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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

February 2014

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. Interventions to manage immediate and long-term symptoms of food allergy and promote desensitization/tolerance.

de Silva D, Geromi M, Panesar SS, Muraro A, Werfel T et al. Acute and long-term management of food allergy: systematic review. Allergy 2014; 69(2): 159-167. (doi:10.1111/all.12314)

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Editor’s comment: This systematic review summarizes the evidence about the immediate management of reactions and the longer-term approaches to minimize adverse outcomes in patients with food allergy. The authors concluded that the evidence base about acute and longer-term management is weak and needs to be strengthened as a matter of priority.

2. Update on food allergy.

Sicherer SH and Sampson HA. Food allergy: Epidemiology, pathogenesis, diagnosis, and treatment.  The Journal of Allergy and Clinical Immunology 2014; 133(2): 291-307.

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Editor’s comment: This comprehensive review focuses on advances and updates in the epidemiology, pathogenesis, diagnosis, and treatment of food allergy over the past 3 years. The authors highlight recent clinical observations and advances regarding the prevention, diagnosis, and management of food allergy that apply now, and they speculate on those that may be important in the future.

3. Efficacy of oral immunotherapy for the desensitization of children with allergy to peanuts.

Anagnostou K, Islam S, King Y, Foley L, Pasea L et al. Assessing the efficacy of oral immunotherapy for the desensitisation of peanut allergy in children (STOP II): a phase 2 randomised controlled trial. The Lancet 2014; Article in press; published online before print (30 January) (doi:10.1016/S0140-6736[13]62301-6)

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Editor’s comment: The authors concluded that oral immunotherapy successfully induced desensitization in most children within the study population with peanut allergy of any severity, by inducing a clinically meaningful increase in the threshold dose to peanut challenge. There was also a good safety profile.

4. A better understanding and management of patients with hypersensitivity drug reactions (HDRs).

Fernandez TD, Mayorga C, Guéant JL, Blanca M, Cornejo-Garcia Ja. Contributions of pharmacogenetics and transcriptomics to the understanding of the hypersensitivity drug reactions. Allergy 2014; 69(2):150-158. (doi:10.1111/all12304)

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Editor’s comment: In this excellent review the authors discuss advances in our knowledge of the pharmacogenetics, immunology and transcriptomics involved in hypersensitivity drug reactions.

5. Current developments in the field of β 2-agonists and muscarinic antagonists and novel drug targets for potential clinical utility.

Spina D.Current and novel bronchodilators in respiratory disease. Current Opinion in Pulmonary Medicine 2014;20(1):73-86.

Abstract

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Editor’s comment: This review summarizes the clinical effectiveness of a number of once a day inhaled β 2-agonists and muscarinic antagonists, and identifies novel targets (e.g., bitter taste receptor TASR2), as well as discusses the clinical effectiveness of other agents (e.g., phosphodiesterase [PDE]3/4).   

6. Allergens and risk factors for the high prevalence of allergic airway disease in a tropical urban environment.

Andiappan AK, Puan KJ, Lee B, Nardin A, Poidinger M et al. Allergic airway diseases in a tropical urban environment are driven by dominant mono-specific sensitization against house dust mites. Allergy 2014; published online before print (24 January). (doi:10.1111/all.12364)

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Editor’s comment: In a tropical urban environment (Singapore), the allergic response was dominated by a mono-specific IgE sensitization against house dust mites. This mono-specific sensitization produced a high prevalence of allergic airway disease impacting a large proportion of the population in Singapore.

7. Association between CD203c expression level and clinical disease activity in chronic urticaria (CU).

Ye Y-M, Yang E-M, Yoo H-S, Shin Y-S, Kim S-H, Park H-S. Increased level of basophil CD203c expression predicts severe chronic urticaria. Journal of Korean Medical Science 2014; 29(1): 43-47. (doi:10.3346/jkms.2014.29.1.43)

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Editor’s comment: The authors found that the degree of basophil activation detected by the measurement of the expression of basophil CD203c correlated with disease severity in patients with chronic urticaria (CU). They suggested that the measurement of CD203c at baseline may be used as a potential predictor of severe CU requiring another treatment option beyond antihistamines.

8. Effectiveness of interventions for the acute and long-term management of anaphylaxis.

Dhami S, Panesar SS, Roberts G, Muraro A, Worm M et al. Management of anaphylaxis: a systematic review. Allergy 2014; 69(2):168-175. (doi:10.1111/all.12318)

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Editor’s comment: In this systematic review the authors failed to find robust studies investigating the effectiveness of adrenaline, H1-antihistamines, systemic glucocorticosteroids or methylxanthines in the management of anaphylaxis. They found evidence regarding the optimum route and site of injection of adrenaline suggesting that administration of intramuscular adrenaline into the middle of the vastus lateralis muscle is the optimum treatment.

9. Risks of asthma/wheezing disorders in children born preterm.

Been JV, Lugtenberg MJ, Smets E, van Schayck CP, Kramer BW et al. Preterm birth and childhood wheezing disorders: a systematic review and meta-analysis. PLoS Medicine 2014; 11(1):e1001596. (doi:10.1371/journal.pmed.1001596)

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Editor’s comment: In this systematic review with meta-analysis the authors found compelling evidence that preterm birth—particularly very preterm birth—increases the risk of asthma. Given the projected global increase in children surviving preterm births, research now needs to focus on understanding underlying mechanisms and preventive interventions.

10. Preventing the development of food allergy in children and adults.

de Silva D, Geromi M, Halken S, Host A, Panesar SS  et al. Primary prevention of food allergy in children and adults: systematic review. Allergy 2014; published online before print (16 January). (doi:10.1111/all12334)

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Editor’s comment: The authors failed to find good evidence to recommend that pregnant or breastfeeding women should change their diet or take supplements to prevent allergy in infants at high or normal risk. They found mixed evidences about the preventive benefits of breastfeeding for infants at high or normal risk, but there was evidence to recommend avoiding cow's milk and substituting with extensively or partially hydrolyzed whey or casein formulas for infants at high risk for the first 4 months.

11. Documenting changes that are important to patients with urticaria and/or angioedema.

Weldon D. Quality of life in patients with urticaria and angioedema: Assessing burden of disease. Allergy and Asthma Proceedings 2014;35(1):4-9. (doi:10.2500/aap.2014.35.3713)

Abstract

Editor’s comment:  Quality of life (QoL) surveys are useful in defining changes in a patient’s symptoms over a period of time. Based on current surveys available, choosing a broader-based urticaria (CU-Q2oL) or angioedema (AE-QoL) survey along with a measurement tool (e.g., UAS7) to allow the patient to catalog daily changes due to therapy can provide objective documentation of disease activity for the clinician.

12. Updates of allergen names approved at the meetings of IUIS Allergen Nomenclature Sub-Committee in 2011 through 2013.

Radauer C, Nandy A, Ferreira F, Goodman RE, Larsen JN  et al. Update of the WHO/IUIS Allergen Nomenclature Database based on analysis of allergen sequences. Allergy 2014; published online before print (15 January). (doi:10.1111/all.12348)

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Editor’s comment: The goals of this update were to increase consistency in the classification of allergens, isoallergens, and variants and to incorporate the evolutionary classification of proteins into allergen nomenclature, while keeping changes of established names to a minimum in the interest of continuity. The changes reflect recent progress in identification, cloning, and sequencing of allergens