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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: October 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. Updating the World Allergy Organization Guidelines for the assessment and management of anaphylaxis.

Simons FER, Ardusso LRF, Dimov V, Ebisawa M, El-Gamal YM et al. World Allergy Organization Anaphylaxis Guidelines: 2013 update of the evidence base. International Archives of Allergy and Immunology 2013; 162(3): 193-204. (doi:10.1159/000354543)

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Editor’s comment: The new update of this excellent document summarizes major advances in several areas. These include the characterization of patient phenotypes, the development of in vitro tests (for some allergens) that help distinguish clinically significant from asymptomatic sensitization, epinephrine research (including studies of a new epinephrine auto-injector), and randomized controlled trials of immunotherapy to prevent food-induced anaphylaxis.

2. Evidence-based recommendations for the diagnosis and therapy of pediatric rhinitis.

Roberts G, Xatzipsalti M, Borrego LM, Custovic A, Halken S et al. Paediatric rhinitis: position paper of the European Academy of Allergy and Clinical Immunology. European Journal of Allergy and Clinical Immunology 2013; 68(9): 1102-1116. (doi:10.1111/12235)

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Editor’s comment: This is a comprehensive Position Paper on pediatric allergic rhinitis which revises its definition and classification. It also reviews its prevalence, epidemiology, presentations and comorbidities, diagnosis and treatment. The recommendations in this document are labeled to indicate grades of recommendation.

3. Evidence regarding the efficacy, comparative effectiveness, and safety of subcutaneous and sublingual immunotherapy for adult and pediatric patients.

Lin SY, Erekosima N, Suarez-Cuervo C, Ramanathan M, Kim JM et al. Allergen-specific immunotherapy for the treatment of allergic rhinoconjunctivitis and/or asthma: Comparative effectiveness review [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2013; March. (Comparative Effectiveness Reviews, No. 111.)

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Editor’s comment: The authors concluded that the overall body of evidence consistently provides moderate to high support for the effectiveness and safety of both subcutaneous and sublingual immunotherapy for the treatment of allergic rhinitis and asthma.

4. Differences in blood and sputum inflammatory profiles, and inhaled corticosteroid treatment response between ex-, current-, and never-smokers asthmatics.

Telenga ED, Kerstjens HAM, ten Hacken NHT, Postma DS, van den Berge M et al. Inflammation and corticosteroid responsiveness in ex-, current- and never-smoking asthmatics. BMC Pulmonary Medicine 2013; 13:58. (doi:10.1186/1471-2466-13-58)

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Editor’s comment: The authors found that ex- and current-smokers asthmatics have less eosinophils and more neutrophils in their sputum and blood than never-smokers. Although ex- and current-smokers have a reduced short-term corticosteroid treatment response, they did not find a difference in their long-term treatment response.

5. What are the morbidities and mortalities in children with a diagnosis of obstructive sleep apnoea (OSA)?

Jennum P, Ibsen R and Kjellberg J. Morbidity and mortality in children with obstructive sleep apnoea: a controlled national study. Thorax 2013; 68(10): 949-954. (doi:10.1136/2012-202561)

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Editor’s comment: This study describes serious morbidity and increased mortality in children diagnosed with OSA. They have significant morbidities before and after diagnosis, and their 5-year death rates are generally higher than those of control subjects. Closer attention should be paid to high-risk children.

6. Airway hyperresponsiveness (AHR) and body mass index (BMI) in children and adolescents.

Sposato B, Scalese M, Migliorini MG, Riccardi MP, Balducci MT, Petruzzelli L, Scala R et al. Obesity can influence children’s and adolescents’ airway hyperresponsiveness differently. Multidisciplinary Respiratory Medicine 2013; 8:60. (doi:10.1186/2049-6958-8-60)

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Editor’s comment: The authors found that obesity seems to be a risk factor for a greater airway hyperresponsiveness. The risk was greater for female adolescents and greater in children. This risk appears to involve only subjects with moderate/severe hyperresponsiveness and not those with borderline AHR.

7. Evaluating opinions, beliefs and perceptions with respect to respiratory diseases as well as the use of inhaler devices.

Braido F, Baiardini I, Sumberesi M, Blasi F, Canonica GW. Obstructive lung diseases and inhaler treatment: Results from a national public pragmatic survey. Respiratory Research 2013; 14:94. (doi:10.1186/1465-9931-14-94)

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Editor’s comment: The results of the survey highlight the need for public interventions aimed at improving awareness of obstructive lung disease and reveal various potentialities and critical issues for inhaler device usage.

8. Relationship between sleep duration and time and allergic rhinitis (AR).

Kwon JA, Lee M, Yoo K-B, Park E-C. Does the duration and time of sleep increase the risk of allergic rhinitis? Results of the 6-year nationwide Korea Youth Risk Behavior Web-Based Survey. PLOS One 2013; 8(8): e72507. (doi:10.1371/journal.pone.0072507)

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Editor’s comment: This study is the first to focus on the relationship between sleep duration (hours of sleep per night) and time (time at which sleep began) and the risk for Allergic Rhinitis (AR) employing national survey data collected over 6 years. The authors found in the analysis of sleep duration and sleep time that the odds ratio increased in both genders when sleep duration was <7 hours, and when the time of sleep was later than 24:00 hours. In both genders, AR was associated with depression and suicidal ideation.

9. Validation of the eliciting dose (ED) threshold for allergic reactions in peanut allergic subjects.

Zurzolo GA, Allen KJ, Taylor SL, Shreffler WG, Baumert GL et al. Peanut Allergen Threshold Study (PATS): Validation of eliciting doses using a novel single-dose challenge protocol. Allergy, Asthma & Clinical Immunology 2013; 9:35. (doi:10.1186/1710-1492-9-35)

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Editor’s comment: The single dose derived from oral food challenges, based upon the statistical dose-distribution analysis of past challenge trials, promises an efficient approach to identify the most highly sensitive patients within any given food-allergic population.

10. A case of severe refractory atopic dermatitis (AD) in an adolescent patient successfully treated with ustekinumab.

Agusti-Mejias A, Messeguer F, García R, Febrer I et al. Severe refractory atopic dermatitis in an adolescent patient successfully treated with ustekinumab. Annals of Dermatology 2013; 25(8): 368-370. (doi:10.5021/ad.2013.25.3.368)

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Editor’s comment: The authors used ustekinumab (a human monoclonal antibody directed against IL12 and IL23 approved for the treatment of moderate to severe plaque psoriasis) in an off-label manner, to treat an AD patient who had not reached improvement with other systemic treatments. The patient showed a total control of her disease without any side effect related to ustekinumab. Controlled clinical trials will be required to establish the effectiveness of ustekinumab in AD.

11. Th9 cells are a new and evolving subset of helper T cells.

Zhao P, Xiao X , Ghobrial RM, Li XC. IL-9 and Th9 cells: Progress and challenges. International Immunology 2013; 25(10); 547-551. (doi:10.1093/intimm/dxt039)

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Editor’s comment: In this comprehensive review, the authors gathered important information about Th9 cells which are less well studied compared with other T helper subsets. Th9 cells and Th9 products are highly pathogenic in allergic lung inflammation as well as in some autoimmune conditions, but they may be therapeutically desirable in other conditions such as cancer therapies.

12. Sensitization to pet allergens: direct or indirect exposure?

Park Y-B, Mo E-K, Lee J-Y, Kim J-H, Kim C-H, Hyun I-G, Choi J-H. Association between pet ownership and the sensitization to pet allergens in adults with various allergic diseases. Allergy Asthma et Immunology Research 2013; 5(5): 295-300. (doi:10.4168/aair/2013.5.5.295)

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Editor’s comment: The authors found that that the prevalence of direct exposure (defined as present ownership, past ownership, occupational, and occasional exposure) to dog was significantly higher in the dog-sensitized patients whereas no exposure was significantly higher in the cat- or rabbit-sensitized patients. Their results suggest that direct exposure to dogs contributes to sensitization to dog allergens, whereas indirect exposure to cats and rabbits may induce sensitization to each animal's allergen.