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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: November 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. Allergen specific immunotherapy has not yet received adequate attention from European institutions.

Calderón MA, Demoly P, Gerth van Wijk R, Bousquet J, Sheikh A et al. EAACI: A European declaration on immunotherapy. Designing the future of allergen specific immunotherapy. Clinical and Translational Allergy 2012; 2(20). DOI:10.1186/2045-7022-2-20

Provisional PDF, Open Access

Editor's comment: This excellent position paper calls upon Europe's policymakers to coordinate actions and improve individual and public health by promoting awareness of the effectiveness of allergen specific immunotherapy. It fosters updating national healthcare policies to support allergen immunotherapy, prioritizing funding for allergen specific immunotherapy research, monitoring the macroeconomic and health economic parameters of allergy and reinforcing allergy teaching among medical disciplines and specialties.

2. Identification of the factors and subgroups associated with poor asthma control and increased risk of exacerbations.

Chipps BE, Zeiger RS, Dorenbaum A, Borish L, Wenzel S et al. Group Assessment of asthma control and asthma exacerbations in the epidemiology and natural history of asthma: outcomes and treatment regimens (TENOR) observational cohort. Current Respiratory Care Reports 2012; 1(4):259-269. DOI:10.1007/s13665-012-0025-x

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Editor's comment: An excellent review that comprehensively covers our current knowledge of the clinical and genetic heterogeneity of asthma. It discusses emerging phenotypes and subtypes, biomarker diagnostics, and systemic and targeted therapy responses in well-characterized asthma phenotypes.

3. Consideration of sub-phenotypes of wheezing and etiological risk factors.

Granell R, Sterne JAC, Henderson J. Associations of different phenotypes of wheezing illness in early childhood with environmental variables implicated in the aetiology of asthma. PLoS One 2012; 7(10): e48359. DOI:10.1371/journal.pone.0048359

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Editor's comment: The authors concluded that the associations with early life risk factors suggested that prolonged early wheeze might be a severe form of transient early wheezing. Other approaches to phenotypic classification will be necessary to further elucidate potential etiological mechanisms that differ between phenotypes.

4. Avoiding diagnostic mistakes associated with the prescription and administration of immunotherapy.

Asero R. Component-resolved diagnosis-assisted prescription of allergen-specific immunotherapy: a practical guide. European Annal of Allergy and Clinical Immunology 2012; 44(5): 183-187.

Full Text PDF Available

Editor's comment: This interesting review is a practical guide on how to employ component allergen testing to precisely detect the primary sensitizing allergen in subjects demonstrating multiple sensitization to seasonal and/or perennial airborne allergens.

5. Fetal factors to predict atopic dermatitis (AD).

Kim HB, Ahn KM, Kim KW, Shin YH, Yu J et al. Cord blood cellular proliferative response as a predictive factor for atopic dermatitis at 12 months. Journal of Korean Medical Science 2012; 27(11): 1320-1326. DOI:10.3346/jkms.2012.27.11.1320

Full Text, Open Access

Editor's comment: This is a prospective birth cohort study performed in Korea. It examines factors including cord blood characteristics for their ability to detect risk factors for allergic diseases, especially AD. The investigators found that gender, mode of delivery and parental history of AD were important independent risk factors for diagnosis of AD at 12 months, and that the cord blood mononuclear cell proliferative response to phytohemagglutinin stimulation was higher in infants with, than without, AD.

6. Relative individual contributions of Ara h 2 and Ara h 6 to the overall allergenic activity of a crude peanut extract.

Chen X, Wang Q, El-Mezayen R, Zhuang Y, Dreskin SC. Ara h 2 and Ara h 6 have similar allergenic activity and are substantially redundant. International Archives of Allergy and Immunology 2013; 160(3): 251-258. DOI:10.1159/000341642

Abstract
Free Supplementary Material, Table 1

Editor's comment: The authors demonstrate in a quantitative fashion that Ara h 2 and Ara h 6 account for the great majority of the allergenic activity in a crude peanut extract. These components have redundant biologic activity with 60% sequence homology. Thus, the similarities between these proteins are more important than their differences.

7. Risk of current asthma at 6 years of age among children with and without eczema at age 2.

Saunes M, Øien T, Dotterud CK, Romundstad PR, Storrø O, Holmen TL, Johnsen R. Early eczema and the risk of childhood asthma: a prospective, population-based study. BMC Pediatrics 2012; 12: 168. DOI:10.1186/1471-2431-12-168

Provisional PDF, Open Access

Editor's comment: In an evaluation of patients in the general population, this study found that early eczema was associated with an increased risk of developing childhood asthma. The authors concluded these findings support the hypothesis of the atopic march.

8. Fish consumption in infancy and prevalence of wheezing.

Kieta-de Jung JC, de Varies JH, Franco OH, Jodie VWV, Hoffman A et al. Fish consumption in infancy and asthma-like symptoms at preschool age. Pediatrics 2012; 130(6): 1060-1069. DOI:10.1542/peds.2012-0875

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Editor's comment: This population-based birth cohort from The Netherlands assessed the effect of the timing of the introduction of fish into an infant's diet on the development of wheezing at the age of 12 and 14 months. The authors concluded that introduction of fish between 6 and 12 months but not fish consumption afterward is associated with a lower prevalence of wheezing.

9. Relationship between atopy and sleep-disordered breathing (SDB).

Zicari AM, Marzo G, Rugiano A et al. Habitual snoring and atopic state: correlations with respiratory function and teeth occlusion. BMC Pediatrics 2012; 12:175. DOI:1 0.1186/1471-2431-12-17

Provisional PDF, Open Access

Editor's comment: The authors studied SBD in atopic children vs. non-atopic children with this disorder. They concluded that major factors impacting SDB in children were the presence of upper airway obstruction (hypertrophy in the adenotonsillar lymphatic tissue, odontostomatological alterations) and obesity rather than atopy per se. These findings demonstrate the importance of physiologic nasal respiration in the pathogenesis of SDB.

10. Allergen immunotherapy with fungal antigens as an adjunct in treatment of allergic fungal sinusitis (AFS).

Hall, AG and deShazo RD. Immunotherapy for allergic fungal sinusitis. Current Opinion in Allergy & Clinical Immunology 2012; 12(6): 629-634. DOI:10.1097/ACI.0b013e328357a233

Abstract

Editor's comment: In this excellent review the authors concluded that allergen immunotherapy to fungi shows promise as a treatment to decrease the recurrence of AFS and should be considered a part of the treatment regimen. However, controlled studies are essential to moving forward because the number of patients treated has been small.

11. Exposure to nicotine during pregnancy can become permanently programmed and transferred to subsequent generations.

Rehan VK, Liu J, Naeem E, Tian J, Sakurai R et al. Perinatal nicotine exposure induces asthma in second generation offspring. BMC Medicine 2012; 10:129. DOI:10.1186/1741-7015-10-129

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Editor's comment: In this experimental assay in rats the authors demonstrated that germline epigenetic marks imposed by exposure to nicotine during pregnancy can become permanently programmed and transferred through the germline to subsequent generations.

12. Pollen exposure in pregnancy and risk of asthma hospitalization in infancy.

Lowe AJ, Olsson D, Bråbäck L, Forsberg B. Pollen exposure in pregnancy and infancy and risk of asthma hospitalisation - a register based cohort study. Allergy, Asthma & Clinical Immunology 2012; 8:17. DOI:10.1186/1710-1492-8-17

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Editor's comment: The authors registered pollen exposure for the first and last 12 weeks of pregnancy and the first 12 weeks of infancy for all children conceived by women residing in Stockholm, Sweden, between 1988 and 1995. They found that high levels of pollen exposure during late pregnancy were associated with an elevated risk of hospitalization for asthma within the first year of life.

13. Possible associations between Toxocara spp. seropositivity and atopy and childhood wheezing.

Mendonça LR, Veiga RV, Dattoli VCC, Figueiredo CA, Fiaccone R et al. Toxocara seropositivity, atopy and wheezing in children living in poor neighbourhoods in urban Latin America. PLoS Neglected Tropical Diseases 2012; 6(11): e1886. DOI:10.1731/journal.pntd.0001886

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Editor's comment: The authors concluded that toxicara infection, although associated with eosinophilia and raised levels of total and allergen-specific IgE, may modulate allergic effector responses in the skin as manifested by diminished immediate hypersensitivity skin test responses to aeroallergens.

14. Performance of a metered-dose inhaler (MDI) electronic monitor in patients with asthma.

Patel M, Pilcher J, Travers J, Perrin K, Shaw D et al. Use of Metered-Dose Inhaler (MDI) electronic monitoring in a real-world asthma randomized controlled trial. The Journal of Allergy and Clinical Immunology: In Practice 2012; Published Online 6 November. DOI:10.1016/j.jaip.2012.08.004

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Editor's comment: The authors found that the use of an electronic monitoring system is an effective and reliable means for measuring MDI use in a real-world setting.