Medical Journal Reviews
Articles are selected for their importance to clinicians who care for patients with asthma and allergic/immunologic diseases by Juan Carlos Ivancevich, MD, WAO Web Editor-in-Chief, and John J. Oppenheimer, MD - FACAAI - FAAAAI, WAO Reviews Editor.
1. Volatile organic compounds defining adult asthma endotypes.
Meyer N, Dallinga JW, Nuss SJ, Moonen EJC, van Berkel JJBN et al. Defining adult asthma endotypes by clinical features and patterns of volatile organic compounds in exhaled air. Respiratory Research 2014; 15(136). (doi:10.1186/s12931-014-0136-8)
Editor’s comment: The authors found that 16 volatile organic compounds (VOCs) from the exhaled air of subjects with or without asthma could distinguish between healthy and asthma subjects with a sensitivity of 100% and a specificity of 91.1%. It is presumed that these VOCs which are released during inflammation in response to oxidative stress as a result of activated leukocytes in the airways may further aid in the classification of asthma subtypes.
2. No absolute contraindication to administration of epinephrine in the setting of anaphylaxis.
Campbell RL, Li JTC, Nicklas RA, and Sadosty AT. Emergency department diagnosis and treatment of anaphylaxis: a practice parameter. Annals of Allergy, Asthma & Immunology 2014; 113(6): 599-608. (doi:http://dx.doi.org/10.1016/j.anai.2014.10.007)
Editor’s comment: This practice parameter is a joint effort between emergency physicians who are often on the front line in the management of anaphylaxis, and allergists-immunologists who have a vested interest in how allergic patients are managed. This document reinforced that groups agree that the timely administration of epinephrine is essential for the effective treatment of anaphylaxis.
3. Decreasing the risk of side effects and increasing efficacy of allergen immunotherapy.
Jongejan L, van Ree R. Modified allergens and their potential to treat allergic disease. Current Allergy and Asthma Reports 2014; 14: 478. (doi:10.1007/s11882-014-0478-9)
Editor’s comment: In this review the authors summarize the recent advances regarding allergen modifications as well as new adjuvants for the treatment of allergic disease. They analyzed recombinant hypo-allergens, peptides, fusion proteins, and different routes of administration as well as the addition of new adjuvants that attempt to skew the immune system from a Th2 towards a Th1 or regulatory T cell phenotype.
4. Climate change and the increase of allergic and asthmatic symptoms through changes in pollen biology.
Albertine JM, Manning WJ, DaCosta M, Stinson KA, Muilenberg ML, and Rogers CA. Projected carbon dioxide to increase grass pollen and allergen exposure despite higher ozone levels. PLOS One 2014; 9(11): e111712. (doi:10.1371/journal.pone.0111712)
Editor’s comment: The results obtained through an experimental model of escalated levels of CO2 and O3 (165–202%) (felt to be in line with potential future levels) demonstrate significant increases in grass pollen production. Due to the widespread existence of grasses and their importance in eliciting allergic responses, these results indicate there will likely be a significant impact on human health worldwide as a result of future climate change.
5. Aberrations in the gut microbiome and intestinal homeostasis have multisystem effects.
West CE, Renz H, Jenmalm MC, Kozyrskyj AL, Allen KJ et al. The gut microbiota and inflammatory noncommunicable diseases: associations and potentials for gut microbiota therapies. Journal of Allergy and Clinical Immunology 2015; 125(1): 3-13. (doi:http://dx.doi.org/10.1016/j.jaci.2014.11.012)
Editor’s comment: The authors reviewed the impact of microbial composition that is implicated in the increasing prevalence of inflammatory diseases, including: allergic disease, asthma, inflammatory bowel disease, obesity, and associated noncommunicable diseases.