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Archives: Medical Journal Reviews

WAO Reviews - Editors' Choice

Posted: January 2013

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 Phillip Lieberman, MD, WAO Reviews Editor.

1. Expression of single nucleotide polymorphisms (SNPs) in relevant cytokines expressed in food allergic patients.

Brown P, Nair B, Mahajan SD, Sykes DE, Rich G et al. Single nucleotide polymorphisms (SNPs) in key cytokines may modulate food allergy phenotypes. European Food Research and Technology 2012; 235(5): 971-980.


Editor's comment: This interesting study shows a definite association between the IL-4Ra (1652A/G) polymorphism and altered atopy in food allergic patients, providing clinicians insight into better management of early sensitizations and symptoms of food allergies.

2. Tests for airway hyperresponsiveness are useful objective measures to aid in asthma diagnosis by identifying a central feature of asthma.

Brannan JD, Lougheed MD. Airway hyperresponsiveness in asthma: mechanisms, clinical significance, and treatment. Frontiers in Respiratory Physiology 2012; 3(460). doi: 10.3389/fphys.2012.00460

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Editor's comment: This comprehensive review helps to understand the differences in mechanisms between direct and indirect tests in order to employ them appropriately in both a clinical and research environment.

3. Direct asthma-related medical costs, trends in total and per-patient costs of hospitalizations, physician visits, and medications.

Bedouch P, Marra CA, FitzGerald JM, Lynd LD, Sadatsafavi M. Trends in Asthma-Related Direct Medical Costs from 2002 to 2007 in British Columbia, Canada: A Population Based-Cohort Study. PLoS ONE 2012; 7(12). doi:10.1371/journal.pone.0050949

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Editor's comment: First study to document a recent decrease in asthma-related hospitalizations and physician visit costs alongside an increase in medication costs.

4. Study about the relation between occupational exposure and new-onset asthma.

Lillienberg L, Andersson E, Janson C, Dahlman-höglund A, Forsberg B, Holm M et al. Occupational exposure and new-onset asthma in a population-based study in northern Europe (RHINE). Oxford University Press 2012; December 1. doi:10.1093/annhyg/mes083

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Editor's comment: The authors concluded that the lifetime prevalence and point prevalence of self-reported food allergy (FA) in Europe are around 17% and 6%, respectively. The point prevalence of FA challenge-verified was under 1%. The frequency is higher among children than among adults. The risk or prognostic factors for the development of FA are inconsistent, although sex, age, country of residence, the presence of other allergic diseases, and familial history of allergy may be important. Clearly, there is need to improve this evidence base in order to validly estimate the putative frequency of food allergy.

5. Examination of the short-term effects of initial oral steroids followed by topical steroid therapy in patients with nasal polyps.

Kirtsreesakul V, Wongsritrang K, Ruttanaphol. Does oral prednisolone increase the efficacy of subsequent nasal steroids in treating nasal polyposis? American Journal of Rhinology and Allergy 2012; 26(6): 455-462.


Editor's comment: Combined oral and nasal steroid therapy effectively improve hyposmia, polyps size, and nasal airflow. Massive polyposis and/or positive meatal discharge can be considered as major risk factors for steroid insensitivity.

6. Asthma: the most common chronic disease affecting pregnancy.

Maselli DJ, Adams SG, Peters JI, Levine SM. Management of asthma during pregnancy. Therapeutic Advances in Respiratory Disease 2012; November 5, Published online before print. doi:10.1177/1753465812464287


Editor's comment: This excellent review article summarizes the most recent literature about the immunological changes that occur during pregnancy, physiological and clinical implications of asthma on pregnancy, and asthma management and medication use in pregnant women.

7. Predictive value of clinical parameters for a positive double-blind placebo-controlled food challenge (DBPCFC) in infants suspected of cow's milk allergy (CMA).

van Thuijl A, Schoemaker A-F, Menting S, van Dulmen J, Boeting J et al. Towards better triage of infants suspected of cow's milk allergy: development of a preliminary multivariable diagnostic index. European Journal of Pediatrics 2012; December. doi:10.1007/s00431-012-1900-8


Editor's comment: A triage model based on easily obtainable parameters might have a reasonably good ability to discriminate between infants suspected of CMA with and without a positive DBPCFC. In addition, when the objective SCORAD index was added as a variable, the authors found that the probability of a positive DBPCFC increased when objective SCORAD indexes were higher.

8. Antibiotics and paracetamol should not be withheld from infants or young children for fears they might develop asthma.

Heintze K, Petersen K-U. The case of drug causation of childhood asthma: antibiotics and paracetamol. European Journal of Clinical Pharmacology 2013; January 5. doi:10.1007/s00228-012-1463-7

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Editor's comment: The weight of evidence of the collected studies in this review strongly suggests that the association of antibiotics with childhood asthma reflects various forms of bias, the most prominent of which is confounding by indication. Recent studies and meta-analyses support the same conclusion for paracetamol.

9. Allergen-specific immunotherapy (ASIT) affects the nasal levels of human ?-defensins (HBDs) in patients with seasonal allergic rhinitis (SAR).

Bogefors J, Kvarnhammar AM, Cardell L-O. Upregulated levels of human ?-defensins in patients with seasonal allergic rhinitis after allergen-specific immunotherapy treatment. International Forum of Allergy and Rhinology 2012; published online before print December 16. doi: 10.1002/alr.21127


Editor's comment: The present study demonstrates expression, localization, and secretion of HBD1-3 in the nose and that ASIT increases the nasal release of HBD1 and HBD2 in patients with SAR.

10. Montelukast as an alternative to salmeterol as tailored second-line asthma controller therapy in children expressing the Arg16 genotype.

Lipworth BJ, Basu K, Donald HP, Tavendale R, Macgregor DF et al. Tailored second-line therapy in asthmatic children with the Arg16 genotype. Clinical Science 2013; 124(8): 521-528. doi: 10.1042/CS20120528

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Editor's comment: This pragmatic randomized controlled trial shows that in children expressing the arginine genotype, in comparison with salmeterol, adding montelukast to inhaled fluticasone significantly reduced school absences, improved asthma symptoms and quality of life, while reducing inhaled reliever use, along with no difference in FEV1.