December 2005 World Medical Journal Review
Reviewed by Richard F. Lockey, M.D., Editor-In-Chief
1. IRREVERSIBLE LUNG FUNCTION IN YOUNG ADULTS WITH A HISTORY OF CHILDHOOD ASTHMA
Eighty-four (78% male) of 121 adults (17-30 years) who were included in the Childhood Asthma Study (1984-1994) were reevaluated by spirometry at age 17-30 years. Forty (48%) had severe spirometric abnormalities, twenty-eight of whom were given 1 mg/kg prednisone for one week and reevaluated. Twenty-one (75%) did not improve. Adult and childhood spirometric results were positively correlated (r = 0.49-0.72, P<.0001). Abnormal adult spirometric results were associated with: 1) longer duration of asthma at enrollment as a child, 2) increased childhood methacholine sensitivity and 3) premature birth. Editor's comment: More information is needed about early onset of asthma and how to prevent irreversible lung changes. Limb SL, et al. J Allergy Clin Immunol 2005; 116: 1213-19.
2. TRANSGENIC RICE FOR ALLERGY IMMUNOTHERAPY
Transgenic rice was used to express and orally deliver specific peptide epitopes of Japanese tree pollen, Cry j 1 and Cry j 2 to attenuate the development of allergic immune responses and inhibit allergen-specific IgE and IgG production in mice. This oral administration inhibits allergen-specific Th2 responses and decreases the level of allergen-specific CD4 + T cell-derived allergen-associated T helper 2 cytokine production of IL-4, IL-5, and IL-13 and histamine release. These experiments demonstrate that it is feasible to develop an effective peptide-based oral vaccine using transgenic plants to treat allergic diseases. Editor's comment: This paper suggests that "Atopically challenged children" may be able to eat rice to prevent allergic diseases. Takagi H, et al. PNAS 2005; 102: 17525. Editorial by Ma S, et al. 2005; 102: 17255.
3. ESOPHAGEAL EOSINOPHILS IN PATIENTS WITH POLLEN ALLERGY
Thirty-eight patients with symptomatic allergic rhinitis (with or without asthma) sensitive to grass pollen and 25 healthy non-atopics and 25 patients with GERD underwent gastrointestinal endoscopy during the grass season. High levels of esophageal eosinophils were found in ten allergic patients (26%), five GERD patients (21%) but not in healthy controls. Eosinophilic infiltration at the distal esophagus (versus the entire esophagus) was more prominent in the reflux group vs. the allergic group. The authors speculate that these findings may reflect the systemic and common mucosal aspects of allergic inflammation. Editor's comment: High levels of eosinophils in the esophagus can be associated with inhalant allergens. Onbasi K, et al. Clin Exp Allergy 2005; 35: 1423. Editorial by Spergel JM, 2005; 35: 1421.
4. PROTECTIVE EFFECT OF PNEUMOCOCCAL VACCINATION IN ELDERLY SUBJECTS
These authors studied the effectiveness of the 23-valent pneumococcal vaccine to prevent pneumonia and death in the elderly in Spain (n511, 241) by means of a multivariate Cox proportional-hazard models, adjusted by age, sex, influenza vaccination status, comorbidity and immunological status. The pneumococcal vaccination did not alter the risk of hospitalization from pneumonia or overall pneumonia but was associated with a considerable reduction of death risk from pneumonia. Editor's comment: The 23-valent polysaccharide pneumococcal vaccine is effective for older subjects. This article is accompanied by an editorial calling for vaccination of older individuals to both pneumococcal and influenza vaccines and for better pneumococcal vaccines. Vila-Córcoles A, et al. Eur Respir J 2005; 26: 1087. Editorial by de Roux A, Lode H, 2005; 26: 983.
5. SEVERE ASTHMA EXACERBATIONS DURING PREGNANCY
One hundred and forty-six patients were examined in a prospective study of asthma and pregnancy. Severe asthma occurred in 8% with mild asthma, 47% with moderate asthma and 65% with severe asthma at a mean gestational age of 25.1 + 0.9 weeks. Among those with severe exacerbations, there were 2 male stillbirths and a significant increased rate of male low birth weight. Forty-three percent of severe exacerbations occurred in the winter, 34% were associated with self-reported viral infections and 29% with non-adherence to inhaled corticosteroid medication. The authors conclude that the exacerbation rate in pregnant women with asthma is high and associated with poor outcomes for the male fetus. Editor's comment: Asthma is a risk factor during pregnancy. Murphy VE, et al. Obstetrics & Gynecology 2005; 106: 1046.
6. INFLUENZA-ASSOCIATED DEATHS IN CHILDREN IN THE UNITED STATES, 2003-2005
Health Department related deaths associated with laboratory-confirmed influenza in the U.S.A. in residents less than 18 years were analyzed at the Center for Disease Control and Prevention. Of 143 deaths, 53% were less than five years, 33% had an underlying condition recognized as a risk factor for the disease and 20% other chronic conditions. Twenty percent had chronic pulmonary disease with or without asthma. Editor's comment: Influenza vaccine is necessary for children, especially for those with chronic diseases such as asthma. Bhat N, et al. N Eng J Med 2005; 353: 2559.
7. EPINEPHRINE ADMINISTRATION FOR ALLERGIC REACTIONS IN SCHOOL
This study determined the incidence of anaphylaxis in schools, the surrounding circumstances associated with anaphylaxis, practices used to manage such reactions and opportunities for improvement. One-hundred and nine school districts in Massachusetts were surveyed from September 2001 to August 2003. Thirty-one percent of students who received epinephrine had allergies to multiple substances and 25% had allergies to peanut or tree nuts only. Twenty-two (19%) occurred outside the school building during school hours. The average time from onset to administration of epinephrine was ten minutes and epinephrine was most often administered by the school nurse. Ninety-two percent of the cases were transferred for emergency care. Editor's comment: This article identifies opportunities for improvement in the treatment of students with a history of anaphylaxis. McIntyre CL, et al. Pediatrics 2005; 116: 1134.
8. SOY FORMULA FEEDINGS AND SOY AND PEANUT ALLERGY
These authors question whether or not peanut allergy is associated with the intake of soy formula in milk-sensitive individuals. One-hundred and seventy infants with documented cow's milk allergy randomly received either a soy formula or an extensively hydrolyzed formula (EHF). They were followed to age four years. Peanut allergy developed in two of the soy and four of the EHF groups. The authors conclude that soy formula used during the first two years of life does not increase peanut-specific IgE or peanut allergy. Editor's comment: Eating soy formula does not cause peanut allergy. Klemola T, et al. Pediatr Allergy Immunol 2005; 16; 641.
9. EFFECT ON ASTHMA OF TREATING ALLERGIC RHINITIS WITH INTRANASAL CORTICOSTEROIDS
This study determined the effects of inhaled (into the lungs) or topical nasal beclomethasone dipropionate (BDP) administered separately or in combination to control asthma and bronchial hyperresponsiveness (BHR) in patients with allergic rhinitis and asthma. It is a double-blind, parallel, three-group study of 74 patients over 16 weeks. Nasal and pulmonary symptoms, pulmonary function and BHR were compared at four and 16 weeks. All three groups, including those using only intranasal glucocorticoids, demonstrated decreased nasal and pulmonary symptoms, which started at four weeks and continued throughout treatment. The authors conclude that the treatment of allergic rhinitis is essential to manage and control asthma. Editor's comment: Another study which demonstrates the concept of united airways. Stelmach R, et al. Chest 2005; 128: 3140.
10. REVIEW ARTICLES, ONE ON HOUSE-DUST MITES AND THE ATOPIC PATCH TEST IN ATOPIC DERMATITIS AND THE SECOND ON LACTOSE INTOLERANCE
The Journal of the Allergy Society of South Africa (ALLSA) contains two excellent review articles. The first involves the controversy associated with atopic patch testing and the care of patients with atopic dermatitis. The second is an excellent review on lactose intolerance, when it should be suspected and how to diagnose and treat it. Editor's comment: Excellent reading – web page address for ALLSA is: www.allergysa.org. Fox A. Current Allergy & Clinical Immunology 2005; 18: 108 and Stear GIJ, et al. 2005; 18: 114.
11. A PRACTICE PARAMETER ON THE DIAGNOSIS AND MANAGEMENT OF SINUSITIS
This is a 34-page summary of the practice of medicine as it relates to sinusitis and includes 288 references. Editor's comment: Must reading for all physicians. Slavin RG, Spector SL, Bernstein IL (eds). J Allergy Clin Immunol 2005; 116: S13-47.
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