December Medical Journal Review
by Richard F. Lockey, M.D., Editor-In-Chief, and Samuel C. Bukantz, M.D.
1. THIS 48 PAGE SUPERB SUPPLEMENT TO THE Journal of Allergy & Clinical Immunology BY ALLERGISTS AND OTOLARYNGOLOGISTS THROUGHOUT THE WORLD REDEFINES RHINOSINUSITIS AND INCLUDES CLINICAL TRIAL GUIDELINES FOR THIS DISEASE. It is essential reading. Meltzer EO, Hamilos D, Hadley JA, Lanza DC, Marple BF, Nicklas RA (eds), J Allergy Clin Immunol 2004;114:S156-S204.
2. TWELVE PATIENTS WITH ASPIRIN-INDUCED ASTHMA RECEIVED EITHER ORAL TACROLIMUS (0.1 MG/KG) OR PLACEBO TWO HOURS BEFORE A THRESHOLD DOSE OF ORAL ASPIRIN. WITH PLACEBO, ORAL ASPIRIN DECREASES FEV1 AND INCREASES SPUTUM EOSINOPHILIC CATIONIC PROTEIN (ECP) AND URINARY LEUKOTRIENE E4 LEVELS. TACROLIMUS SIGNIFICANTLY INHIBITS BRONCHOCONSTRICTION AND ABROGATES THE INCREASES IN SUPTUM ECP AND URINARY LEUKOTRIENE E4 LEVELS. This study suggests that tacrolimus inhibits bronchoconstriction to a threshold dose of aspirin by inhibition of cysteinyl leukotriene excretion. Kawano T, et al, J Allergy Clin Immunol 2004;114:1278.
3. VARIOUS SPICES ARE COMMONLY ADDED TO FOODS TO IMPROVE TASTE. DERIVED FROM PLANTS, THEY CAN INDUCE PHARMACOLOGIC AS WELL AS ALLERGIC REACTIONS. This article extensively reviews botanical and allergological aspects of spices and molecules responsible for eliciting IgE reactions. It is a must reading for allergists. Schöll I, Jensen-Jarolim E, Int Arch Allergy Immunol 2004;135:247.
4. THE INTERNATIONAL BONE MARROW TRANSPLANT REGISTRY AND NATIONAL CORD BLOOD PROGRAM OF THE NEW YORK BLOOD CENTER STUDY INDICATES THAT HLA-MISMATCHED CORD BLOOD IS AN ACCEPTABLE SOURCE OF HEMATOPOIETIC STEM-CELL GRAFTS FOR ADULTS WITH LEUKEMIA IN THE ABSENCE OF AN HLA-MATCHED ADULT DONOR. Laughlin MJ, et al, N Engl J Med 2004;351:2265.
5. IN A SECOND STUDY BY THE EUROCORD AND THE EUROPEAN BLOOD AND MARROW TRANSPLANT GROUP, CORD BLOOD FROM UNRELATED DONORS WAS ALSO FOUND TO BE AN ALTERNATIVE SOURCE OF HEMATOPOIETIC STEM CELLS FOR ADULTS WITH ACUTE LEUKEMIA WHO LACK AN HLA-MATCHED BONE MARROW DONOR . Rocha V, et al, N Engl J Med 2004;351:2276.
6. EXCELLENT REVIEW ARTICLE ON ACETYLSALICYLIC ACID (ASA) SENSITIVITY AND ITS IMPLICATIONS FOR PATIENTS WITH CORONARY ARTERY DISEASE. The authors outline the rational for considering ASA desensitization for individuals with NSAID sensitivity and concomitant coronary artery disease. Gollapudi RR, et al, JAMA, 2004;292:3017.
7. AIRWAY REMODELING IN ASTHMA MAY INVOLVE REACTIVATION OF A DEVELOPMENTAL UNIT CONSISTING OF THE AIRWAY EPITHELIUM, RETICULAR BASEMENT MEMBRANE (RBM), AND ASSOCIATED ATTENUATED FIBROBLAST SHEATH, TERMED THE EPITHELIAL-MESENCHYMAL TROPHIC UNIT (EMTU). Allergen challenge in humans with mild asthma induces activation of epithelial cells and fibroblasts in the EMTU and increases tenascin deposition within the RBM. Thus, airway remodeling in asthma may, in part, result from repeated acute activation of the EMTU by allergen exposure. Phipps S, et al, Am J Respir Cell Mol Biol 2004; 31:626.
8. IMMUNOSTIMULATORY DNA SEQUENCES (ISS) CONTAIN A CpG DINUCLEOTIDE (CpG MOTIF) THAT IS CHARACTERISTIC OF BACTERIAL DNA. THESE SEQUENCES INHIBIT AIRWAY REMODELING AND AIRWAY HYPERRESPONSIVENESS IN MURINE MODELS. THEY DO THE SAME IN RHESUS MONKEYS. In this study, ISS mitigates the asthmatic phenotype (airways hyperresponsiveness and airways remodeling) in rhesus monkeys with experimentally induced allergic airways disease (airway ISS-treated had thinner basement membranes, fewer eosinophils, and fewer mast cells than controls). Fanucchi MV et al, Am J Respir Crit Care Med 2004; 170:1153.
9. REGRESSION ANALYSIS IN THE FARMING STATE OF NORTH CAROLINA, USA OF ASTHMA AND WHEEZE IN CHILDREN, AGE TWELVE TO FOURTEEN, DEMONSTRATES THAT THE LARGEST DECREASES IN ASTHMA AND WHEEZING PREVALENCE ARE ASSOCIATED WITH THE NUMBER OF FARMS, ACREAGE OF HAY, AND BEEF CATTLE. Thus, farm exposure is protective against childhood asthma. Elliott L, et al, Eur Respir J 2004; 24:938.
10. THE RISK FACTORS ASSOCIATED WITH ASTHMA AND SENSITIZATION WERE INVESTIGATED IN KUWAIT. ONE-HUNDRED AND SIXTY CHILDREN (9-16 YEARS) WITH PHYSICIAN-DIAGNOSED ASTHMA WERE MATCHED WITH 304 HEALTHY CONTROLS. RISK FACTORS WERE ASSESSED BY QUESTIONAIRES, SKIN TEST AND IgE, AND HOME ALLERGY EXPOSURE (MITE, CAT, DOG, COCKROACH BY ELISA). The authors conclude that pet ownership markedly increases the risk for sensitization to pets. Sensitization to Alternaria was the strongest independent associate of the asthma group. Al-Mousawi MSH et al, J Allergy Clin Immunol 2004;114:1389.
11. PATIENTS WITH CHRONIC RHINOSINUSITIS (CRS) HAVE INCREASED HUMORAL AND CELLULAR RESPONSES, BOTH TH1 AND TH2 TYPES, TO COMMON AIRBORNE FUNGI, PARTICULARLY Alternaria. The authors hypothesize that the immune and inflammatory responses to ubiquitous fungi may explain the chronicity of airway inflammation in this disease. Shin SH, et al, J Allergy Clin Immunol 2004;114:1369.
12. SEVERAL EXAMINATION MANEUVERS, EXPECIALLY LOW WEIGHT, SIGNIFICANTLY CHANGE THE PRETEST PROBABILITY FOR OSTEOPOROSIS AND SUGGEST THE NEED FOR EARLIER SCREENING. WALL-OCCIPUT DISTANCE EXCEDING 0 CM AND RIB-PELVIS DISTANCE LESS THAN 2 FINGERBREADTHS, SUGGEST THE PRESENCE OF OCCULT SPINAL FRACTURES DUE TO OSTEOPOROSIS. TOOTH COUNT OF LESS THAN 20 TEETH, INCREASES THE RISK FOR THIS DISEASE. Asthma and COPD are associated with an increased incidence of osteoporosis; therefore, all clinicians should beware of these clinical parameters which suggest osteoporosis. Green AD, et al, JAMA 2004;292:2890.
