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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

July 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 John J. Oppenheimer, MD - FACAAI - FAAAAI, WAO Reviews Editor.

1. Clinical Review. Allergic rhinitis in children.

Barr JG, Al-Reefy H, Fox AT, and Hopkins C. Allergic rhinitis in children. BMJ 2014; 349: g4153 1 July 2014. (doi:http://dx.doi.org/10.1136/bmj.g4153)

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Editor’s comment: In this comprehensive and updated clinical review regarding allergic rhinitis in children, the authors perform a thorough review of the current literature, with particular attention to the Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines, produced by the World Health Organization, and from this they develop a comprehensive summary regarding the most prevalent illness in our specialty.

2. An extensive rice protein-based hydrolyzed formula is shown to be effective in the treatment of cow’s milk protein allergy.

Vandenplas Y, De Greef E, and Hauser B. An extensively hydrolysed rice protein-based formula in the management of infants with cow’s milk protein allergy: preliminary results after 1 month.  Archives of Disease in Childhood 2014; published online before print, 9 June 2014. (doi:10.1136/archdischild-2013-304727)

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Editor’s comment: Guidelines recommend extensively hydrolyzed cow’s milk protein formulas in the treatment of infants with cow’s milk allergy (CMA); however, extensively hydrolyzed rice protein infant formulas have recently become available, in this study the investigators demonstrate that it is tolerated by more than 90% of children with proven CMA with a 95% CI and thus may be a good alternative.

3. Systematic review about the evidence for epidemiological association between low levels of serum vitamin D and asthma diagnosis in children.

Rajabbik MH, Lotfi T , Alkhaled L, Fares M, Fuleihan GEH, Mroueh S, and Akl EA. Association between low vitamin D levels and the diagnosis of asthma in children: a systematic review of cohort studies. Allergy, Asthma & Clinical Immunology 2014; 10:31, 11 June 2014. (doi:10.1186/1710-1492-10-31)

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Editor’s comment: The authors systematically reviewed the evidence for an epidemiological association between low serum levels of vitamin D and the diagnosis of asthma in children and concluded that available evidence suggests a potential association, but high quality studies are needed to bring closure to this question.

4. Current perspectives and future directions of mucosal vaccine development.

Azegami T, Yuki Y, and Kiyono H. Challenges in mucosal vaccines for the control of infectious diseases. International Immunology 2014; accepted manuscript, published online before print, 9 June. (doi:10.1093/intimm/dxu063)

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Editor’s comment: The authors reviewed the accumulated data regarding the innate and acquired immunity of the mucosal immune system with a focus on the recent scientific and technical advancements in the development of the next generation of mucosal vaccines for the control of infectious diseases.

5. Defining asthma phenotypes on the basis of clinical and epidemiological data.

Henderson AJ. Childhood asthma phenotypes in the twenty-first century. Breathe 2014; 10(2): 100 – 108. (doi:10.1183/20734735.014613)

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Editor’s comment: The author reviewed the developing concept of asthma phenotypes in children.  He considers the implications for disease aetiology and treatment and suggests new possibilities in approaching this problem in this era of “big data”.

6. Evidence for a causal effect of body mass index (BMI) on asthma.

Granell R, Henderson AJ, Evans DM, Smith GD, Ness AR, Lewis S, Palmer TM, and Sterne JAC. Effects of BMI, Fat mass, and lean mass on asthma in childhood: A Mendelian randomization study. PLoS Med 2014; 11(7): e1001669. (doi:10.1371/journal.pmed.1001669)

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Editor’s comment: The authors investigated evidence for a causal effect of BMI on asthma using a Mendelian randomization approach. Their findings suggest that a higher BMI increases the risk of asthma in mid-childhood and that global increases in BMI over the latter aspect of the 20th century may have contributed to the global increase in asthma that occurred at the same time.

7. IL-23 in the pathogenesis of allergic asthma.

Li Y and Hua S. Mechanisms of pathogenesis in allergic asthma: Role of interleukin-23. Respirology 2014; 19(5): 663 -669. (doi:10.1111/resp.12299)

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Editor’s comment:  This review examines the role of IL-23 in asthma and the proposed mechanisms of IL-23-induced airway inflammation as well as examines agents currently under investigation that target IL-23 related pathways.

8. A systematic review to appraise the evidence on the epidemiology of food allergy in Europe.

Nwaru BI, Hickstein L, Panesar SS, Roberts B, Muraro A, and Sheikh A. Prevalence of common food allergies in Europe: a systematic review and meta-analysis. Allergy 2014; 69(8): 992 – 1007. (doi:10.1111/all.12423)

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Editor’s comment: This systematic review provides up-to-date estimates of the prevalence of food allergy in Europe. In summary, the lifetime self-reported prevalence of allergy to common foods in Europe ranged from 0.1 to 6.0%, with a high heterogeneity between studies. The authors concluded that future research should include improved standardization in the assessment of food allergy as well as initiating strategies to increase subject participation.

9. Algorithm for patients with suspected systemic mastocytosis.

Valent P, Escribano L, Broesby-Olsen S, Hartmann K, Grattan C et al. Proposed diagnostic algorithm for patients with suspected mastocytosis: a proposal of the European Competence Network on Mastocytosis. Allergy 2014; Published online before print, 19 May. (doi:10.1111/all.12436)

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Editor’s comment: The European Competence Network on Mastocytosis (ECNM) has been created with the aim of studying the aetiology and manifestations of mastocytosis and to improve diagnosis and therapy. In the current report, the ECNM proposes guidelines and an algorithm of care for patients with suspected (systemic) mastocytosis.

10. Microbial exposure as a predictor of respiratory symptoms and allergies.

Karvonen AM, Hyvärinen A, Rintala H, Korppi M, Taubel M et al. Quantity and diversity of environmental microbial exposure and development of asthma: a birth cohort study. Allergy 2014; 69(8): 1092 – 1101. (doi:10.1111/all.12439)

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Editor’s comment: The authors prospectively studied the association between several markers of environmental microbial exposure and the development of physician-diagnosed asthma, respiratory symptoms, atopic dermatitis, and sensitization up to the age of 6 years, and they concluded that a quantitative score of microbial exposure predicted asthma better than single microbial markers independently of microbial diversity and amount of dust.

11. Modulation of functions of Tregs may provide a novel strategy to prevent and treat allergic diseases.

Zhang H, Kong H, Zeng X, Guo L, Sun X, and He S. Subsets of regulatory T cells and their roles in allergy. Journal of Translational Medicine 2014; 12:125. (doi:10.1186/1479-5876-12-125)

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Editor’s comment: The authors examined the involvement of Tregs in a host of allergic diseases and concluded that Tregs play a pivotal role in the development of allergy, particularly in the sensitization phase. In light of this, they suggest that targeting Tregs may be a useful intervention for the prevention and treatment of allergy.

12. Retrospective evaluation of data from the anaphylaxis registry from Germany, Austria and Switzerland.

Worm M, Eckermann O, Dölle S, Aberer W, Beyer K et al. Triggers and treatment of anaphylaxis: an analysis of 4000 cases from Germany, Austria and Switzerland. Deutsches Ärzteblatt International 2014; 111(21): 367-375. (doi:10.3238/arztebl.2014.0367)

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Editor’s comment: The authors evaluated data from the anaphylaxis registry of the German-speaking countries (4141 patients) from 2006–2013 as well as the data from the ADAC air rescue service (1123 patients) from 2010–2011, to study the triggers, clinical manifestations, and treatment of anaphylaxis. The authors found that in this study population the most common triggers for anaphylaxis were insect venom (50.1%), foods (25.1%), and drugs (15.1%).