known to initiate a cascade of mediator release and accumulation of immune and inflammatory cells in the lower airways. The authors investigated and compared the effects of CS on upper and lower airways in a mouse model of subacute and chronic CS exposure. C57BL/6 mice were whole-body exposed to mainstream CS or air, for 2, 4 and 24 weeks. Bronchoalveolar lavage fluid (BAL) was obtained and tissue cryosections from nasal turbinates were stained for neutrophils and T cells. Furthermore the investigators evaluated GCP-2, KC, MCP-1, MIP-3alpha, RORc, IL-17, FoxP3, and TGF-beta1 in nasal turbinates and lungs by RT-PCR. In both upper and lower airways, subacute CS-exposure induced the expression of GCP-2, MCP-1, MIP-3alpha and resulted in a neutrophilic influx. However, after chronic CS-exposure, there was a significant downregulation of inflammation in the upper airways, while on the contrary, lower airway inflammation remained present. Whereas nasal FoxP3 mRNA levels increased after 2 weeks, lung FoxP3 mRNA increased only after 4 weeks, suggesting that mechanisms to suppress inflammation occur earlier and are more efficient in the nose than in the lung. Altogether, these data demonstrate that CS induced inflammation may be differently regulated in the upper versus lower airways in mice. Furthermore, these data may help to identify new therapeutic targets in this disease model.
Editor's comment: CS induced inflammation may be differently regulated in the upper versus lower airways in mice.
Huvenne W, Pérez-Novo CA, Derycke L et al. Different regulation of cigarette smoke induced inflammation in upper versus lower airway. Respiratory Research 2010;
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