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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: December 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. The evidence base about acute and longer-term management of food allergy is weak and needs to be strengthened.

de Silva D, Geromi M, Panesar SS, Muraro A, Werfel T, Hoffmann-Sommergruber K, Roberts G et al. Acute and long-term management of food allergy: Systematic review. Allergy 2013; published online before print, 12 November. (doi:10.1111/all.12314)

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Editor’s comment: This systematic review summarizes the available evidence about the immediate management of food allergy reactions and longer-term approaches to minimize adverse impacts.

2. Angiotensin converting enzyme-induced angioedema: prognosis and treatment options.

Rasmussen ER, Mey K, Bygum A. Angiotensin. Converting enzyme-induced angioedema – A dangerous new epidemic. Acta Dermato Venereologica 2013; 21 November. (doi:10.2340/00015555-1760)

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Editor’s comment: This review focuses on epidemiology, clinical presentation, patho¬physiology and discusses the treatment of angiotensin converting enzyme-induced angioedema.

3. New approaches for understanding the complexity of the hypersensitivity drug reactions (HDRs).

Fernandez TD, Mayorga C, Guéant JL, Blanca M, Cornejo-García JA. Contributions of pharmacogenetics and transcriptomics to the understanding of the hypersensitivity drug reactions. Allergy 2013; published online before print, 5 November. (doi:10.1111/all.12304)

Abstract

Editor’s comment: To fully understand the HDRs and to develop diagnostic tools, a mechanistic approach must be employed. Understanding pharmacogenetics and transcriptomic analysis will also be necessary to achieve this goal.

4. The frequencies and phenotypes of CD154-positive T helper cells following stimulation with seasonal and perennial allergens.

Smith KS, Gray NJ, Femi Saleh F, Cheek E, Frew AJ, Kern F, Tarzi MD. Characterisation of CD154+ T cells following ex vivo allergen stimulation illustrates distinct T cell responses to seasonal and perennial allergens in allergic and non-allergic individuals. BMC Immunology 2013; 14(49). (doi:10.1186/1471-2172-14-49.

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Editor’s comment: In allergic individuals, the relationship between Th1, Th2 and Tr1-like responses is dysregulated with a higher Th2: Th1 ratio and an elevated IgE concentration that correlates with the number of Th2 cells. Assaying CD154+ T cells following short-term allergen stimulation ex vivo is a useful method for the investigation of allergen-specific T cells.

5. Emergency department (ED) visits for infant cough and cold medications (CCMs) induced adverse drug events (ADEs) declined after withdrawal and labeling revision.

Hampton LM, Nguyen DB, Edwards JR, Budntiz DS. Cough and cold medication adverse events after market withdrawal and labeling revision. Pediatrics 2013; published online before print, 11 November. (doi:10.1542/peds.2013-2236)

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Editor’s comment: Among children aged <2 and 2 to 3 years, emergency department visits for CCM adverse events declined nationally after the withdrawal and labeling revision announcement relative to all adverse drug event visits.

6. A case-control study to evaluate the effect of sublingual-specific immunotherapy (SLIT) in children with allergic asthma and rhinitis.

De Castro G, Zicari AM, Indinnimeo L, Tancredi G, Di Coste A, Occasi F, Catagna G et al. Efficacy of sublingual specific immunotherapy on allergic asthma and rhinitis in children’s real life. European Review for Medical and Pharmacological Sciences 2013; 17(16): 2225-2231.

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Editor’s comment: The authors concluded that SLIT is an effective treatment in pediatric patients suffering from allergic respiratory diseases such as allergic rhinitis and asthma. Subjects treated with SLIT demonstrated significantly improved clinical out-comes (less symptoms and less medication intake) compared with children treated with symptomatic drugs only.

7. The Role of co-factors in patients with food-induced anaphylaxis (FIA).

Hompes S, Dölle S, Grünhagen J, Grabenhenrich L, Worm M. Elicitors and co-factors in food-induced anaphylaxis in adults. Clinical and Translational Allergy 2013; 3(38). (doi:10.1186/2045-7022-3-38)

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Editor’s comment: Considering co-factors such as exercise and alcohol for the challenge protocol, and including them in provocation tests, increased the rate of positive reactions. The implementation of co-factors into current challenge protocols seems to be worthwhile to improve the identification rate of elicitors in adult patients with food-induced anaphylaxis.

8. Self-reported symptoms of depression as an effect modifier of controller medication adherence in asthma.

Guglani L, Havstad SL, Ownby DR, Saltzgaber J, Johnson DA, Johnson CC, Joseph CLM. Exploring the impact of elevated depressive symptoms on the ability of a tailored asthma intervention to improve medication adherence among urban adolescents with asthma. Allergy, Asthma & Clinical Immunology 2013; 9:45. (doi:10.1186/1710-1492-9-45)

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Editor’s comment: The authors concluded that interventions aimed at improving controller medication adherence as part of asthma self-management programs may need to be tailored for adolescents with depressive symptoms.

9. Investigation about inattention and hyperactivity in allergic rhinitis (AR) children using objective and scientific measurements.

Yang M-T, Lee W-T, Liang J-S, Lin Y-J, Fu W-M, Chen C-C. Hyperactivity and impulsivity in children with untreated allergic rhinitis: Corroborated by rating scale and continuous performance test. Pediatrics and Neonatology 2013; published online before print, 8 November. (doi:10.1016/j.pedneo.2013.09.003

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Editor’s comment: Pediatricians caring for allergic rhinitis (AR) children should not only treat their allergy but also the possible comorbid impulsivity and inattention seen in children with this disease, especially in AR children with potential risk factors.

10. The incidence of fatal food anaphylaxis and its relation to other mortality risks in the general population.

Umasunthar T, Leonardi-Bee J, Hodes M, Turner PJ, Gore C, Habibi P, Warner JO, Boyle RJ. Incidence of fatal food anaphylaxis in people with food allergy: a systematic review and meta-analysis. Clinical & Experimental Allergy 2013; 43(12): 1333-1341. (doi:10.1111/cea.12211)

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Editor’s comment: Although fatal food anaphylaxis is a rapid and frightening event, it appears to be very rare. Thus the presence of food allergy with anaphylaxis is likely to add relatively little to a person’s overall mortality risk.

11. Influence of breastfeeding and the introduction of solids on food allergy.

Grimshaw KEC, Maskell J, Oliver EM, Morris RCG, Foote KD, Mills ENC, Roberts G, Margetts BM. Introduction of complementary foods and the relationship to food allergy. Pediatrics 2013; 132(6): e1529-1538. (doi:10.1542/peds.2012-3692)

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Editor’s comment: This study supports the current recommendations on complementary feeding to not introduce solids before 4 to 6 months of age. It also supports that breastfeeding should continue while solids are introduced into the diet and that breastfeeding should continue for 1 year, or longer, as mutually desired by mother and infant.

12. Pathogenetic pathways and the biological effects of immunomodulatory agents to optimize or adopt therapeutic strategies for atopic disorders?

von Gunten S, Cortinas-Elizondo F, Kollarik M, Beisswenger C, Lepper PM. Mechanisms and potential therapeutic targets in allergic inflammation: Recent insights. Allergy 2013; 68(12): 1487-1498. (doi:10.1111/all.12312)

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Editor’s comment: The authors reviewed selected findings of potential therapeutic relevance that emerged from recent mechanistic studies which focus on molecular and cellular aspects of allergic inflammation.