Medical Journal Review: January 2010
Juan Carlos Ivancevich, MD, in collaboration with Phil Lieberman, MD, conducted these reviews of premier medical journal articles for practicing allergists. Read their top three picks here, and link to the remaining reviews from the menu. You may also visit the Medical Journal Review section of the WAO Web site.
1. Thirteen-year follow-up of early intervention with an inhaled corticosteroid (ICS) in patients with asthma.
To evaluate the long-term effects of early diagnosis and treatment of asthma, the researchers studied data on 103 adult patients with newly-diagnosed asthma who participated in the START (Inhaled Steroid Treatment as Regular Therapy in Early Asthma) study. Half of the patients (n=50) were assigned to receive high-dose budesonide (600 µg twice daily) within 12 months of symptom development (early therapy), and the other half (n=53) were assigned to receive initial terbutaline treatment followed by budesonide (375 µg twice daily) after 2 years (delayed therapy). All the patients had their medications individually adjusted after 3 years. Ten years later, the researchers found that there were no statistically significant differences in clinical or functional variables. However, patients in the delayed therapy group had a higher neutrophil count, and higher concentrations of eosinophilic cationic protein and myeloperoxidase in induced sputum, and they also had used more asthma medications and visited the hospital more often at follow-up.
Editor's comment: Early ICS treatment seems to improve asthma control.
Haatela T, Tamminen K, Kava T et al, Thirteen-year follow-up of early intervention with an inhaled corticosteroid in patients with asthma. Journal of Allergy and Clinical Immunology 2009; 124(6):1180-1185.
2. Childhood immunization and atopic disease into middle-age - a prospective cohort study.
To address possible associations between childhood immunizations and asthma and allergies in middle-aged adults, the researchers assessed data from the Tasmanian Longitudinal Health Study on 5,729 participants who were followed-up from ages 7 to 44. Most of the participants (up to 90.7%) had undergone childhood immunization against diphtheria, tetanus, pertussis, polio, and/or smallpox. By the age of 44 years, 11.2% of the participants had been diagnosed with asthma; 11.1% had at least one food allergy; 37.0% had eczema; and 50.3% had hayfever. After accounting for confounders, multivariable regression analysis revealed no significant associations between any childhood immunization and asthma (odds ratios [ORs] ranging from 0.87 to 1.17), eczema (ORs=0.99-1.07), food allergy (ORs=0.97-1.11), and hayfever (ORs=1.02-1.05) at age 44 years. Cox regression analysis also revealed no significant associations between any childhood immunization and incident asthma after the age of 7 years (ORs=1.03-1.21).
Editor's comment: Childhood immunization could not be linked to asthma in adulthood.
Matheson MC, Walters EH, Burgess JA et al, Childhood immunization and atopic disease into middle-age - a prospective cohort study. Pediatric Allergy and Immunology, Early View - online in advance of print 7 December 2009.
3. Alternaria and Cladosporium fungal allergen epitopes are denatured by sodium hypochlorite.
To investigate removal of environmental allergenic material derived from Alternaria and Cladosporium using sodium hypochlorite in vivo and in vitro, the authors used freeze dried allergen extract from Alternaria alternata and Cladosporium herbarum treated with hypochlorite concentrations of 322, 88, 38, 16, 3, 0.3, and 0 mM, respectively. They quantified remaining native allergenic material using enzyme immunoassay and evaluated remaining viable fungal material. The results of treating Alternaria or Cladosporium extract with sodium hypochlorite were immediate and obvious. Concentrations greater than 100 mM removed color and concentrations between 100 and 38 mM partially uncolored the extract. Immunoassay for total antigenic and allergenic material remaining after treatment with sodium hypochlorite, including 2 concentrations recommended for killing fungus, confirmed a general destruction of antigenic and allergenic material at concentrations of 38 mM or greater. Destruction of recognized antigenic and allergenic epitopes occurred at hypochlorite concentrations commonly used for household cleaning.
Editor's comment: This work confirms the ability of solutions of sodium hypochlorite to denature fungal allergenic material from common outdoor and indoor fungi.
Barnes C, Pacheco F, Dhar M et al, Alternaria and Cladosporium fungal allergen epitopes are denatured by sodium hypochlorite. World Allergy Organization Journal, 2(12):296-302.
Additional Journal Reviews
- Interferon-γ (INF-γ) release test can detect cutaneous adverse effects to statins. スタチンの皮膚反応の予測に末梢リンパ球IFNγ産生試験が有用
- Influence of early gut microbiota on the maturation of childhood mucosal and systemic immune responses. 新生児期の腸内細菌叢とその後の疾患発症に関する研究
- Increased levels of outdoor air pollutants are associated with reduced bronchodilation in children with asthma. 大気汚染と喘息症状
- Predicting short term response to anti-inflammatory therapy in young children with asthma. 乳児期の喘息に対する短期的抗炎症療法の使用により予後を予測できる
- Variants of DENND1B associated with asthma in children. 著者らは以前に乳児期発症ウイルス関連喘鳴発症と17q21に存在する遺伝子多型が相関することを報告しているが、さらに1q31に存在するDENND1B遺伝子多型も相関することを報告した（NEJM）。
- Gaps in anaphylaxis management at the level of physicians, patients, and the community: a systematic review of the literature. アナフィラキシーに対する患者、医師、社会での考え方の違いに関する総説
- The effect of oral steroids with and without vitamin D3 on early efficacy of immunotherapy in asthmatic children. 免疫療法実施時のステロイド内服やVitamineD内服は有用とはいえない
- Time trends in asthma and wheeze in Swedish children 1996-2006: prevalence and risk factors by sex. 10年間でスウェーデンでは喘息児の増加は認めない
- Mortality from pandemic A/H1N1 2009 influenza in England: public health surveillance study. 英国における新型インフルエンザの頻度は予測よりも低かった
- Physical inactivity and obesity: Relation to asthma and chronic obstructive pulmonary disease? 肥満、喘息、COPDに関する総説
- Epidemiology of the origins of airflow limitation in asthma. 喘息における非可逆的な気流制限の発生に関する総説