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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: June 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. Efficacy of a fully human monoclonal antibody to the alpha subunit of the interleukin-4 receptor (dupilumab), in patients with persistent, moderate-to-severe asthma and elevated eosinophil levels.

Wenzel S, Ford L, Pearlman D, Spector S, Sher L et al. Dupilumab in persistent asthma with elevated eosinophil. The New England Journal of Medicine, 2013 May; In press, published online ahead of print. (doi: 10.1056/NEJMoa1304048)

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Editor’s comment:  This 12-week study showed that in a subpopulation of patients with persistent asthma, dupilumab therapy, as compared with placebo, was associated with fewer exacerbations induced by medication withdrawal. Further studies are needed to confirm these observations and better define the target population, dosing regimen, and long-term efficacy and safety.

2. Beneficial effect of fish on asthma and allergy development.

Goksör E, Alm B, Pettersson R, Möllborg P, Erdes L et al. Early fish introduction and neonatal antibiotics affect the risk of asthma into school age. Pediatric Allergy and Immunology 2013; 24(4): 339-344. (doi:10.1111/pai.12078)

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Editor’s comment: In this prospective cohort study the authors reported a reduced risk of doctor-diagnosed asthma, even at 8 years, following the early introduction of fish. Antibiotics during the first week of life increased the risk. These associations were significant for atopic asthma but not for non-atopic asthma.

3. PRACTALL consensus report on chronic rhinosinusitis (CRS).

Akdis CA, Bachert C, Cingi C, Dykewicz M, Hellings P et al. Endotypes and phenotypes of chronic rhinosinusitis: A PRACTALL document of the European Academy of Allergy and Clinical Immunology and the American Academy of Allergy, Asthma & Immunology. Journal of Allergy and Clinical Immunology 2013; 131 (6): 1479-1490. (doi:10.1016/j.jaci.2013.02.036)

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Editor’s comment: This PRACTALL consensus report on CRS produced by experts from the European Academy of Allergy and Clinical Immunology and the American Academy of Allergy, Asthma & Immunology summarizes the existing knowledge of CRS phenotypes and endotypes and clarifies the questions requiring additional research.

4. Mechanism of airway remodelling in chronic bronchial asthma.

Yasukawa A, Hosoki K, Toda M, Miyake Y, Matsushima Y et al. Eosinophils promote epithelial to mesenchymal transition of bronchial epithelial cells. PLoS ONE 2013; 8(5), May. (doi:10.1371/journal.pone.0064281)

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Editor’s comment: This study provides the evidence that eosinophils induce fibrosis and epithelial to mesenchymal transition of bronchial epithelial cells in the airway.

5. Overview of the field of epigenetics.

Capell BC, Berger SL. Genome -wide epigenetics. Journal of Investigative Dermatology 2013; 133, e9. (doi:10.1038/jid.2013.173)

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Editor’s comment: This article provides a brief overview of the field of epigenetics and offers a glimpse into some of the major techniques used to study it, with a particular focus on chromatin immunoprecipitation followed by sequencing (ChIP-seq), the current standard method for studying proteins and other epigenetic factors that bind to DNA.

6. A continuing medical education review on specific immunotherapy (SIT).

Brehler R, Klimek L, Volkmar Kopp M, Virchow JC. Specific immunotherapy—Indications and mode of action. Dtsch Arztebl International 2013; 110(9): 148–158. (doi:10.3238/arztebl.2013.0148)

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Editor’s comment: The authors concluded that even though the efficacy of SIT is well documented, it is still underused, and SIT should be offered as standard treatment to patients suffering from allergic rhinitis.

7. Using modern antihistamines alone rather than the traditional combination of antihistamines and intranasal steroids for lowering the symptom score in allergic rhinitis.

Mösges R, König V,  Köberlein J.  The effectiveness of modern antihistamines for treatment of allergic rhinitis - An IPD meta-analysis of 140,853 patients. Allergology International, 2013; 62: 215-222. (doi:10.2332/allergolint.12-OA-0486)

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Editor’s comment: The authors analyzed a database containing the data from 92,900 patients with allergic rhinitis and concluded that the administration of an antihistamine as monotherapy should be considered a primary treatment choice for patients with moderate to severe allergic rhinitis symptoms.

8. Seasonal variation in asthma exacerbations and to allergens.

Canova C, Heinrich J , Anto JM, Leynaert B, Smith M et al. The influence of sensitisation to pollens and moulds on seasonal variations in asthma attacks. European Respiratory Journal 2013; published online ahead of print, 7 March. (doi: 10.1183/09031936.00097412)

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Editor’s comment: The authors studied 2,637 young adults with asthma living in 15 countries and reported months in which they usually had asthma exacerbations and had skin prick tests performed. They concluded that seasonal variation in asthma attacks in young adults is common and is different depending on sensitization to outdoor, but not indoor, allergens.

9. Role of IgE and associated signalling cascades in airway smooth muscle cell remodelling.

Roth M, Zhong J, Zumkeller C, S’ng CT, Goulet S, Tamm M. The role of IgE-receptors in IgE-dependent airway smooth muscle cell remodelling. PLoS ONE 2013; 8(2): e56015. (doi:10.1371/journal.pone.0056015)

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Editor’s comment: The authors concluded that IgE increases airway remodeling in asthma through increased airway smooth muscle cell proliferation and deposition of pro-inflammatory collagens and fibronectin. Blocking IgE action prevents several aspects of airway smooth muscle cell remodeling.

10. Stature in children atopic dermatitis (AD).

Kyung Park M, Young Park K, Li K, Jun Seo S, Kwun Hong C. The short stature in atopic dermatitis patients: Are atopic children really small for their age? Annals of Dermatology 2013; 25(1) 23-27. (doi:10.5021/ad.2013.25.123)

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Editor’s comment: The authors studied if AD itself affects stature in children and evaluated the influence of other relevant factors such as genetic background, diet restrictions, and sleep disturbance. They concluded that AD itself may not be the causative factor for short stature in children with AD. Therefore, consideration of other relevant factors related to short stature in patients with AD is important for the proper management of the disease.

11. Anaphylaxis underdiagnosed.

Hocagil H, Karakilic E, Hocagil C, Senlikci H, Buyukcam F et al. Underdiagnosis of anaphylaxis in the emergency department: misdiagnosed or miscoded? Hong Kong Medical Journal 2013; 19:  Published online before print, May 20. (doi: 10.12809/hkmj133895)

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Editor’s comment: The authors studied adults admitted to the Emergency Department between 1 May 2005 and 30 April 2010 with allergic diseases considered to be anaphylactic reactions. They found  88 patients not diagnosed as having this condition although recorded physical examination findings were consistent with anaphylaxis. They concluded that emergency physicians should be better able to recognize the clinical features of anaphylaxis, so as to treat the episode promptly and appropriately.

12. Evidence of beneficial effects of early adenotonsillectomy compared with watchful waiting with supportive care for childhood sleep apnea.

Marcus CL, Moore RH , Rosen CL, Giordani B, Garetz S et al. A randomized trial of adenotonsillectomy for childhood sleep apnea. The New England Journal of Medicine 2013, Published online ahead of print. (doi: 10.1056/NEJMoa1215881)

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Editor’s comment: Surgical treatment for the obstructive sleep apnea syndrome in school-age children did not significantly improve attention or executive function as measured by neuropsychological testing but did reduce symptoms and improve secondary outcomes of behavior, quality of life, and polysomnographic findings