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Archives: Medical Journal Reviews

WAO Reviews - Editors' Choice

Posted: March 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. Eosinophilic and non-eosinophilic sputum inflammatory phenotypes in children with asthma.

Fleming L, Tsartsali L, Wilson N, Regamey N, Bush A. Sputum inflammatory phenotypes are not stable in children with asthma. Thorax 2012; published online before print, 29 February. (doi.10.1136/thoraxjnl-2011-201064)


Editor's comment: This is the first study to assess sputum inflammatory phenotype longitudinally in children with asthma using accepted definitions of eosinophilic and non-eosinophilic asthma.

2. International Consensus (ICON) on Food Allergy.

Burks W, Tang M, Sicherer S, Muraro A, Eigenmann PA et al. ICON: Food allergy. Journal of Allergy and Clinical Immunology 2012; article in press, published online before print, 24 February (doi.10.1016/j.jaci.2012.02.001).

Free full text

Editor's comment: The AAAAI, ACAAI, EAACI, and WAO have come together to increase the communication of information about allergies and asthma at a global level. Within the framework of this collaboration, termed the International Collaboration in Asthma, Allergy and Immunology (iCAALL), this is the first of a series of consensus documents called International Consensus (ICON) reports, developed to serve as an important resource and support for physicians on food allergy.

3. FAST project (Food Allergy Specific Immunotherapy).

Zuidmeer-Jongejan L, Fernandez-Rivas M, Poulsen LK, Neubauer A, Asturias J et al. FAST: Towards safe and effective subcutaneous immunotherapy of persistent life-threatening food allergies. Clinical and Translational Allergy 2012; 2(5) (doi.10.1186/2045-7022-2-5)

Provisional abstract
Provisional full text PDF

Editor's comment: The FAST project aims at the development of safe and effective treatment of food allergies, targeting prevalent, persistent and severe allergy to fish and peach. It investigates the development of novel therapies for the treatment of food allergy by combining the principles of traditional allergen-specific immunotherapy with biotechnology (hypoallergenic recombinant allergens).

4. Association between increasing ambient levels of grass pollen and asthma Emergency Department (ED) presentations in children.

Erbas B, Akram M, Dharmage SC, Tham R, Dennekamp M et al. The role of seasonal grass pollen on childhood asthma emergency department presentations. Clinical & Experimental Allergy 2012; accepted article, published online before print 8 March. (doi.10.1111/j.1365-2222.2012.03995.x)


Editor's comment: Levels of pollen much lower than the current level of 50 grains /m3, which is used as the trigger point for warning asthma patients to avoid non-essential outdoor activities and/or take additional asthma medication, can contribute to asthma symptoms.

5. Ability of an electronic prompt to promote an asthma assessment during primary care visits.

Lim KG, Rank MA, Cabanela RL, Furst JW, Rohrer JE et al. The asthma ePrompt: A novel electronic solution for chronic disease management. Journal of Asthma 2012; 49(2): 213-218.


Editor's comment: The introduction of an electronic prompt increased the frequency of asthma assessment during asthma and non-asthma-related office visits. In the future, it will be important to evaluate whether this process will improve the assessment of asthma control, medication compliance, and exacerbations, and lead to better asthma outcomes.

6. Mechanisms of the Development of Allergy (MeDALL), a Seventh Framework Program European Union project, aims to generate novel knowledge on the mechanisms of initiation of allergy.

Antó JM, Pinart M, Akdis M, Auffray C, Bachert C et al. Understanding the complexity of IgE-related phenotypes from childhood to young adulthood: A Mechanisms of the Development of Allergy (MeDALL) Seminar. Journal of Allergy and Clinical Immunology 2012; in press, published online before print, 5 March. (doi.10.1016/j.jaci.2012.01.047)


Editor's comment: This article summarizes the results of a seminar designed to review new approaches proposed to investigate the complexity of allergic phenotypes and provide a synthesis of the state of the art of system-based research of IgE-associated diseases.

7. Clinical features and management of delayed hypersensitivity to mammalian meat mediated by IgE antibodies.

Saleh H, Embry S, Nauli A, Atyia S, Krishnaswamy G. Anaphylactic reactions to oligosaccharides in red meat: a syndrome in evolution. Clinical and Molecular Allergy 2012; 10(5). (doi.10.1186/1476-7961-10-5)

Provisional abstract
Provisional PDF

Editor's comment: The authors reviewed cases reported with delayed IgE mediated reactions to galactose-alpha 1,3-galactose (alpha-gal), an oligosaccharide found in non human mammals and originally detected as an allergen causing anaphylactic reactions to cetuximab. Reactions to alpha-gal tend to occur several hours after antigen exposure and are usually due to the ingestion of red meat. Skin tests with commercial allergens are characteristically negative. Such events account for reactions previously reported as idiopathic.

8. Evaluation of cell mediated immunity in asthma patients taking high dose inhaled corticosteroids chronically and not taking inhaled corticosteroids.

Lee C, Klaustermeyer WB. Effect of high dose inhaled corticosteroids on cell mediated immunity in patients with asthma. Allergologia et Immunopathologia 2012; 40(2): 100-103.


Editor's comment: Patients with asthma treated with high dose inhaled corticosteroids for at least 6 months did not have reduced cellular immunity in comparison to asthma patients taking albuterol as needed without inhaled corticosteroids. However, there was a wide spread of values in this study and there were only a small number of subjects, so further studies with larger numbers of asthma patients may be warranted.

9. Evaluation of drug allergy related history-taking by internists compared to allergists and the effect of a simple, structured questionnaire on the accuracy of drug allergy diagnosis.

Confino-Cohen R, Leader A, Klein N, Pereg D, Khoury S et al. Drug allergy in hospitalized patients: The contribution of allergy consultation and a structured questionnaire. International Archives of Allergy and Immunology 2012; 158(3): 307-312. (doi.10.1159/000332147)


Editor's comment: The present study showed significant discrepancies between medical records and in-depth allergy history and demonstrated that allergist consultation or use of a simple structured questionnaire may be beneficial for accurate diagnosis of drug allergies.

10. Influenza vaccination in egg-sensitized children.

Upton JEM, Hummel DB, Kasprzak A, Atkinson AR. No systemic reactions to influenza vaccination in egg-sensitized tertiary-care pediatric patients. Allergy, Asthma & Clinical Immunology 2012; 8(2). (doi.10.1186/1710-1492-8-2)

Provisional Abstract
Provisional PDF

Editor's comment: The authors concluded that most egg-allergic pediatric patients can be vaccinated with a low ovalbumin content influenza vaccine without prior vaccine testing. Vaccine skin testing, if used at all, can be reserved for special circumstances.

11. Lessons learned through the Severe Asthma Research Program (SARP).

Jarjour NN, Erzurum SC, Bleecker ER, Calhoun WJ, Castro M et al. Severe asthma. Lessons learned from the National Heart, Lung, and Blood Institute Severe Asthma Research Program. American Journal of Respiratory and Critical Care Medicine 2012; 185(4): 356-362. Published online before print, 15 February (doi.10.1164/rccm.201107-1317PP)


Editor's comment: The results of SARP investigations led to the largest and most comprehensively characterized cohort of patients with severe asthma ever assembled. These investigations have significantly advanced our understanding of asthma in general and severe asthma in particular.

12. Which asthma outcomes should be assessed with standardized methodology in future asthma clinical research studies?

Busse WW, Morgan WJ, Taggart V, Togias A et al. Standardizing asthma outcomes in clinical research: Report of the Asthma Outcomes Workshop. Journal of Allergy and Clinical Immunology 2012; 129(3)Supplement: S1-S8.

Full Text

Editor's comment: An excellent full supplement in the JACI summarizing the deliberations of a workshop designed to evaluate and standardize parameters used in asthma clinical trials. These included such measures as biomarkers, composite scores of asthma control, exacerbations, healthcare utilization and costs, pulmonary physiology, quality of life, symptoms and mediators.

13. Improved classification of severe asthma in children.

Fitzpatrick AM, Baena-Cagnani CE, Bacharier LB. Severe asthma in childhood: recent advances in phenotyping and pathogenesis. Current Opinion in Allergy & Clinical Immunology 2012; 12(2): 193-201. (doi.10/1097/ACI.0b013e32835090ac)


Editor's comment: Current treatment guidelines assume that asthma is a unified disorder with a common inflammatory mechanism, but developments in asthma endotyping are likely to challenge this paradigm in the next decade.

14. Generalizing the approach of the uniform definition of severe asthma for chronic allergic and associated diseases (rhinitis, chronic rhinosinusitis, chronic urticaria and atopic dermatitis).

Bousquet J, Anto JM, Demoly P, Schünemann JH, Togias A et al., in collaboration with the WHO Collaborating Center for Asthma and Rhinitis. Severe Chronic Allergic (and Related) Diseases: A Uniform Approach - A MeDALL - GA2LEN - ARIA Position Paper. International Archives of Allergy and Immunology 2012; 158(3): 216-231. Published online before print (doi.10.1159/000332924)


Editor's comment: A uniform definition of severe allergic diseases will help in better understanding allergic phenotypes. However, there is a need for a validation process of the proposed definition for severe chronic allergic diseases across different populations and countries with different incomes, age groups and disease phenotypes.

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