June Medical Journal Review by the editor-in-chief
WAO's monthly review of premier journal articles for practicing allergists (June, 2004) (ALL, AJRCCM, CEA, ERJ, IAAI, JACI, J of P, LAN, NEJM, SC)
1. ACIDIC MAMMALIAN CHITINASE (AMCase) IS INDUCED VIA A TH-2-SPECIFIC, IL-13-MEDIATED PATHWAY IN EPITHELIAL CELLS AND MACROPHAGES IN AN AEROALLERGEN ASTHMA MOUSE MODEL AND IS PRESENT IN HUMAN ASTHMA. AMCase neutralization ameliorated Th2 inflammation and airway hyperresponsiveness, in part by inhibiting IL-13 pathway activation and chemokine induction and thus may be an important mediator of IL-13-induced responses in asthma. Zhu Z et al, Science 2004;304:1678.
2. ORAL ADMINISTRATION OF A MITE ALLERGEN EXPRESSED BY ZUCCHINI YELLOW MOSAIC VIRUS IN PLANTS OF THE GOURD FAMILY DOWNREGULATES ALLERGEN-INDUCED AIRWAY INFLAMMATION AND IGE SYNTHESIS IN MICE. This suggests that oral feeding with allergen produced by a plant viral vector could provide a novel approach for allergic asthma therapy. Hsu CH et al, J Allergy Clin Immunol 2004;113:1079.
3. TWELVE-YEAR SURVEY (1990-2001) IN USA OF SCIT REVEALED FATAL REACTIONS OCCURRED EVERY 1 PER 2.5 MILLION INJECTIONS OR 3.4 DEATHS PER YEAR. One fatality was associated with skin prick testing with multiple food allergens. Most fatalities occurred in patients with asthma. Bernstein DI et al, J Allergy Clin Immunol 2004;113:1129.
4. COPD PROGRESSION ASSOCIATED WITH INFLAMMATORY MUCOUS EXUDATES IN SMALL AIRWAYS OF RESECTED LUNG TISSUE. Progression associated with increased volume of tissue in wall and accumulation of inflammatory exudates in lumen (PMNs; macrophages; CD4, CD8 and B cells; and lymphoid aggregates containing follicles). Absolute volume of B and CD8 cells increased with severity. Hogg JC et al, N Engl J Med 2004;350:2645.
5. EXCELLENT REVIEW ARTICLE ON THE MANAGEMENT OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE. An algorithm for treatment of COPD included. Sutherland ER, Cherniack RM, N Engl J Med 2004;350:2689.
6. EARLY THERAPY IMPROVES OUTCOMES OF EXACERBATIONS OF COPD. Patient recognition of exacerbation symptoms and prompt treatment improves exacerbation recovery, reduces risks of hospitalization, and is associated with a better health-related quality of life . Wilkinson TMA et al, Am J Respir Crit Care Med 2004;169:1298.
7. IMPROVEMENT IN RESPONSIVENESS TO METHACHOLINE IN HIGH MOLECULAR AND LOW MOLECULAR WEIGHT OCCUPATIONAL ASTHMA OCCURS MOST RAPIDLY IN THE FIRST 2.5 YEARS AFTER CESSATION OF EXPOSURE BUT CONTINUES FOR YEARS THEREAFTER. Patients should be re-evaluated for resolution of asthma for years after cessation of exposure. Malo JL, Ghezzo H, Am J Respir Crit Care Med 2004;169:1304.
8. SPECIFIC IGE CONCENTRATION FOR MILK AND CASEIN BY THE CAP SYSTEM IN ALLERGIC CHILDREN TO COW'S MILK PROTEIN PREDICTS, TO A HIGH DEGREE, CLINICAL REACTIVITY. Age is important in evaluating specific IgE levels as predictors of tolerance or clinical reactivity. Garcia-Ara MC et al, Clin Exp Allergy 2004; 34:866.
9. SUSTAINED HYPOXIA AND POSSIBLE HYPERCAPNIA IMPAIR SENSATIONS OF RESPIRATORY LOAD AND THE EFFECTS OF HYPOXIA PERSIST FOR AT LEAST 10 MINUTES AFTER RETURNING TO NORMOXIA. Individuals with asthma may fail to recognize the seriousness of their symptoms because of an inability to recognize the degree of respiratory distress. Eckert DJ et al, Am J Respir Crit Care Med 2004;169:1224.
10. COCKROACH EXTRACT OF B germanica DIRECTLY INDUCES ACTIVATION OF HUMAN EOSINOPHILS IN VITRO TO RELEASE CYTOTOXIC INFLAMMATORY MEDIATORS SUCH AS SUPEROXIDE AND GRANULAR PROTEINS. Cockroach extract may directly affect eosinophilic inflammation. Sohn MH et al, Int Arch Allergy Immunol 2004;134:141.
11. MACROPHAGE MANNOSE RECEPTOR IS UPREGULATED IN NASAL POLYPOSIS AS COMPARED TO PATIENTS WITH CHRONIC SINUSITIS WITHOUT NASAL POLYPOSIS OR TURBINATE TISSUE OF CONTROLS. Macrophages expressing macrophage mannose receptor accumulate in cell aggregates in nasal polyps and could play a role in pathogen-macrophage interaction in nasal polyposis disease. Claeys S et al, Allergy 2004;59:606.
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