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Archives: Medical Journal Reviews

WAO Reviews - Editors' Choice

Posted: January 2012

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 Phillip Lieberman, MD, WAO Reviews Editor.

1. The level of asthma control is directly proportional to adherence rate.

Jentzsch NS, Camargos P, Sarinho ESC, Bousquet J. Adherence rate to beclomethasone dipropionate and the level of asthma control. Respiratory Medicine 2012; 106 (3): 338-343, 2012.


Editor's comment: In this year long study of children with mild or moderate persistent asthma adherence to inhaled corticosteroid treatment was directly related to asthma control. Therefore, the adherence rate to inhaled corticosteroids and the level of asthma control should be systematically checked in scheduled and non-scheduled appointments. The authors found that a minimum of 60% adherence to the prescribed regimen was enough to achieve asthma control, as defined by symptoms – including exercise induced asthma – and lung function. In addition, they noted that a dose of 300 micrograms of beclomethasone daily was sufficient to achieve control in most patients in this population.

2. Multi-allergen or single-allergen immunotherapy in polysensitized patients?

Calderón MA, Cox L, Casale TB, Moingeon P, Demoly P. Multiple-allergen and single-allergen immunotherapy strategies in polysensitized patients: Looking at the published evidence. The Journal of Allergy and Clinical Immunology In press, corrected proof. 13 January 2012. (doi:10.1016/j.jaci.2011.11.019)


Editor's comment: The goal of this review article was to clarify the roles of multi-allergen vs single allergen immunotherapy in multi-sensitized patients. Both multi-allergen and single-allergen immunotherapy have proved to be safe and effective in polysensitized patients. The authors concluded that more work is required to determine whether single-allergen and multi-allergen immunotherapy protocols elicit distinct immune responses in monosensitized and polysensitized patients. They also felt that sublingual and subcutaneous multiallergen immunotherapy in polysensitized patients requires more supporting data to validate its efficacy in practice.

3. Vasculitides associated with antineutrophil cytoplasmic antibodies (ANCAs).

Berden A, Göçeroglu A, Jayne D, Luqmani DJ, Rasmussen N et al. Diagnosis and management of ANCA associated vasculitis. BMJ 2012; 344:e26.


Editor's comment: This is an excellent review, drawing on the findings of observational studies, randomized controlled trials, and meta-analyses, of ANCA associated vasculitides. It focuses on granulomatosis with polyangiitis and microscopic polyangiitis. The authors emphasize the importance of early diagnosis and treatment of ANCA associated vasculitides to prevent the progression of disease.

4. Adolescent-onset asthma is associated with significant morbidity.

Kurukulaaratchy RJ, Raza A, Scott M, Williams P, Ewart S et al. Characterization of asthma that develops during adolescence; findings from the Isle of Wight Birth Cohort. Respiratory Medicine 2012; 106(3): 329-337.


Editor’s comment: The authors characterized adolescent-onset asthma in the Isle of Wight Birth Cohort, identifying relevant risk factors for its development. These factors included the presence of atopy, rhinitis, and increased bronchial hyper-responsiveness at age 10 years.

5. Allergen specificity of subcutaneous immunotherapy (SCIT).

Dreborg S, Lee TH, Kay AB, Durham SR. Immunotherapy Is Allergen-Specific: A Double-Blind Trial of Mite or Timothy Extract in Mite and Grass Dual-Allergic Patients. International Archives of Allergy and Immunology 2012; 158(1):63-70.


Editor’s comment: The authors demonstrate the allergen specificity of subcutaneous immunotherapy using a double-blind design employing either grass or mite SCIT in dual grass-and mite-allergic individuals.

6. Is it safe to use asthma medications during pregnancy?

Nelsen LM, Shields KE, Cunningham ML, Stoler JM, Bamshad MJ et al. Congenital malformations among infants born to women receiving montelukast, inhaled corticosteroids, and other asthma medications. The Journal of Allergy and Clinical Immunology 2012; 129(1): 251-254.e6.

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Editor’s comment: There is no epidemiologic evidence to support a causal relationship between asthma-treatment and limb reduction or other birth defects.

7. Is it safe to use asthma medications during pregnancy? 2

Lin S, Munsie JPW, Herdt-Losavio ML, Druschel CM, Campbell K et al. Maternal Asthma Medication Use and the Risk of Selected Birth Defects. Pediatrics 2012; published online January 2012 (doi: 10.1542/peds.2010-2660).


Editor’s comment: The association between several types of defects and asthma or asthma medication use during pregnancy may be chance findings or may be a result of maternal asthma severity and related hypoxia rather than medication use.

8. Regular apple consumption has an effect on oral allergy syndrome (OAS).

Kopac P, Rudin M, Gentinetta T, Gerber R, Pichler Ch et al. Continuous apple consumption induces oral tolerance in birch-pollen-associated apple allergy. Allergy 2012; 67(2): 280-285.


Editor’s comment: In patients with OAS to apple, transient tolerance can be safely induced with slowly, gradually increasing regular consumption of apple.

9. Retrospective study to determine whether L-thyroxine treatment can improve chronic urticaria (CIU) in patients with the co-occurrence of autoimmune thyroiditis (AT) and CIU.

Magen, E, Mishal, J. The effect of thyroxine treatment on chronic idiopathic urticaria and autoimmune thyroiditis. International Journal of Dermatology 2012; 51(1): 94-97.

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Editor’s comment: This study does not support previous observations that in hypothyroid patients with CIU and AT, L-thyroxine treatment improves the clinical course of CIU.

10. Characterization of gustatory rhinitis using recent advances in pathophysiology and novel surgical and medical management strategies.

Georgalas C; Jovancevic L. Gustatory rhinitis. Current Opinion in Otolaryngology & Head and Neck Surgery 2012; 20(1): 9-14.


Editor’s comment: Specific and complete review of gustatory rhinitis, reviewing the causes, pathophysiology, differential diagnosis and treatment.

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