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Medical Journal Review

July 2016

WAO Reviews - Editors' Choice

The Editors select articles for their importance to clinicians who care for patients with asthma and allergic/immunologic diseases, and whenever possible they seek articles that everyone can access freely. The Editors’ Choice comes to you each month from Juan Carlos Ivancevich, MD, WAO Web Editor-in-Chief, and summary author, John J. Oppenheimer, MD, FACAAI, FAAAAI, WAO Reviews Editor.

1. Endotypes of allergic diseases and asthma: An important step in building blocks for the future of precision.

Agache I, Akdis CA. Endotypes of allergic diseases and asthma: An important step in building blocks for the future of precision. Allergology International 2016; article in press. (doi:10.1016/j.alit.2016.04.011)

Full Text, Open Access

The recent focus on precision medicine opens new opportunities for the allergy community to advance the clinical care of allergic patients. As we attempt to practice personalized medicine, clinicians will have to better understand phenotypes, endotypes, and biomarkers that aid in the stratification of disease. In this review, the authors explore our understanding of disease endotypes based on pathophysiological principles and their validation across clinically meaningful outcomes in asthma, allergic rhinitis, chronic rhinosinusitis, atopic dermatitis, and food allergy.

2. Patterns of Growth and Decline in Lung Function in Persistent Childhood Asthma

McGeachie MJ, Yates KP, Zhou X, Guo F, Sternberg AL  et al. Patterns of Growth and Decline in Lung Function in Persistent Childhood Asthma. The New England Journal of Medicine 2016; 374(19): 1842-1952. (doi:1056/NEJMoa1513737). 

Preview

In this study, the authors examine longitudinal measurements of growth and decline in lung function in the participants of the CAMP study (persistent childhood asthma), to determine if they could find indicators of the link between asthma and subsequent chronic airflow obstruction. McGeachie et al found that of the 684 study participants, 170 (25%) had a normal pattern of lung function growth without early decline, and 514 (75%) had abnormal patterns: 176 (26%) had reduced growth and an early decline, 160 (23%) had reduced growth only, and 178 (26%) had normal growth and an early decline.

Reduced lung growth was observed in subjects with lower baseline values for FEV1, smaller bronchodilator response, airway hyperresponsiveness at baseline, and male sex (P<0.001 for all comparisons).  Further, at the last spirometric measurement (mean [±SD] age, 26.0±1.8 years), 73 participants (11%) met the Global Initiative for Chronic Obstructive Lung Disease spirometric criteria for lung-function impairment that was consistent with chronic obstructive pulmonary disease (COPD); these participants were more likely to have a reduced pattern of growth than a normal pattern (18% vs. 3%, P<0.001).  This study demonstrates predictors of abnormal longitudinal patterns of lung function growth and decline and shows that children with persistent asthma and reduced growth of lung function are at increased risk for fixed airflow obstruction and even possibly COPD in early adulthood.

3. Questions and answers in chronic urticaria: where do we stand and where do we go?

Maurer M, Church MK, Marsland AM, Sussman G, Siebenhaar F, Vestergaard C, and Broom B. Questions and answers in chronic urticaria: where do we stand and where do we go? Journal of the European Academy of Dermatology and Venereology 2016; 30(5): 7 -15. (doi:10.1111/jdv.13695).

Full Text, Free

This supplement reports proceedings of the second international Global Urticaria Forum, which took place in 2015. In this document, the authors summarize some of the recent key insights regarding CU, as well as unmet needs and how to address them with future studies. The authors stress that our increased understanding of the pathophysiology of urticaria and consideration of the patient as a whole will need to be translated to better treatment algorithms.  We can be sure that much more will be coming in the upcoming years.

4. Prevalence of allergic rhinitis and asthma in patients with chronic rhinosinusitis and gastroesophageal reflux disease

Mahdavinia M, Bishehsari F, Hayat W, Codispoti CD, Sarrafi S. Prevalence of allergic rhinitis and asthma in patients with chronic rhinosinusitis and gastroesophageal reflux disease. Annals of Allergy, Asthma and Immunology 2016; article in press. (doi:10.1016/j.anai.2016.05.018)

Abstract

Previous studies have demonstrated an association between chronic rhinosinusitis (CRS) and gastroesophageal reflux disease (GERD) (Bohnhorst I, Jawad S, Lange B, Kjeldsen J, Hansen JM, Kjeldsen AD. Prevalence of chronic rhinosinusitis in a population of patients with gastroesophageal reflux disease. American Journal of Rhinology & Allergy 2015; 29(3): 70-74. el-Serag HB, Sonnenberg A. Comorbid occurrence of laryngeal or pulmonary disease with esophagitis in United States military veterans. Gastroenterology 1997; 113: 755-760). In this study by Mahdavinia and colleagues, the authors explore the underlying factors linking CRS and GERD via both a retrospective and prospective study. The retrospective study comprised a large cohort of CRS cases, whereas the prospective arm evaluated a series of CRS cases and controls.  Through the retrospective study (1066 patients with CRS, 112 (10.5%) had GERD) they found that the odds ratios (ORs) for asthma and allergic rhinitis in the CRS group with GERD compared with the CRS group without GERD were 2.89 (95% confidence interval [CI], 1.905-4.389) and 2.021 (95% CI, 1.035-3.947).

In the prospective trial, 90 subjects with CRS and 81 controls were enrolled. In the CRS group, GERD was associated with asthma (OR, 4.77; 95% CI, 1.27-18.01). Patients with CRS and GERD had a longer duration and a younger age at onset of CRS; while in controls, no association was found between GERD and asthma (OR, 0.67; 95% CI, 0.09-5.19) or allergic rhinitis (OR, 0.35; 95% CI, 0.05-2.59).

Juxtaposing these two studies, they note that the fact that patients with CRS and GERD are more likely to have atopic conditions and asthma when compared with patients with CRS, but without GERD and opine that this link may be that comorbid GERD and atopic disease are potential risk factors for the development of CRS.

5, Role of IgE in autoimmunity

Sanjuan MA, Sagar D, Kolbeck R. Role of IgE in autoimmunity. Journal of Allergy and Clinical Immunology 2016; 137(6): 1651-1661. (doi:10.1016/j.jaci.2016.04.007)

Abstract

Although it has long been known that there are circulating self-reactive IgE in patients with autoimmune disease, this association has been largely understudied. We, as allergists, are well aware of IgE’s importance in allergic disease, but only recently IgE autoantibodies have been recognized to participate in the self-inflicted damaging immune responses that characterize autoimmunity. These responses include direct damage on tissue-containing autoantigens, activation and migration of basophils to lymph nodes, and even the induction of Type 1 interferon responses from plasmacytoid dendritic cells.  In this review, the authors examine the recent literature regarding the prevalence of self-reactive IgE, highlighting IgE’s role in the pathogenesis of inflammatory autoimmune disorders.