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Medical Journal Review

May 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. Relevance of fractional exhaled nitric oxide (FeNO) in clinical practice.

Ricciardolo FLM, Sorbello V, Ciprandi G. A pathophysiological approach for FeNO: A biomarker for asthma. Allergologia et Immunopathologia 2015. (doi:10.1016/j.aller.2014.11.004)

Abstract

Editor’s comment:
In this review, the authors explore the role of exhaled NO as an inflammatory biomarker in patients with asthma and in allergic rhinitis, focusing on a pathophysiological perspective.

2. Prevalence and risk factors of allergic rhinitis (AR) in a large population-based study.

An SY, Choi HG, Kim SW, Park B, Lee JS, Jang JH, and Sung MW. Analysis of various risk factors predisposing subjects to allergic rhinitis. Asian Pacific Journal of Allergy and Immunology 2015; 33(2); published online before print, June.

Full Text, Free

Editor’s comment:
This study revealed that age, stress level, marriage, occupation, asthma, atopic dermatitis, pulmonary tuberculosis, depression, thyroid disease, and parental AR history affected the prevalence of AR. It is hoped by the authors that by better defining the influence of these various factors (and manipulating them) associated with AR one can help prevent development of the condition.

3. Calcilytics may represent effective asthma therapeutics.

Yarova PL, Stewart AL, Sathish V, Britt Jr. RD, Thompson MA et al. Calcium-sensing receptor antagonists abrogate airway hyperresponsiveness and inflammation in allergic asthma. Science Translational Medicine 2015; 7(284): 284ra60. (doi:10.1126/scitranslmed.aaa0282)

Abstract

Editor’s comment:
This research team studied mouse models of asthma as well as human airway tissue from asthmatic and non-asthmatic subjects and found that asthma associated with activation of the calcium-sensing receptor (CaSR). Activation of this receptor triggers multiple reactions that result in both contraction of airway smooth muscle (ASM) as well as upregulation of CaSR. They further demonstrated that treatment with a calcilytic agent prevented the excessive activity of CaSR in airway tissue, opening a new and exciting potential treatment for asthma.

4. A subunit vaccine against herpes zoster has a vaccine efficacy of 97.2%.

Lal H, Cunningham AL, Godeaux O, Chlibek R, Diez-Domingo J et al. Efficacy of an adjuvanted herpes zoster subunit vaccine in older adults. New England Journal of Medicine 2015; published online before print 28 April. (doi:10.1056/NEJMoa1501184)

Full Text, Free

Editor’s comment:
The authors concluded that the herpes zoster subunit vaccine significantly reduced the risk of herpes zoster among adults who were 50 years of age or older. Overall efficacy was well preserved even among participants who were 70 years of age or older.

5. A primary care-personalized asthma management system.

Tamblyn R , Ernst P, Winslade N, Huang A, Grad R et al. Evaluating the impact of an integrated computer-based decision support with person-centered analytics for the management of asthma in primary care: a randomized controlled trial. Journal of the American Medical Informatics Association 2015; published online before print, 10 February. (doi:http://dx.doi.org/10.1093/jamia/ocu099)

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Editor’s comment:
The authors found that by implementing a primary care-personalized asthma management system they could reduce the rate of “out-of-control” asthma episodes among patients who had poorly controlled asthma at the study’s onset.

6. Nickel sensitization and dietary nickel in patients with allergic-like chronic dermatitis syndromes.

Antico A and Soana R. Nickel sensitization and dietary nickel are a substantial cause of symptoms provocation in patients with chronic allergic-like dermatitis syndromes. Allergy & Rhinology 2015; 6(1): e56-e63(8). (doi:http://dx.doi.org/10.2500/ar.2015.6.0109)

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Editor’s comment:
In this retrospective study examining a case series of 1726 patients referred to an allergy unit for chronic allergic-like skin diseases, the authors concluded that nickel sensitization through dietary nickel exposure, triggered symptoms in a significant number (11%) of patients with chronic allergic-like dermatitis syndromes.

7. Allergic rhinitis increases the risk of developing obstructive sleep apnea.

Chirakalwasan N and Ruxrungtham K. The linkage of allergic rhinitis and obstructive sleep apnea. Asian Pacific Journal of Allergy and Immunology 2014; 32(4): 276-286.

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Editor’s comment:
In this review, the authors propose that allergic rhinitis increases the risk of developing obstructive sleep apnea via two major mechanisms: increase in airway resistance through higher nasal resistance and reduction in pharyngeal diameter secondary to mouth breathing. They also suggest that inflammatory mediators of allergic rhinitis, including histamine, CysLTs, IL 1β and IL-4 may add to worsening sleep quality.

8. Asthma e-Lab, a secure web-based research environment.

Custovic A, Ainsworth J, Arshad H, Bishop C, Buchan I et al.  Audit, research and guideline update: The Study Team for Early Life Asthma Research (STELAR) consortium “Asthma e-lab”: team science bringing data, methods and investigators together. Thorax 2015; published online before print 24 March. (doi:10.1136/thoraxjnl-2015-206781)

Full Text, Free

Editor’s comment:
The authors describe the creation of a secure web-based platform for uniform storage of UK birth cohorts data to aid in determining asthma endotypes as well as  endotype-specific environmental protective and susceptibility factors. Through this approach, it is hoped that specific biomarkers and target pathways can be identified with the ultimate hope of new drug discoveries.   

9. Understanding childhood severe asthma by analyzing gene expression and modeling the underlying regulatory transcription factor networks.

Persson H, Kwon AT, Ramilowski JA, Silberberg G, Soderhall C et al. Transcriptome analysis of controlled and therapy-resistant childhood asthma reveals distinct gene expression profiles. The Journal of Allergy and Clinical Immunology 2015; in press, corrected proof. (doi:http://dx.doi.org/10.1016/j.jaci.2015.02.026)

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Editor’s comment:
The authors concluded that circulating leukocytes from children with controlled asthma compared with those with severe asthma have disparate gene expression profiles, demonstrating the possible utilization of specific molecular biomarkers for the development of novel therapeutic approaches.

10. Use and impact of differential diagnosis (DDX) generators in real-world settings.

Barbieri JS, French B and Umscheid CA. Uptake and impact of a clinical diagnostic decision support tool at an academic medical center. Diagnosis 2015; 2(2): 123-127.

Full Text, Open Access

Editor’s comment:
The authors explored the use of a differential diagnosis (DDX) generator, focused on dermatologic disease, in attempt to reduce the incidence of misdiagnosis in a real-world setting (an academic healthcare system). They found that this tool was primarily accessed on mobile devices and inpatient workstations, and interestingly, was not associated with a change in inpatient dermatology consultation requests.