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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.

WAO Reviews - Editors' Choice

Posted: February 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. Characterization of bacterial communities in induced sputum obtained from subjects with and without asthma.

Reddy Marri P, Stern DA, Wright AL, Billheimer D, Martinez FD. Asthma-associated differences in microbial composition of induced sputum.  The Journal of Allergy and Clinical Immunology 2012; 131(2): 346-352.

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Editor’s comment:  Young adults with mild asthma show changes in the composition of induced sputum microbiota compared with nonasthmatic subjects, and these changes might play a role in pathogenesis and have implications for asthma management.

2. Including atopy in the diagnostic work-up and management of Chronic Obstructive Pulmonary Disease (COPD).

Fattahi F, ten Hacken NH, Löfdahl C-G, Hylkema MN, Timens W et al. Atopy is a risk factor for respiratory symptoms in COPD patients: results from the EUROSCOP study. Respiratory Research 2013; 14(10), January. doi:10.1186/1465-9921-14-10

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Editor’s comment: The prevalence of atopy in COPD patients is higher in males, subjects with overweight/obesity and younger patients, is associated with a higher prevalence and incidence of respiratory symptoms, and has higher remission rates when treated with inhaled corticosteroids.

3. Impact of glucocorticoids on the innate immune system and antibacterial host defense in asthma.

Wang P, Wang X, Yang X, Liu Z, Wu M, Li G. Budesonide suppresses pulmonary antibacterial host defense by down-regulating cathelicidin-related antimicrobial peptide in allergic inflammation mice and in lung epithelial cells.  BMC Immunology 2013; 14(7), February. doi:10.1186/1471-2172-14-7

Provisional PDF, open access

Editor’s comment: Inhaled budesonide suppressed pulmonary antibacterial host defense in an asthmatic mouse model and in lung epithelium cells in vitro through the down-regulation of cathelicidin-related antimicrobial peptide (CRAMP).

4. Efficacy and safety of acupuncture in the treatment for allergic rhinitis.

Choi SM, Park JE, Li SS, Jung H, Zi M et al.  A multicenter, randomized, controlled trial testing the effects of acupuncture on allergic rhinitis. European Journal of Allergy and Clinical Immunology 2012; 68(3): 365-374. doi: 10.1111/all.12053

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Editor’s comment: This study is the first multination acupuncture trial to evaluate the efficacy of acupuncture for persistent allergic rhinitis showing a significant reduction in the symptoms of persistent allergic rhinitis after acupuncture treatment compared to sham acupuncture or no treatment.

5. Early gestation air pollution exposure, in particular ozone (O3), affects the risk of adverse birth outcomes.

Olsson D, Mogren I, Forsberg B. Air pollution exposure in early pregnancy and adverse pregnancy outcomes: a register-based cohort study. BMJ Open 2013; 3(2).  doi:10.1136/bmjopen-2012-001955

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Editor’s comment: This large European study adds to the evidence that preterm birth may be caused by O3 exposure, and that the effect may be greater among asthmatic mothers. It also shows an association between O3 exposure and pre-eclampsia.

6. Remarkable advances in the understanding of the genetics and pathophysiology of atopic dermatitis (AD).

Schneider L, Tilles S, Lio P, Boguniewicz M, Beck L et al. Atopic dermatitis: A practice parameter update 2012.  The Journal of Allergy and Clinical Immunology 2013; 131(2):295-299.e27.

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Editor’s comment: This parameter was developed by the Joint Task Force on Practice Parameters, and updates the 2004 parameter on AD. It is an evidence-based, broadly accepted consensus opinion document. It has sections on definitions, immunopathology and genetics, clinical diagnosis, first-line management and treatment, identification and elimination of triggering factors, microbes, emotional stress, patient education, and treatment of the difficult-to-manage patient.

7. Classifying the etiology of chronic cough by its response to systematic diagnostic treatments.

Shimizu H, Hayashi M, Saito Y, Mieno Y, Takeuchi Y et al. Classification of chronic cough by systematic treatment cascade trial starting with beta agonist. Cough 2013; 9(4), February. doi:10.1186/1745-9974-9-4

Provisional PDF, Open Access

Editor’s comment: Diagnosing chronic cough with a bronchodilator is inexpensive and effective for categorizing the etiology of chronic cough. The majority of patients with chronic cough had β2 agonist responsive cough.

8. Consequences on health of climate change, air pollution and extreme events.

D´Amato G, Baena-Cagnani CE, Cecchi L, Annesi-Maesano, Nunes C et al. Climate change, air pollution and extreme events leading to increasing prevalence of allergic respiratory diseases. Multidisciplinary Respiratory Medicine 2013; 8(12), February. doi:10.1186/2049-6958-8-12

Full text, open access

Editor’s comment: This interesting review describes the effects of climate change and air pollution patterns on respiratory health and allergic diseases. The observational evidence indicates that recent regional changes in climate, particularly temperature increases, have already affected a diverse set of physical and biological systems.

9. Eosinophil-derived neurotoxin (EDN) may be a novel biomarker for the diagnosis, treatment, and monitoring of asthma/allergic disease.

Kim CK. Eosinophil-derived neurotoxin: a novel biomarker for diagnosis and monitoring of asthma. Korean Journal of Pediatrics 2013; 56(1): 8-12.

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Editor’s comment: This excellent review takes up the subject of eosinophilia and eosinophil-derived proteins as markers of asthma activity and proposes serum EDN to be used as a novel biomarker for the diagnosis, treatment, and monitoring of asthma/allergic disease in children and adults.

10. Interactive effects between IL-13 haplotypes and environmental exposures on childhood asthma.

Tsai C-H, Tung K-Y, Su M-W, Chiang B-L,  Chew FT et al. Interleukin-13 Genetic Variants, Household Carpet Use and Childhood Asthma. PLoS One 2013; 8(1). doi:10.1371/journal.pone.0051970

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Editor’s comment: IL-13 genetic variants showed significant adverse effects on asthma phenotypes, and household carpet use appears to modify the effects of IL-13 gene on wheeze and late-onset asthma.

11. Association between maternal exposure to particulate air pollution and term birth weight and low birth weight.

Dadvand P, Parker J, Bell ML, Bonzini M, Brauer M et al. Maternal Exposure to Particulate Air Pollution and Term Birth Weight: A Multi-Country Evaluation of Effect and Heterogeneity. Environmental Health Perspectives 2013, Advance Publication, Online 6 February. doi:10.1289/ehp.1205575

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Editor’s comment: The International Collaboration on Air Pollution and Pregnancy Outcomes (ICAPPO) was established to investigate the association between maternal exposure to ambient air pollution and pregnancy outcomes. This study was carried out by fourteen ICAPPO centers from nine countries with more than three million singleton term births and concludes that maternal exposure to particulate pollution was associated with low birth weight at term across study populations.

12. A Chronic rhinosinusitis (CRS) diagnostic algorithm may drastically reduce the number of computed tomography exams needed.

Amine M, Lininger L, Fargo KN, Welch KC. Outcomes of endoscopy and computed tomography in patients with chronic rhinosinusitis. International Forum of Allergy and Rhinology 2013; 3(1): 73-79. doi: 10.1002/alr.21071

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Editor’s comment: Incorporating the number of symptoms in a CRS diagnostic algorithm based on questions may drastically reduce the number of CTs needed. Clinical diagnostic accuracy is enhanced with this new algorithm while significantly reducing the cost and radiation burden of CTs.