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Medical Journal Review

June 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. Analysis of airway wall structure and inflammation in preschoolers with severe recurrent wheeze.

Lezmi G, Gosset P, Deschildre A, Abou-Taam R, Mahut B, Beydon N, and de Blic J.  Airway remodeling in preschool children with severe recurrent wheeze. American Journal of Respiratory and Critical Care Medicine 2015; published online before print, 11 May. (doi:10.1164/rccm.201411-1958OC)

Abstract

Editor’s comment: The authors found that in a group of preschoolers with severe wheezing episodes, markers of lung remodeling vary depending upon the patient’s age.  Interestingly, airway wall structural changes were not related to biopsy derived inflammatory cell counts. Lastly, markers of remodeling were surprisingly similar between those who wheezed as a result of multiple triggers, compared to those solely triggered by viral infection.

2. Therapeutic targeting of GATA3, an important transcription factor of the Th2 pathway, in allergic asthma.

Krug N, Hohlfeld JM, Kirsten AM, Kornmann O, Beeh KM et al. Allergen-induced asthmatic responses modified by a GATA3-specific DNAzyme. The New England Journal of Medicine 2015; 372: 1987-1995. (doi:10.1056/NEJMoa141176)

Abstract

Editor’s comment: In patients with allergic asthma, treatment with a novel DNA enzyme able to cleave and inactivate GATA3 messenger RNA significantly attenuated both the early and late asthmatic response after allergen provocation.

3. Identifying the EP receptor that mediates the anti-inflammatory actions of PGE2 in the lung.

Birrell MA, Maher SA, Dekkak B, Jones V, Wong S, Brook P, and Belvisi MG.  Anti-inflammatory effects of PGE2 in the lung: role of the EP4 receptor subtype. Thorax 2015; published online before print, 4 May. (doi.10/1136/throaxjnl-2014-206592)

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Editor’s comment: This study identified, for the first time, through several clinically relevant models, the importance of the EP4 receptor and its associated signaling pathway as a target for a dual bronchodilator/anti-inflammatory therapy in the treatment of respiratory diseases, including asthma and chronic obstructive pulmonary disease.

4. An updated guideline on adult rhinosinusitis.

Rosenfeld RM, Piccirillo JF, Chandrasekhar SS, Brook I, Kumar KA et al.  Clinical Practice Guideline (update): adult sinusitis executive summary. Otorhinolaryngology Head Neck Surgery 2015; 152(4): 598-609. (doi:10.1177/0194599815574247)

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Editor’s comment: This article summarizes the rationale, purpose, and key action statements of the updated “Clinical Practice Guideline: Adult Sinusitis”. The 14 guideline recommendations address diagnostic accuracy and the appropriate use of ancillary tests to confirm the diagnosis and guide management (including radiography, nasal endoscopy, computed tomography, and testing for allergy and immune function) of adult rhinosinusitis. The authors also make recommendations regarding the optimal use of topical and systemic therapy.

5. Characterizing patients with chronic respiratory symptoms.

Turner AM, Tamasi L, Schleich F, Hoxha M, Horvath I, Louis R, and Barnes N. Clinically relevant subgroups in COPD and asthma. European Respiratory Review 2015; 24(136): 283-298. (doi:10.1183/16000617.000090)

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Editor’s comment: In this comprehensive review, the authors develop subgroups of COPD and asthma patients whose clinical characteristics they believe have therapeutic or major prognostic implications, and they examine whether these subgroup stratifications remain constant over time. Finally, they analyze whether these subgroups are common to both asthma and COPD, focusing on how treatment might be tailored in patients where the subgroup classification is clear but the label of asthma or COPD is not.

6. T cell epitope peptide therapy: a promising, safe and effective new class of specific treatment for allergy.

Prickett SR, Rolland JM and O’Hehir RE. Immunoregulatory T cell epitope peptides: the new frontier in allergy therapy. Clinical & Experimental Allergy 2015; 45(6): 1015-1026. (doi:10.1111/cea.12554)

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Editor’s comment:

In this review the authors explore the use of T cell epitope peptide therapies for allergic disease.  They report sustained efficacy with few adverse events for cat, house dust mite and grass pollen allergy after only a short course of treatment. The underlying immunological mechanism(s) remain to be fully elucidated, but anergy, deletion, immune deviation and Treg induction all seem to play a role.  Interestingly, changes in IgG4 appear to be less important compared to conventional AIT. Certainly, more is to come regarding this promising therapeutic approach.

7. Appropriate animal models of pathological itch are needed for the pharmacological evaluation of the antipruritic efficacy.

Kuraishi Y. Methods for preclinical assessment of antipruritic agents and itch mechanisms independent of mast-cell histamine. Biological and Pharmaceutical Bulletin 2015; 38(5): 635-644 (doi:http://doi.org/10.1248/bpb.b15-00090)

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Editor’s comment:  The author, through a comprehensive review of the animal model literature regarding pruritus, notes that through these experiments, it appears that itch is due to multiple mediators, the roles of which vary depending upon the etiology of pruritus. He concludes that further models of itch are needed, and through this work it is hoped that better antipruritic agents will be found.

8. Relevant indoor allergens.

Raulf M, Bergmann KC, Kull S, Sander I, Hilger CH, Brüning T, Jappe Y et al. Mites and other indoor allergens — from exposure to sensitization and treatment. Allergo International 2015; 24(49). (doi:10.1007/s40629-015-0049-1)

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Editor’s comment: This short overview summarizes the current key points regarding the subject of “mites and other indoor allergens” and provides a review of several articles published in a special issue of the German journal, Allergologie (February 2015; Vol 38, Num 2) on this topic.

9. Prevalence of nickel hypersensitivity and orthodontic treatment.

Gölz L, Papageorgiou SN, and Jäger A. Nickel hypersensitivity and orthodontic treatment: a systematic review and meta-analysis. Contact Dermatitis 2015; 73(1): 1-14. (doi:10.1111/cod.12392)

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Editor’s comment: In the present systematic review the authors failed to demonstrate that orthodontic treatment influences the prevalence of nickel hypersensitivity. It should be noted, however, that there was a significantly lower risk of nickel hypersensitivity when orthodontic treatment preceded body piercing compared to orthodontic treatment occurring after piercing.

10. Presence of major foods allergens in breast milk.

Pastor-Vargas C, Maroto AS, Díaz-Perales A, Villaba M, Casillas Diaz N, Vivanco F, Cuesta-Herranz J. Sensitive detection of major food allergens in breast milk: first gateway for allergenic contact during breastfeeding. European Journal of Allergy and Clinical Immunology 2015, published online before print, 27 May. (doi:10.1111/all.12646)

Abstract

Editor’s comment: The authors developed a microarray with antibodies produced against major food allergens and demonstrated the presence of these allergens in breast milk. They concluded that analysis of allergens presented in breast milk could be a useful tool in food allergy prevention.