July 2005 World Medical Journal Review
Reviewed by Richard F. Lockey, M.D., Editor-In-Chief
1. DAY-CARE INDOOR ALLERGENS CAPABLE OF SENSITIZING.
Detectable levels of A alternata, Can f 1, Fel d 1, Blag 1, Der p 1, Der f 1, and Mus m 1 were found in day-care centers. Most levels were higher than those proposed to cause allergic sensitization. Can f 1 and Fel d 1 were detected in 97% and 100%, respectively, even though animals were not observed in most. Editor's comment: This study confirms others which indicate that sensitization to many allergens probably takes place in various indoor environments. Arbes SJ, et al. J Allergy Clin Immunol 2005; 116: 133.
2. VARIATION IN INTEGRIN-ß3 GENE (ITGß3) ASSOCIATED WITH ASTHMA AND PROTECTION FROM MOLD ALLERGENS.
Integrin-ß3 gene was implicated as a candidate gene for susceptibility to asthma- and atopy- related phenotypes. These authors genotyped and performed association tests on 19 single nucleotide polymorphisms in the ITGß3 gene in several populations. ITGß3 was strongly associated with susceptibility to bronchial hyperresponsiveness and protection from allergic sensitization to mold allergens. Editor's comment: Genes do make a difference. Weiss LA, et al. Am J Respir Crit Care Med 2005; 172: 67.
3. CROSS-REACTIVITY TO CEPHALOSPORINS (C) AND PENICILLINS (P) IN CHILDREN
This prospective study examined 1170 children with suspected immediate allergic reactions to C and/or P over an 8 year period. Fifty-eight percent were found to be skin or challenge test positive to either group. Among them, 94% were positive to P and 35% to C. Thirty-two percent of P allergic children demonstrated cross-reactivity to C. If a child was allergic to a C, positive reactions to P occurred in 84%. The cross-reactivity among different generations of C varied between 0% and 69% being the highest for first and second and 0% for third generations of C. Editor's comment: Cross-reactivity among C and P is common in children. Atanaskovic-Markovic M, et al. Pediatr Allergy Immunol 2005; 16: 341.
4. GPRA ASTHMA AND INCREASED IgE SUSCEPTIBILITY GENE
The G-protein-related receptor for asthma (GPRA) gene has been associated in Finish and Canadian populations with asthma and elevated serum IgE levels. In this large nested case-control study, associations with GPRA polymorphisms, asthma, and serum IgE levels were analyzed. The results of the study indicate that GPRA polymorphisms increase susceptibility for asthma and bronchial hyperreactivity and, to a lesser extent, for elevation of serum IgE. Editor's comment: GPRA may be a potential drug target to treat asthma. Kormann MSD, et al. Am J Respir Crit Care Med 2005; 171: 1358.
5. CAT ALLERGENS ARE FOUND IN HUMAN HAIR.
Seventy-three women (25 with a non-neutered male cat and 25 with a dog at home) and 23 controls without any direct animal contact were studied to determine the amount of Fel d 1 present in human hair. Detectable levels were found in 13 women with a cat, in two controls, and two with a dog. Editor's comment: Cat allergens are in the hair of women who live with cats. Liccardi G, et al. Int Arch Allergy Immunol 2005; 137: 141.
6. CARDIOVASCULAR RESPONSES TO EPINEPHRINE.
Sixty-three adult patients with acute allergic reactions first received ranitidine and diphenhydramine given IV over 5 minutes within 6 hours of symptomatic onset. They then received either IM or SC epinephrine in their arm. Heart rate (HR) and blood pressure (BP) results from IM and SC epinephrine were similar. Editor's comment: IM and SC injections have similar effects on HR and BP. Lin RY, et al. American J of Emergency Medicine 2005; 23: 266.
7. DOGS PRODUCE DIFFERENT AMOUNTS OF CAN F 1.
Two hundred and eighty-eight dogs were evaluated to determine if the Can f 1 on fur varied among breeds. Wide variations in Can f 1 concentrations (measured in µg/g fur by ELISA) were found among dog breeds, with Labradors first and Yorkshires and Poodles last. No differences were found according to hair length or hormonal status. Seborrhea significantly increased the amount of Can f 1. Editor's comment: Your breed of dog makes a difference. Ramadour M, et al. Allergy 2005; 60: 1060.
8. DOES TREATING SMALL AIRWAY DISEASE MAKE A DIFFERENCE IN POORLY CONTROLLED ASTHMA.
Thirty adults were randomized in a single-blind fashion to receive either CFC-fluticasone (CFC-FP) 220 µg each morning and 110 µg each evening (n=10) or HFA-beclomethasone (HFA-BDP) 160 mcg twice daily (n=20) in addition to their current asthma therapy. The findings suggests that the addition of HFA-BDP, compared with CFC-FP in patients with poorly controlled asthma, despite receiving moderate to high doses of inhaled glucocorticosteroids, has a greater effect on parameters reflecting small airway patency. Editor's comment: Treating the small airways may be important in some patients with asthma. More studies are needed. Thongngarm T, et al. Journal of Asthma 2005; 42: 257.
9. TYPE 1 DIABETES CD3-ANTIBODY THERAPY.
Type 1 diabetes is a T-cell mediated autoimmune disease that leads to a major loss of insulin-secreting beta cells. Patients with new-onset type 1 diabetes were randomized to receive an antibody to CD3 cells or a placebo for 6 consecutive days. Residual beta-cell function was significantly better for 18 months in the treated vs. the untreated group. Editor's comment: CD3 monoclonal antibodies may be effective to treat type 1 diabetes. Keymeulen B, et al. N Engl J Med 2005; 352: 2598.
10. COMBINED TETANUS, DIPHTHERIA, AND 5-COMPONENT PERTUSSIS VACCINE (Tdap).
The new Tdap vaccine elicited robust immune response in adolescents and adults to pertussis, diphtheria, and tetanus antigens while exhibiting an overall safety profile similar to Td vaccine. Data support the potential routine use in adolescents and adults. Editor's comment: Tdap has been approved for use in adolescence in the USA. Pichichero ME, et al. JAMA 2005; 24: 3003
11. INTERLEUKIN-4 (IL-4) AND THERAPEUTIC STRATEGIES.
This review outlines the importance of this cytokine in the signaling pathways in the allergic inflammatory cascade. Editor's comment: Is IL-4 a viable target to treat allergy and asthma? Time will tell. Kelly-Welch A, et al. Sci. STKE 2005, Issue 293, pp. cm9.
12. A REVIEW OF HERIDITARY ANGIOOEDEMA IN CHILDREN
An excellent review of hereditary angioedema in children is published in Pediatric Allergy and Immunology. Editor's comment: Recommended reading for all physicians. Boyle RJ, et al. Pediatr Allergy Immunol 2005; 16: 288.
13. IgA REVIEW
IgA is a glycoprotein that plays a critical role in the protection of mucosal surfaces. This is a short and extensive review of IgA and its importance in health. Editor's comment: Excellent reading for an update on secretory IgA. Yoo EM, Morrison SL. Clinical Immunology 2005; 116: 3.
