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World Allergy Organization
WAO's mission: To be a global resource and advocate in the field of allergy, advancing excellence in clinical care through education, research and training as a world-wide alliance of allergy and clinical immunology societies.

Medical Journal Reviews

July 2015

The Editors select articles for their importance to clinicians who care for patients with asthma and allergic/immunologic diseases, and whenever possible they seek articles that everyone can access freely. The Editors' Choice comes to you each month from Juan Carlos Ivancevich, MD, WAO Web Editor-in-Chief, and John J. Oppenheimer, MD, FACAAI, FAAAAI, the WAO Reviews Editor.

1. The immune response that occurs in patients with severe asthma is markedly different than what occurs in milder forms.

Raundhal M, Morse C, Khare A, Oriss TB, Milosevic J et al. High IFN-γ and low SLPI mark severe asthma in mice and humans. Journal of Clinical Investigation 2015; published online ahead of print, 25 June. (doi:10.1172/JCI80911)

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Editor’s comment: The authors observed that CD4 T-cells in the airways of severe asthmatics secreted different inflammatory proteins than those with mild disease – particularly interferon gamma. The analysis of human samples helped them to develop a mouse model of the disease. They introduced an allergen and a bacterial product to induce an immune profile and airway hyper-reactivity that were poorly controlled by corticosteroids and are comparable to human severe asthma patients. Through this model, the investigators found that boosting secretory leukocyte protease inhibitor (SLPI) levels reduced airway hyper-reactivity.

2. An updated and comprehensive review about contact dermatitis.

Fonacier L, Bernstein DI, Pacheco K, Holness DL, Blessing-Moore J et al. Contact dermatitis: a practice parameter-update. JACI: In Practice 2015; 3(3): S1–S39. (doi:10.1016/j.jaip.2015.02.009)

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Editor’s comment: This is a complete and comprehensive document regarding the diagnosis and treatment of contact dermatitis. The Joint Task Force on Practice Parameters, which represents the American Academy of Allergy, Asthma & Immunology (AAAAI); the American College of Allergy, Asthma & Immunology (ACAAI); and the Joint Council of Allergy, Asthma & Immunology developed this parameter.

3. Relationship between patient information and adherence to allergen immunotherapy in clinical practice.

Calderon MA, Cox L, Casale TB, Mösges R, Pfaar O et al. The effect of a new communication template on anticipated willingness to initiate or resume allergen immunotherapy: an internet-based patient survey. Allergy, Asthma & Clinical Immunology 2015; 11:17. (doi:10.1186/s13223-015-0083-z)

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Editor’s comment: In attempt to assess patients’ understanding of allergy and acceptance of allergen immunotherapy, the authors performed an Internet-based survey of patient panels in France, Germany, Spain, the United States and Russia. The survey participants had either recently discontinued allergen immunotherapy before the end of the prescribed course or decided not to initiate a course of allergen immunotherapy recommended by their physician.  Participants completed an online questionnaire immediately before and after viewing a recently developed communication template, in an attempt to validate the template and to assess its impact on anticipated willingness to initiate or resume allergen immunotherapy.  They found that sixty-seven percent of participants stated that viewing the communication template would have made them more likely to continue or initiate allergen immunotherapy. They also demonstrated that early abandoners reported a perception of low effectiveness (39 %) and complained about expense (39 %) and practical constraints (32 %), while the non-starters feared side effects (22%).

4. Infliximab systemic adverse reactions and desensitization.

Mourad AA, Boktor MN, Yilmaz-Demirdag Y, Bahna SL. Adverse reactions to infliximab and the outcome of desensitization. Annals of Allergy, Asthma & Immunology 2015; published online ahead of print, 17 June. (doi:http://dx.doi.org/10.1016/j.anai.2015.06.004)

Abstract

Editor’s comment: The authors aimed to investigate the frequency and characteristics of adverse reactions to infliximab at the authors' institution and the outcome of their management, including desensitization. They found that Infliximab can trigger systemic reactions and that in such cases desensitization appears to be safe and effective.

5. Small-particle inhaled corticosteroids (ICS) in pediatric asthma.

van Aalderen WM, Grigg J, Guilbert TW, Roche N, Istael E et al. Small-particle inhaled corticosteroid as first-line or step-up controller therapy in childhood asthma. JACI: In Practice 2015, published online ahead of print, 29 May. (doi:http://dx.doi.org/10.1016/j.jaip.2015.04.012)

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Editor’s comment: The authors compared the effectiveness of a small-particle inhaled corticosteroid (ICS) with that of standard size-particle ICS for children initiating or stepping up ICS therapy for asthma and also compared the effectiveness of ICS dose step-up using small-particle ICS with adding long-acting β2-agonist (LABA) to the ICS. They found that initiating or stepping up the ICS dose with small-particle ICS rather than with standard size-particle, ICS was more effective and showed similar effectiveness to add-on LABA in childhood asthma.