WAO Medical Literature Reviews

WAC 2011

Volume 8, Issue 1, January 2011

Medical Journal Article Reviews

Juan Carlos Ivancevich, MD, WAO Web Editor-in-Chief, in collaboration with Phil Lieberman, MD, Web Editor of Medical Literature Reviews, 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. Medical Journal Review section of the WAO Web site.

To read translations of past Medical Journal Reviews, click here.

1. Allergic rhinitis as a predictor for wheezing onset in school-aged children.
To investigate whether the development of rhinitis in early life predicts wheezing between the ages of 5 and 13 years, the researchers studied 1,314 children who participated in the German Multicentre Allergy Study. All the children were monitored from birth, and their parents completed regular questionnaires assessing respiratory symptoms and other health issues. Specific immunoglobulin (Ig)E levels were measured annually and airway hyper-responsiveness was assessed at the age of 7 years. They found that rhinitis prevalence was highest at the age of 3 years, at 9.2%, and ranged from 2.5% to 7.7% throughout the other years. By the age of 13 years, the cumulative incidence of rhinitis was 47.8%. The prevalence of wheezing was highest at the end of the second year of life, at 19.8%, and decreased to less than 7.0% in following years. The cumulative incidence of wheezing was 40.5% by the age of 13 years. After accounting for factors such as parental atopy, gender, maternal smoking during pregnancy, and number of siblings, the researchers found that children who suffered from allergic rhinitis before the age of 5 years were 3.82 times more likely to develop wheeze between the ages of 5 and 13 years than those who did not. Indeed, 41.5% of all children who developed wheeze had previously developed allergic rhinitis. The association between allergic rhinitis and wheeze was not linked to type or severity of sensitization. The authors concluded that allergic rhinitis in preschool children is a risk factor for subsequent wheezing onset. Preschool children with rhinitis might benefit from early assessment of allergic sensitization.
Editor's comment: The present analysis suggests that the first manifestation of allergic rhinitis occurs in preschool children, in whom it's a risk factor for subsequent wheezing onset.
Rochat MK, Illi S, Ege MJ et al. Allergic rhinitis as a predictor for wheezing onset in school-aged children. Journal of Allergy and Clinical Immunology 2010; 126(6): 1170-1175.

2. Multi-symptom asthma and nasal blockage, rhinorrhea and symptoms of chronic rhinosinusitis.
The aims of this study were to determine whether multi-symptom asthma is related to signs of severe asthma, and to investigate the association between multi-symptom asthma and different symptoms of allergic and chronic rhinosinusitis. This study analyzed data on asthma symptoms, rhinitis, and chronic rhinosinusitis from the 2008 West Sweden Asthma Study, which is an epidemiologically based study using the OLIN and GA²LEN respiratory and allergy focused questionnaires. To be considered as having multi-symptom asthma, a subject was required to report physician-diagnosed asthma and asthma medication and attacks of shortness of breath and recurrent wheeze and at least one out of the following: wheeze, dyspnoea, breathlessness on exertion, breathlessness in cold, and breathlessness-exertion in cold. For the purpose of this paper all subjects reporting physician-diagnosed asthma and not fulfilling the requirements of multi-symptom asthma are referred to as having fewer-symptom asthma. Multi-symptom asthma was present in 2.1% of the general population. Subjects with multi-symptom asthma had more than double the risk of having night-time awakenings caused by asthma compared with those with fewer asthma symptoms. The prevalence of allergic rhinitis was similar in the fewer- and multi-symptom asthma groups, but nasal blockage and rhinorrhea were significantly increased in those with multi- versus fewer-symptom asthma. Having any or one to four symptoms of chronic rhinosinusitis significantly increased the risk of having multi- versus fewer-symptom asthma. An epidemiologically identified group of individuals with multiple asthma symptoms harbor to greater extent those with signs of severe asthma. The degree of rhinitis, described by the presence of symptoms of nasal blockage or rhinorrhea, as well as the presence of any or several signs of chronic rhinosinusitis, significantly increases the risk of having multi-symptom asthma.
Editor's comment: Multi-symptom asthma is likely to describe a population with more severe disease.
Lotvall J, Ekerljung L and Lundback B. Multi-symptom asthma is closely related to nasal blockage, rhinorrhea and symptoms of chronic rhinosinusitis - evidence from the West Sweden Asthma Study. Respiratory Research 2010; 11(1): 164
Full text, open access

3. An increased intake of fruit would be associated with a reduced risk for asthma symptoms and sensitization to inhalant allergens.
To address the effects of long-term dietary exposure or differences in effects of dietary habits at early or later age, the authors studied data on 4,146 children who were followed up from birth until the age of 8 years as part of the Prevention and Incidence of Asthma and Mite Allergy (PIAMA) study. Associations between intake of fruit, vegetables, brown/wholemeal bread, fish, milk, butter, and margarine in early (2-3 years of age) and later (7-8 years of age) childhood, as well as long-term intake, were compared with asthma and atopy outcomes at the age of 8 years. Complete dietary data from 2 to 8 years of age for at least one of the investigated food groups were obtained for 2,870 children. Overall, 13.0% of the children had asthma symptoms (composite variable of wheeze, dyspnea or inhaled steroid use) and 32.1% were sensitized to inhalant allergens at the age of 8 years. After accounting for potential confounding factors, such as parental atopy, maternal smoking, breast feeding, and birth weight, the researchers found that long-term intake of fresh fruit was significantly inversely associated with asthma symptoms and sensitization to inhalant allergens, with each one consumption-day per week associated with a 10.0% reduced risk for either outcome. Similarly, each one consumption-day per week of fruit at 2-3 years of age was associated with a 7.0% reduced risk for asthma symptoms. However, fruit consumption at 7-8 years of age was not associated with asthma symptoms or sensitization to inhalant allergens. There were no significant associations between increased consumption of any of the other foods and risk for asthma symptoms or atopy. The authors concluded that the results of this study indicate no consistent effects of increased early or late consumption, or increased long-term intake of certain foods or food groups on asthma and allergy outcomes in 8-year-old children, with a possible exception for fruit.
Editor's comment: Future prospective studies should use more detailed dietary data to better assess nutrient or food specific effects on asthma and sensitization to inhalant allergens.
Willers SM, Wijga AH, Brunekreef B et al. Childhood diet and asthma and atopy at 8 years of age: the PIAMA birth cohort study. European Respiratory Journal November 25, 2010 [Published online before print. doi: 10.1183/09031936.00106109]

All 11 journal article reviews are posted in the literature review section of the WAO website.

Reviews of medical books can be accessed on the Reviews and News section of the website.

WAO Journal

WAO Journal

January 2011
Volume 4, Issue 1
ISSN: 1939-4551


Food Allergy in Lebanon: Is Sesame Seed the “Middle Eastern” Peanut?
Irani, Carla; Maalouly, George; Germanos, Mirna; Kazma, Hassan

Key Role of Water-Insoluble Allergens of Pollen Cytoplasmic Granules in Biased Allergic Response in a Rat Model
Abou Chakra, Oussama R.; Sutra, Jean-Pierre; Poncet, Pascal; Lacroix, Ghislaine; Sénéchal, Hélène


Nasal-Ocular Reflexes and Their Role in the Management of Allergic Rhinoconjunctivitis with Intranasal Steroids
Fuad M. Baroody, MD and Robert M. Naclerio, MD

Burden of Chronic Respiratory Diseases (CRD) in the Middle East and North Africa (MENA)
F. Chermiti Ben Abdallah, MD; S. Taktak, MD; A. Chtourou, MD; R. Mahouachi, MD; and Ali Ben Kheder, MD


If you are a current member of a WAO Member Society:

Go to the WAO website (www.worldallergy.org). Click "Members Only" and you will be provided with instructions on how to access the full text of all articles published in the WAO Journal. To enjoy continual access, return to www.WorldAllergy.org and Members Only each time to newly access the full text.

Not a member? Sign up for the WAO Journal at: www.waojournal.org


The World Allergy Journal accepts original scientific and clinically relevant information concerned with the practice of allergy and clinical immunology including state-of-the-art review articles and editorials on translational and clinical medicine. Note that the Journal will be retroactively indexed. If you have an original contribution not previously published, visit www.WAOJournal.org and click on "For Authors," then the "instructions and guidelines" link.

Additional Journal Reviews

  1. Practical recommendations for safety considerations of omalizumab.
  2. Endotoxin and tobacco smoke exposure on wheeze and diurnal peak expiratory flow variability in children and adolescents.
  3. The influenza A virus (H3N1) and a novel pathway that can regulate airway hyperreactivity (AHR).
  4. Relationship between low levels of serum vitamin D and reduced lung function exercise-induced bronchoconstriction in asthmatic children.
  5. Implication of CPI-17 (protein-kinase C-potentiated myosin phosphatase inhibitor) in asthma.
  6. Brain-derived neurotrophic factor (BDNF) as severity marker in childhood asthma.
  7. Protozoa in sputum and asthma.
  8. Perioperative Management of Obstructive Sleep Apnea (OSA).


To read translations of past Medical Journal Reviews, click here.

WAO News & Reviews content is now searchable.

Medical Book Review

Anaphylaxis (Chemical Immunology and Allergy, Volume 95)
Edited by Johannes Ring
2010 S. Karger AG
ISBN: 978-3-8055-9441-7

List Price: Print Edition $198
Available from: Karger

Ahmed Butt, MD
Division of Allergy and Clinical Immunology
Department of Internal Medicine
University of South Florida
James A. Haley Veterans' Hospital
Tampa, Florida USA

This book provides an in-depth review on anaphylaxis pertinent to any clinician whatever their specialty. A thorough review of this subject is presented in a concise format, emphasizing the pathophysiology of anaphylaxis as it translates into clinical medicine.

The goal of the text is to provide a high yield review on the epidemiology, pathophysiology, and diagnostic and clinical manifestations of anaphylaxis. The incorporation of breakthrough research performed by experts worldwide enables the reader to better understand the etiology of clinical manifestations and current treatment modalities. This book is designed to educate not only allergists and immunologists but also physicians from any discipline and even lay individuals.

The reference will be a benefit to any professional, novice or experienced, in various medical disciplines. Although it better serves medical professionals, it is written with clarity.

There are five major sections in this text. The first three focus on the background of anaphylaxis, i.e., epidemiology, pathophysiology, clinical symptomatology and diagnosis. The fourth is devoted to specific allergens and elicitors of anaphylaxis. Included in this section is a description of the pathophysiology, clinical presentation and management of reactions to venoms, radiocontrast media, analgesics and anesthetics. Finally, the last section discusses the treatment and management of anaphylaxis in a concise, yet comprehensive manner.

Each section incorporates significant breakthroughs on anaphylaxis quoting reputable journals from throughout the world permitting the reader to appreciate the complexity in defining and managing this life-threatening condition. Limitations within various studies are acknowledged enabling the reader to interpret their significance more accurately.

The book provides a thorough overview of anaphylaxis. It is a concise, to the point review, which helps keep the reader's attention. Sections of the text are comprehensible to all educated individuals, yet contain information pertinent to the specialists who regularly manage and treat anaphylaxis. The cellular and molecular pathophysiology is adequately reviewed and therefore, may be a useful reference for those interested in understanding the basic science of anaphylaxis. I recommend this text to physicians and other medical professionals primarily because it explains the rationale for current guidelines used to treat and manage anaphylaxis through evidence based medicine.

Find more allergy book reviews on the WAO Web site.