March 2005 Medical Journal Review
Reviewed by Richard F. Lockey, M.D., Editor-In-Chief
1. OF 109 PATIENTS WITH NASAL POLYPS, 53 WERE RANDOMLY ALLOCATED TO RECEIVE ORAL PREDNISONE AND 56 UNDERWENT ENDOSCOPIC SINUS SURGERY. ALL WERE GIVEN INTRANASAL BUDESONIDE FOR 12 MONTHS THEREAFTER. NASAL POLYPS IMPACT THE QUALITY OF LIFE (QoL) AND BOTH MEDICAL AND SURGICAL TREATMENTS WERE EQUALLY EFFECTIVE IN IMPROVING QoL. Editor's comment: Medical and surgical treatment of nasal polyps were equally effective. Alobid I, et al. Allergy 2005; 60: 452.
2. BODY MASS INDEX (BMI) WAS POSITIVELY ASSOCIATED WITH ASTHMA, WHEEZE, ASTHMA TREATMENT, ATOPY, IgE, AND INVERSELY ASSOCIATED WITH THE FEV1/FVC RATIO IN FEMALES. THERE WAS NO ASSOCIATION WITH AIRWAY RESPONSES WITH METHACHOLINE OR SALBUTAMOL. IN MALES, THERE WAS NO ASSOCIATION WITH BMI AND ASTHMA OR ATOPY. CONCLUSION: 28% OF ASTHMA IN WOMEN AFTER THE AGE OF 9 IS ATTRIBUTABLE TO BEING OVERWEIGHT. Editor's comment: Another disease linked to obesity. Hancox RJ, et al. Am J Respir Crit Care Med 2005; 171: 440.
3. ANTIGEN-SPECIFIC IG FREE LIGHT CHAINS (LCs) MEDIATE HYPERSENSITIVITY-LIKE RESPONSES AND MAY BE IMPORTANT IN THE PATHOPHYSIOLOGY OF NON-ATOPIC ASTHMA. USING A MURINE EXPERIMENTAL MODEL OF NON-ATOPIC ASTHMA, A LC ANTAGONIST ABROGATES THE DEVELOPMENT OF AIRWAY OBSTRUCTION, HYPERRESPONSIVENESS, AND PULMONARY INFLAMMATION. FREE LCs ARE SIGNIFICANTLY INCREASED IN THE SERA OF PATIENTS WITH ADULT ASTHMA. THE USE OF A LC ANTAGONIST MAY PROVIDE A THERAPEUTIC MEANS TO PREVENT OR AMELIORATE THIS DISEASE. Editor's comment: This article addresses the pathogenesis of non allergic or intrinsic asthma, the etiology of which still remains unknown. Kraneveld AD, et al., PNAS 2005; 102: 1578.
4. OF THE 1,389 PATIENTS FOR WHOM VENOM IMMUNOTHERAPY (VIT) WAS RECOMMENDED, 11.2% HAD CARDIOVASCULAR DISEASE; 44 PATIENTS WERE ON β-BLOCKERS (BB) BEFORE VIT. IN 4, THE DRUG WAS CONTINUED THROUGH-OUT TREATMENT AND IN 9 A BB WAS REINTRODUCED AFTER MAINTENANCE. TWELVE OTHER PATIENTS HAD BB STARTED DURING VIT. NO SEVERE REACTIONS OCCURRED TO VIT OR STING CHALLENGES OR FIELD STINGS. Editor's comment: The risk-benefit of using a BB with VIT in patients with cardiovascular disease must be considered in each case. BB may not carry as much risk as previously thought. Müller UR , et al. J Allergy Clin Immunol 2005; 115: 606.
5. RHINOPHOTOTHERAPY WAS USED IN A RANDOMIZED DOUBLE-BLIND STUDY OF 49 PATIENTS WITH ALLERGIC RHINITIS DURING THE RAGWEED SEASON. EACH INTRANASAL CAVITY WAS ILLUMINATED 3 TIMES A WEEK FOR 3 WEEKS. RHINOPHOTOTHERAPY WAS TOLERATED AND IMPROVED SNEEZING (P< .016), RHINORRHEA (P < .007), NASAL ITCHING (P < .014), AND TOTAL NASAL SCORE (P < .004) VS CONTROL. Editor's comment: Phototherapy is immunosuppressive and maybe a means to treat allergic rhinitis and immune-mediated mucosal diseases. Korec AI, et al. J Allergy Clin Immunol 2005; 115: 541.
6. THIS STUDY WAS PERFORMED TO DETERMINE WHETHER OR NOT A GENOTYPE-DEPENDENT EFFECT OF REGULARLY SCHEDULED ALBUTEROL EXISTS IN PATIENTS WITH MILD ASTHMA. SEVENTY-EIGHT PATIENTS, 18 TO 55 YEARS OF AGE, WERE GIVEN INHALED β-AGONIST AS THEIR ONLY TREATMENT. THEY EITHER HAD THE ARG/ARG OR GLY/GLY GENOTYPE. PATIENTS WITH A GLY/GLY GENOTYPE BENEFITED FROM ALBUTEROL WHEREAS THE ARG/ARG DID NOT. Editor's comment: These genotypes determine responses to albuterol, even in mild asthma. Chinchilli IE, et al. Lancet 2004; 364: 1505.
7. CHILDREN LESS THAN 2 YEARS OLD WITH RECURRENT WHEEZING AND RISK FACTORS FOR DEVELOPING ASTHMA WERE RANDOMIZED TO RECEIVE FLUTICASONE (F) (125 μg) (N = 14) VS PLACEBO (N = 12) TWICE DAILY VIA A SPACER FOR 6 MONTHS IN A DOUBLE-BLIND PLACEBO-CONTROLLED STUDY. TREATMENT WITH F TWICE DAILY FOR 6 MONTHS IMPROVES PULMONARY FUNCTION AND CLINICAL OUTCOMES. Editor's comment: Fluticasone, via a spacer, improves asthma in children less than 2 years of age. Teper AM, et al. Am J Resir Crit Care Med 2005; 171: 587.
8. THIS PROSPECTIVE RANDOMIZED DOUBLE-BLIND MULTICENTER STUDY INVESTIGATES THE CLINICAL EFFICACY OF GRASS SUBLINGUAL–SWALLOW IMMUNOTHERAPY (SLIT) IN 29 CHILDREN (17 ON SLIT, 12 ON PLACEBO), MEDIAN AGE 10.5 YEARS. PROLIFERATION OF PERIPHERAL BLOOD MONONUCLEAR CELLS (³H-THYMIDINE INCORPORATION) AND SECRETION OF IL-4, IFNγ AND IL-5 AFTER IN VITRO STIMULATION WITH ALLERGEN OR PHYTOHEMAGGLUTININ WERE OBTAINED AFTER 1 AND 2 YEARS OF TREATMENT. INTRACELLULAR PRODUCTION OF IL-4, IL-13, IFNγ , IL-2, IL-10 AND IL-5 AND SERUM TOTAL AND SPECIFIC IgE AND IgG4 WERE ANALYZED. SLIT HAD NO SIGNIFICANT EFFECTS ON ANY OF THESE IMMUNE PARAMETERS. Editor's comment: Reproducible and consistent alterations in immune responses with SLIT are yet to be determined. Rolinck-Werninghaus C, et al. Int Arch Allergy Immunol 2005; 136: 134.
9. POOLED DATA FROM SEVEN STUDIES OF OMALIZUMAB WERE ANALYZED. OMALIZUMAB SIGNIFICANTLY REDUCED THE RATE OF ASTHMA EXACERBATION BY 38% (P < 0.0001 VS CONTROL) AND TOTAL EMERGENCY VISITS BY 47% (P < 0.0001 VS CONTROL). Editor's comment: Omalizumab is indicated for patients who have severe persistent asthma not adequately controlled by optimal pharmacotherapy. Bousquet J, et al. Allergy 2005; 60: 302.
10. "THE DIAGNOSIS AND MANAGEMENT OF ANAPHYLAXIS, AN UPDATED PRACTICE PARAMETER" IS A MARCH SUPPLEMENT TO THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IT IS A COMPLETE AND COMPREHENSIVE REVIEW OF THIS SUBJECT. ANOTHER MARCH SUPPLEMENT, "OUTCOME MEASURES IN ALLERGIC RHINITIS", WILL ALSO BE OF INTEREST TO THE WAO WEB PAGE READERS. Editor's comment: Both should be read. Lieberman P, Kemp S, Oppenheimer J, Lang D, Bernstein L, Nicklas R, (eds), et al. J Allergy Clin Immunol 2005; 115: S485. Howarth PH, (ed) et al. J Allergy Clin Immunol 2005; 115: (3) S387-S482.
