January Medical Journal Review

by Richard F. Lockey, M.D., Editor-In-Chief

1. THIS PROSPECTIVE STUDY DETERMINED THE EFFECT OF SEVERE RESPIRATORY SYNCYTIAL VIRUS BRONCHIOLITIS IN INFANCY AND INCIDENCES OF ASTHMA AND ALLERGY AT AGE 13. BOTH ARE SIGNIFICANTLY HIGHER IN THE RSV GROUP THAN IN CONTROLS: 43% VERSUS 8% FOR ASTHMA AND 39% VERSUS 15% FOR ALLERGIC RHINOCONJUNCTIVITIS. SENSITIZATION IS MORE COMMON TO INHALED ALLERGENS IN THE RSV GROUP (50% VERSUS 28%; p = 0.022). RSV bronchiolitis in infancy severe enough to cause hospitalization is a risk factor for allergic asthma in early adolescence. Sigurs N, et al. Am J Respir Crit Care Med 2005; 171: 137

2. THIS STUDY INDENTIFIES CLINICAL FEATURES AND EXPOSURES ASSOCIATED WITH PERSISTENCE AND SEVERITY OF CHILDHOOD ASTHMA IN ADULTHOOD. THE DEGREE OF ATOPY IS A CRITICAL DETERMINANT OF ASTHMA PERSISTENCE. THERE IS NO SIGNIFICANT ASSOCIATION BETWEEN CURRENT ASTHMA SEVERITY AND CHILDHOOD IMMUNOTHERAPY. Confirmation that atopy is an important determinant for persistent asthma. Limb SL, et al. J Allergy Clin Immunol 2005; 115: 61.

3. CHILDREN WERE CLASSIFIED AS NEVER WHEEZERS, TRANSIENT EARLY WHEEZERS, LATE-ONSET WHEEZERS, OR PERSISTENT WHEEZERS. SPECIFIC AIRWAY RESISTANCE (sRaw) WAS ASSESSED AT AGE 3 AND 5 YEARS. PERSISTENT WHEEZERS HAVE MARKEDLY POOR LUNG FUNCTION COMPARED WITH OTHER GROUPS. IN CHILDREN WHO WHEEZE BY AGE 3, THE RISK OF PERSISTANT WHEEZE INCREASES WITH INCREASED sRaw. INCREASING sRaw AND SENSITIZATION ARE INDEPENDENT PREDICTORS OF PERSISTENT WHEEZING. Persistence and atopy are predictive of more serious asthma. Lowe LA, et al. Am J Respir Crit Care Med 2005; 171: 231.

4. INTRANASAL AMPHOTERICIN B WAS USED TO TREAT 30 RANDOMLY SELECTED PATIENTS WITH CHRONIC RHINOSINUSITIS IN A PLACEBO-CONTROLLED, DOUBLE-BLIND, SINGLE CENTER TRIAL. THERE IS A SMALL BUT STATISTICALLY SIGNIFICANT DIFFERENCE BETWEEN AMPHOTERICIN VERSUS PLACEBO TREATED SUBJECTS. Ponikau JU, et al. J Allergy Clin Immunol 2005; 115: 125. An editorial states that the overall improvement is unclear and calls for a large scale, multi-centered, placebo-controlled, double-blind study. Bush RK, J Allergy Clin Immunol 2005; 115: 123. Online abstract not available.

5. STUDY INVESTIGATES THE SHORT-TERM EFFECTS OF AN INHALED GLUCOCORTICOSTEROID, FLUTICASONE PROPIONATE (FP), ON COUGH. IN A COMMUNITY-BASED PRIMARY HEALTHCARE CENTER, 135 HEALTHY ADULTS WITH COUGH FOR > 2 WEEKS WERE ENROLLED IN A RANDOMIZED, DOUBLE-BLIND, PLACEBO-CONTROLLED TRIAL OF INHALED FP, 500 g b.i.d., FOR 2 WEEKS. THE FP REDUCES COUGH IN NON-SMOKING PREVIOUSLY HEALTHY ADULTS BUT NOT IN SMOKERS. ALLERGY, FEV1 AND BHR AT BASELINE DOES NOT AFFECT EFFICACY. Many patients develop a cough following a viral respiratory infection. Some may be candidates for short-term inhalational glucocorticosteroid therapy. Ponsioen BP, et al. Eur Respir J 2005; 25: 147

6. THE NATIONAL ASTHMA EDUCATION AND PREVENTION PROGRAM (NAEPP) EXPERT PANEL REPORT ON "MANAGEMENT OF ASTHMA DURING PREGNANCY; RECOMMENDATIONS FOR PHARMACOLOGIC TREATMENT - 2004 UPDATE". This USA report is essential reading for allergist who care for pregnant patients with asthma. J Allergy Clin Immunol 2005; 115: 34. Editorial by Schatz M, J Allergy Clin Immunol 2005; 115: 31. Online abstract not available.

7. HIGH-RESOLUTION CT COMPARES THE FEATURES OF NEAR-FATAL ASTHMA (NFA) VERSUS NON-NFA. RESULTS INDICATE EXTENSIVE SMALL AIRWAY ABNORMALITIES ASSOCIATED WITH NFA, WHICH ARE PARTIALLY REVERSIBLE. Another characterization of the most severe form of asthma. Lee Y-M, et al. Chest 2004; 126: 1840

8. A META-ANALYSIS OF SUBLINGUAL IMMUNOTHERAPY FOR ALLERGIC RHINITIS REVEALS THAT THERE IS A SIGNIFICANT REDUCTION IN SYMPTOMS AND MEDICATIONS REQUIREMENTS. SUCH RESULTS ARE NOT OBSERVED IN STUDIES ONLY INVOLVING CHILDREN. LIKEWISE, INCREASING DURATION OF TREATMENT DOES NOT INCREASE EFFICACY AND THERE IS INSUFFICIENT DATA TO ANALYSE TOTAL DOSE OF ALLERGEN AND EFFICACY. Sublingual swallow mono-immunotherapy reduces symptoms and medication requirements in adults with allergic rhinitis. More studies are needed to define optimal doses, duration, and efficacy in children. Wilson DR, et al. Allergy 2005; 60: 4.

9. REVIEW ARTICLES ON "THE PATHOPHYSIOLOGY OF HEREDITARY ANGIOEDEMA" AND "CURRENT AND FUTURE THERAPY FOR HEREDITARY ANGIOEDEMA" BY DAVIS AE AND ZURAW BL, RESPECTIVELY, IN THE JOURNAL, Clinical Immunology, They are recommended reading. Davis AE, Clinical Immunology 2005; 114: 3. Zuraw BL, Clinical Immunology 2005; 114: 10.

10. TREE POLLENS ARE IMPORTANT ALLERGEN SOURCES, AND ALLERGIC CROSS-REACTIVITY IS BASED ON BOTANICAL RELATIONSHIPS. THESE AUTHORS PROPOSE A CLASSIFICATION ON MAJOR ALLERGEN MOLECULES. BET V 1 INCLUDES THE FRUITS, APPLE, CHERRY, APRICOT, AND PEAR; THE POLLENS, ALDER, BIRCH, WHITE OAK, CHESTNUT, HAZEL, AND HORNBEAM AND THE VEGETABLES, CARROTS, CELERY, AND HAZELNUT. OLE E 1 (OLEACEAE) INCLUDES OLIVE, ASH, LILAC, AND PRIVET AND CRY J 1 AND CRY J 2 (CUPRESSACEAE/TAXODIACEAE FAMILIES) CYPRESS, CEDAR, JUNIPER, AND CRYPTOMERIA. Interesting proposal which makes "allergic" sense. Mothes N, et al. Int Arch Allergy Immunol 2004; 135: 357.

11. THE SIXTH INTERNATIONAL SYMPOSIUM, "ASTHMA AND ALLERGIC DISEASES: PHYSIOLOGY, IMMUNOPHARMACOLOGY AND TREATMENT" IS PUBLISHED IN Clinical and Experimental Allergy Reviews, 2004; 4: SUPPL. 2. This is an excellent review and covers a broad variety of subjects including the environment, genetic factors, immunologic reactions, treatment, and immunotherapy. Online abstract not available.

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