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Medical Journal Review

April 2015

WAO Reviews - Editors' Choice

Articles are selected for their importance to clinicians who care for patients with asthma and allergic/immunologic diseases by Juan Carlos Ivancevich, MD, WAO Web Editor-in-Chief, and John J. Oppenheimer, MD - FACAAI - FAAAAI, WAO Reviews Editor.

1. Use of modern antidepressant during pregnancy do not increase the risk of asthma.

Liu X, Olsen J, Pedersen LH, Agerbo E, Yuan W, and L J. Antidepressant Use During Pregnancy and Asthma in the Offspring. Pediatrics 2015, 9 March. (doi: 10.1542/peds.2014-4073)

Full Text, Free

Editor’s comment:
In this prospective cohort study, the authors found that maternal antidepressant use during pregnancy generally did not increase the risk of asthma except for use of older antidepressants, which could reflect confounding by the severity of maternal depression.

2. Best available evidence on how to monitor children with asthma.

Pijnenburg MW, Baraldi E, Brand PLP, Carlsen KH, Eber E et al.  Monitoring asthma in children. European Respiratory Journal 2015; 45(4): 906 – 925. (doi:10.1183/09031936.00088814)

Abstract

Editor’s comment:
This ERS statement summarizes the literature regarding monitoring children with asthma, reviewing available tools, such as clinical measures (ie. ACT, ACQ etc), lung function, bronchial responsiveness and inflammatory markers in children with asthma. Management-related issues, comorbidities and environmental factors are also reviewed.

3. Current and future use of biological agents for the treatment of asthma.

Darveaux J and Busse WW. Biologics in Asthma—The Next Step Toward Personalized Treatment. The Journal of Allergy and Clinical Immunology 2015; 3(2): 152 – 160. (doi:http://dx.doi.org/10.1016/j.jaip.2014.09.014)

Abstract

Editor’s comment:
The authors identify future and current treatment options for patients with asthma who are suboptimally controlled. They describe how patient endotypes may direct selection of specific monoclonal antibody therapy being developed for the treatment of asthma.

4. Hypothesis: Bystander clinical effect of allergen immunotherapy in poly-allergic patients.

Ciprandi G. Clinical bystander effect exerted by allergen immunotherapy: a hypothesis. European Annals of Allergy and Clinical Immunology 2015; 47(2); 62 -63.

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Editor’s comment:
This case report shows that a poly-allergic patient, successfully treated with immunotherapy to Parietaria, also achieved a clinical tolerance towards other causal allergens, such as mites and cat. From this anecdote the author proposes the hypothesis that a bystander clinical effect may be observed during allergen immunotherapy in poly-allergic patients.  This gives credence to the approach of SLIT with a single dominant allergen.  Certainly, further prospective study is needed to resolve this issue.

5. Improving the classification and coding of hypersensitivity/allergic diseases.

Tanno LK, Calderon MA, Goldberg BJ, Gayraud J, Bircher AJ et al. Constructing a classification of hypersensitivity/allergic diseases for ICD-11 by crowdsourcing the allergist community. European Journal of Allergy and Clinical Immunology, published online before print 17 March 2015. (doi:10.1111/all.12604)

Abstract

Editor’s comment:
An international expert panel review the classification of hypersensitivity/allergic diseases and validate it for the International Classification of Diseases (ICD-11) by crowdsourcing the allergist community to construct a high-level complex structure of classification for hypersensitivity/allergic diseases.

6. Should practicing clinicians measure airway eosinophilia in patients with asthma?

Beghè B, Spanevello A, Fabbri LM. Eosinophilia in asthma: the easy way is not always the best. The Lancet Respiratory Medicine 2015; 3(4): 260 – 261. (doi:http://dx.doi.org/10.1016/S2213-2600(15)00108-3)

Summary

Editor’s comment:
The authors examine whether measuring sputum eosinophils is still the best method of identifying eosinophilic airway inflammation and conclude that the variability between patients reduces the usefulness of this method in clinical practice and confines its use to selected patients followed in specialised centres.

7. Update on clinically relevant advances in the classification, investigations, and management of chronic urticaria.

Sussman G, Hébert J, Gulliver W, Lynde C, Waserman S et al. Insights and advances in chronic urticaria: a Canadian perspective. Allergy, Asthma and Clinical Immunology 2015; 11(7). (doi:10.1186/s13223-015-0072-2)

Full Text, Open Access

Editor’s comment:
In this review the authors aim to update clinically relevant advances in the classification, diagnosis and management of chronic urticaria.  To do so, they clarify the terminology used to describe and classify urticaria, instruments used to assess it, as well as explore the impairment of quality-of-life and the morbidity caused by the disease.  Lastly, they examine the evidence-based literature regarding the management of urticaria.

8. Gastroesophageal reflux disease (GERD) is a risk factor for developing non-infectious rhinitis/rhinosinusitis.

Schiöler L, Ruth M, Jõgi R, Gislason T, Storaas T et al. Nocturnal GERD – a risk factor for rhinitis/rhinosinusitis: the RHINE study. European Journal of Allergy and Clinical Immunology, published online before print 6 April 2015. (doi:10.1111/all.12615)

Abstract

Editor’s comment:
The authors concluded from this large, population-based, 10-year study that nocturnal GERD is a risk factor for non-infectious rhinitis/rhinosinusitis. GERD should therefore be considered in patients with rhinitis of known and unknown origin.

9. Dose-related efficacy and onset of action of the a house dust mite sublingual immunotherapy tablet.

Nolte H, Maloney J, Nelson HS, Bernstein DI, Lu S et al. Onset and dose-related efficacy of house dust mite sublingual immunotherapy tablets in an environmental exposure chamber. The Journal of Allergy and Clinical Immunology, published online before print, 27 January 2015. (doi:http://dx.doi.org/10.1016/j.jaci.2014.12.1911)

Abstract

Editor’s comment:
The authors concluded that the HDM sublingual immunotherapy tablet MK-8237, at a dose of 12 DU (developmental units) , reduced nasal and ocular symptoms and exceeded World Allergy Organization–established clinical efficacy criteria (≥20% improvement vs placebo) with clinical improvement by week 8.

10. T-cell characterization may open a new window for the identification of the etiology of asthma exacerbations.

Wegrzyn AS, Bogdan J, Rückert B, Jutel M, Akdis M, Sanak M, and Akdis CA. T-cell regulation during viral and nonviral asthma exacerbations. The Journal of Allergy and Clinical Immunology, published online before print 17 January 2015. (doi:http://dx.doi.org/10.1016/j.jaci.2014.12.1866)

Summary

Editor’s comment:
The authors demonstrated that distinct immune activation and immune regulation pathways were observed in exacerbations of asthma due to viral and nonviral etiology. Knowledge of these changes in peripheral blood T cells may allow the development of rapid tests for cellular diagnosis of asthma exacerbations.