WAO Reviews - Editors' Choice
Posted: April 2012
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. A global estimate of the burden of asthma in adults suggests that asthma continues to be a major public health concern worldwide.
To T, Stanojevic S, Moores G, Gershon AS, Bateman ED et al. Global asthma prevalence in adults: findings from the cross-sectional world health survey. BMC Public Health 2012; 12(204). doi: 10.1186/1471-2548-12-204
Editor's comment: This World Health Survey (WHS) developed by the World Health Organization surveyed 178,215 individuals from 70 countries aged 18 to 45 years in 2002-2003. The global prevalence rates of doctor diagnosed asthma, clinical/treated asthma and wheezing in adults were 4.3%, 4.5%, and 8.6% respectively, and varied by as much as 21-fold amongst countries. The highest prevalence was observed in resource-rich countries but resource-poor nations were also significantly affected.
2. Characteristics of bronchial inflammation in patients with stable and well-controlled asthma.
Muñoz X, Sanchez-Vidaurre S, Roca O, Torres F, Morell F, Cruz MJ. Bronchial inflammation and hyper responsiveness in well-controlled asthma.Clinical & Experimental Allergy. 2012; doi: 10.1111/j.1365-2222.2012.04004.x; Accepted, unedited article; published online before print.
Editor's comment: The most relevant findings in this study were: 1) persistent bronchial inflammation can be seen even in patients treated with inhaled corticosteroids who were in a controlled phase of the disease, 2) the unexpectedly high percentage of patients with neutrophilic inflammation, and 3) the presence of a greater degree of airway hyper responsiveness in patients with eosinophilic asthma vs those with a predominantly neutrophilic inflammation.
3. Expression and upregulation of IL-32 in chronic rhinosinusitis with nasal polyps.
Zuidmeer-Jongejan L, Fernandez-Rivas M, Poulsen LK, Neubauer A, Asturias J et al. FAST: Towards safe and effective subcutaneous immunotherapy of persistent life-threatening food allergies. Clinical and Translational Allergy 2012; 2(5) (doi.10.1186/2045-7022-2-5)
Editor's comment: The FAST project aims at the development of safe and effective treatment of food allergies, targeting prevalent, persistent and severe allergy to fish and peach. It investigates the development of novel therapies for the treatment of food allergy by combining the principles of traditional allergen-specific immunotherapy with biotechnology (hypoallergenic recombinant allergens).
4. Evidence-based cough algorithm to evaluate if chronic cough in children is dependent on the clinical setting and age.
Chang AB, Robertson CF, Van Asperen PP, Glasgow N, Mellis CM et al. A multi-centre study on chronic cough in children: burden and etiologies based on a standardized management pathway. Chest, 2012. doi: 10.1378/chest.11-2725; Published online before print 29 March 2012
Editor’s comment: This large multicentre study that utilized a children-specific evidence-based protocol with validated outcomes and a-priori defined time frames found that irrespective of etiology and age the burden of chronic cough is high. The frequency of etiologies of chronic cough is dependent on the clinical setting, and age has less influence.
5. A practical and cheaper alternative to reduce the exposure to indoor house dust mite allergens and microbial bio-contaminants.
Wu FF-S, Wu M-W, Pierse N, Crane J, Siebers R. Daily vacuuming of mattresses significantly reduces house dust mite allergens, bacterial endotoxin, and fungal β-glucan. Journal of Asthma 2012; 49(2): 139-143. doi: 10.3109/02770903.2011.654023
Editor’s comment: Daily vacuuming of mattresses significantly decreased levels of house dust mite allergens, endotoxin, and β-glucan, offering sensitized patients an option to reduce their exposure to bio-contaminants. In addition to other allergen-avoidance methods, such as mattress encasings and regular washing of bedding, vacuuming might reduce their exposure even further.
6. New low-molecular-weight (LMW) agents causing occupational asthma (OA) reported during the period 2000–2010.
Pralong JA, Cartier A, Vandenplas O, Labrecque M. Occupational asthma: New low-molecular-weight causal agents, 2000–2010. Journal of Allergy 2012; doi: 10.1155/2012/597306
Editor’s comment: This bibliographic search identified 39 case reports describing 41 new LMW agents causing OA. Among these 41 new LMW agents, 12 belonged to the Drugs category, 11 to the Wood Dust category, 4 to the Metals category, and 8 to the Chemicals category. The authors also found 3 biocides, 2 fungicides, and 1 anhydride salt classified as miscellaneous.
7. Review on innate immunity in the pathogenesis of severe asthma and mechanisms of glucocorticoid resistance.
Yang M, Kumar RK, Hansbro PM, Foster PS. Emerging roles of pulmonary macrophages in driving the development of severe asthma. Journal of Leukocyte Biology, 2012; 91(14): 557-569. doi: 10.1189/jlb.0711357
Editor’s comment: This excellent review highlights the role of pulmonary macrophages in the pathophysiology of severe asthma and resistance to corticosteroids. It discusses the role of macrophage phenotypes infection, IFN-γ, LPS associated signaling pathways, TNF-α, MIF, and other macrophage-associated factors in the production of this phenomenon.
8. Characteristics of ocular symptoms and their impact on daily activities in subjects suffering from allergic rhinitis (AR).
Klossek JM, Annesi-Maesano I, Pribil C, Didier A. The burden associated with ocular symptoms in allergic rhinitis. International Archives of Allergy and Immunology, 2012; 158(4): 411-417. doi: 10.1159/000334286
Editor’s comment: This cross-sectional observational survey using face-to-face interviews found that 31.7% of the population-based sample suffered from AR and 52.0% of AR subjects described ocular symptoms, 57.5% for >5 years, 30.2% for >6 months in the past 12 months, and 92.2% during the pollen season. This survey confirms the impact of ocular symptoms on AR patients’ lives and suggests that they are still neglected and undertreated.
9. PGE2 may not be able to protect allergic lung inflammation under certain circumstances.
Church RJ, Jania LA, and Koller BH. Prostaglandin E2 produced by the lung augments the effector phase of allergic inflammation. Journal of Immunology 2012; 188(8): 4093-4012. doi: 10.4049/jimmunol.1101873, Published online before print
Editor’s comment: Loss of microsomal PGE2 synthase-1 (mPGES1), the primary enzyme required for production of PGE2 from COX-1 and COX-2 metabolites, is not required for Th2 polarization following sensitization of mice to OVA. These findings underscore the challenges of targeting PGE2 and its receptors in the treatment of lung diseases.
10. Sublingual immunotherapy (SLIT) would be safe during pregnancy and when initiated for the first time in a pregnant patient.
Shaikh WA, Shaikh SW. A prospective study on the safety of sublingual immunotherapy in pregnancy. Allergy, 2012; doi: 10.1111/j.1398-9995.2012.02185.x, Published online before print 5 April 2012
Editor’s comment: This is the first ever study on the safety of SLIT during pregnancy demonstrating that the incidence of complications was the lowest in the SLIT group compared with control groups and indeed lower than that seen in the general population.
11. Retrospective review of patients with a history of egg-induced anaphylaxis who received influenza vaccination.
Fung I, Spergel JM. Administration of influenza vaccine to pediatric patients with egg-induced anaphylaxis. The Journal of Allergy and Clinical Immunology 2012; 129(4): 1157-1159. doi: 10.1016/j.jaci.2011.11.038
Editor’s comment: The authors concluded that influenza vaccination is relatively safe in subjects with a history of egg-induced anaphylaxis. They found only 3 cases of skin-limited reactions and no systemic reactions in 119 vaccinations.
12. Effect of patch testing on surgical decision making and outcomes in suspected metal hypersensitivity related to implants in bones or joints.
Mesinkovska NA, Tellez A, Molina L et al. The effect of patch testing on surgical practices and outcomes in orthopedic patients with metal implants. Archives of Dermatology 2012. doi: 10.1001/archdermatol.2012.86, Published online before print 20 February 2012
Editor’s comment: The results of this study support the value of patch testing of patients with a clinical history of metal hypersensitivity before metal surgical implant in bone or a joint as a safe measure to avoid complications.