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Archives: Medical Journal Reviews

WAO Reviews - Editors' Choice

Posted: April 2013

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. Recognition of specific subphenotypes of asthma.

Cottini M, Asero R. Asthma phenotypes today. European Annal of Allergy and Clinical Immunology. 2013; 45(1): 17-24.

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Editor’s comment: In this excellent review the authors concluded that asthma is a complex syndrome, and to improve our understanding of asthma it will be necessary to classify patients according to its underlying disease mechanism rather than its clinical characteristics. The classification of patients with asthma by phenotype/endotype will facilitate future research involving testing of novel therapeutic targets and endotype-specific treatments.

2. Chronic rhinosinusitis (CRS) endotypes can be characterized by differences in responsiveness to different treatments.

Akdis CA, Bachert C, Cingi C, Dykewicz M, Hellings P et al. Endotypes and phenotypes of chronic rhinosinusitis: A PRACTALL document of the European Academy of Allergy and Clinical Immunology and the American Academy of Allergy, Asthma & Immunology. The Journal of Allergy and Clinical Immunology. 2013; Article in press; corrected proof published online 15 April. (doi:10.1016/j.jaci.2013.02.036)

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Editor’s comment:  In this comprehensive review the authors highlight that CRS consists of multiple groups of biological subtypes, or “endotypes”, which are defined by distinct pathophysiologic mechanisms that might be identified by corresponding biomarkers. Better identification of endotypes might permit individualization of therapy that can be targeted against the pathophysiologic processes of a patient’s endotype, with potential for more effective treatment and better patient outcomes.

3. Pollutants along busy roads are responsible for a large and preventable share of asthma and related acute exacerbations in European urban areas.

Perez L, Declercq C, Iñiguez C, Aguilera I, Badaloni C. Chronic burden of near-roadway traffic pollution in 10 European cities (APHEKOM network). European Respiratory Journal. 2013; published online before print, 21 March. (doi: 10.1183/09031936.00031112)

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Editor’s comment: The authors estimated the burden of childhood asthma attributable to air pollution in 10 European cities by calculating the number of cases of: 1) asthma caused by near road traffic-related pollution, and 2) acute asthma events related to urban air pollution levels. Exposure to roads with high vehicle traffic, a proxy for near road traffic-related pollution, accounted for 14% of all asthma cases. When a causal relationship between near road traffic-related pollution and asthma was assumed, 15% of all episodes of asthma symptoms were attributable to air pollution.

4. Reducing indoor pollutant levels might be particularly beneficial in overweight asthmatic children.

Lu KD, Breysse PN, Diette GB, Curtin-Brosnan J, Aloe C et al.Being overweight increases susceptibility to indoor pollutants among urban children with asthma. The Journal of Allergy and Clinical Immunology. 2013; 131(4): 1017-1023.e3.

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Editor’s comment: Being overweight might increase susceptibility to the pulmonary effects of indoor fine particulate matter measuring less than 2.5 mm in diameter (PM2.5) and nitrogen dioxide (NO2) exposure in urban children with asthma.

5. Helpful guidance for researchers in allergen-prediction.

Wang J, Yu Y, Zhao Y, Zhang D, Li J.Evaluation and integration of existing methods for computational prediction of allergens. BMC Bioinformatics. 2013; 14(Suppl 4):S1.(doi:10.1186/1471-2105-14-S4-S1)

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Editor’s comment: This study comprehensively evaluated sequence-, motif- and SVM (Support Vector Machine)-based computational prediction approaches for allergens and optimized their parameters to obtain better performance. Integrating these methods into a web application proAP greatly facilitates the efforts of users to do customizable allergen search and prediction. The proAP application can be accessed at:

6. Atopic dermatitis (AD) and infective endocarditis (IE).

Fukunaga N, Okada Y, Konishi Y, Murashita T, Koyama T.Pay Attention to Valvular Disease in the Presence of Atopic Dermatitis. Circulation Journal. 2013; Published online before print, 27 March. (doi: 10.1253/circj.CJ-12-1371)

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Editor’s comment: The authors concluded that as Staphylococcal colonization in AD skin lesions is high, preoperative skin care should be introduced for AD patients to prevent S. aureus infection arising after open-heart surgery for IE.

7. Applying time series methods to population-based data to measure and project trends in asthma incidence and prevalence.

To T, Stanojevic S, Feldman R, Moineddin R, Atenafu E. Is asthma a vanishing disease? A study to forecast the burden of asthma in 2022. BMC Public Health. 2013; 12:254. (doi:10.1186/1471-2458-13-254)

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Editor’s comment: The authors used health administrative databases to identify and track all individuals with asthma in the Ontario Asthma Surveillance Information System (OASIS). Individuals with asthma were identified between April 1, 1996 and March 31, 2010. Exponential smoothing models were applied to annual data to project incidence to the year 2022, and estimated prevalence by applying the cumulative projected incidence to the projected population. They found that almost 1 in 8 individuals in Ontario will have asthma by the year 2022, suggesting that asthma will continue to be a major burden on individuals and the health care system.

8. Kawasaki disease (KD) and increased risk for allergic diseases.

Kuo H-Ch, Chang W-C, Yang KD, Yu H-R, Wang C-L et al.Kawasaki disease and subsequent risk of allergic diseases: a population-based matched cohort study. BMC Pediatrics. 2013; 13:38.  (doi:10.1186/1471-2431-13-38)

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Editor’s comment: The incidence rate of allergic diseases was significantly higher in the KD cohort than in the control cohort. After adjusting for potential confounders, the adjusted hazard ratios of asthma and allergic rhinitis were 1.51 and 1.30, respectively. The authors conclude that KD patients were at an increased risk for allergic diseases.

9. Disease severity might predict chronic spontaneous urticaria (CSU) duration.

Rabelo-Filardi R, Daltro-Oliveira R, Campos RA. Parameters associated with chronic spontaneous urticaria duration and severity: A systematic review. International Archives of Allergy and Immunology. 2013; 161(3): 197-204. (doi.10.1159/000346896)


Editor’s comment: Two authors independently searched PubMed until June 2012 for observational studies investigating the association between clinical or laboratory parameters with disease duration or severity in CSU patients. Evidence suggests urticaria severity might predict CSU duration, and plasma levels of prothrombin fragment 1 + 2, D-dimer and C-reactive protein might function as markers of CSU severity.

10. Reverse association between IgA levels and the incidence of allergic airway disease.

Gloudemans AK, Lambrecht BN, Smits HH.Potential of Immunoglobulin A to prevent allergic asthma. Clinical and Developmental Immunology. 2013; 2013:542091. (doi:10.1155/2013/542091)

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Editor’s comment: This review highlights the latest literature on the role of mucosal IgA in protection against allergic airway disease, the mechanisms described to induce secretory IgA, and the role of mucosal dendritic cells in this process. Finally, the authors discuss how this information can be used to enhance the development of new therapies for allergic diseases based on, or supplemented with, IgA boosting strategies.

11. Vitamin D in adult asthma patients and its association with asthma severity and control.

Korn S, Hübner M, Jung M, Blettener M, Buhl R. Severe and uncontrolled adult asthma is associated with vitamin D insufficiency and deficiency. Respiratory Research. 2013; 14:25, 22 February. (doi:10.1186/1465-9921-14-25)

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Editor’s comment: The authors evaluated clinical parameters of asthma control and 25-hydroxyvitamin D (25(OH)D) serum concentrations in 280 adult asthma patients. They found that 25(OH)D levels below 30 ng/ml were common in adult asthmatics and lowest in patients with severe and/or uncontrolled asthma, supporting the hypothesis that improving suboptimal vitamin D status might be effective in prevention and treatment of asthma.

12. Consensus evidence-based grading instrument on cautionary recommendations on sulfonamide allergy and cross-reactivity among sulfonamide-containing medications.

Ghimire S,  Kyung E , Lee JH, Kim JW, Kang W et al. An evidence-based approach for providing cautionary recommendations to sulfonamide-allergic patients and determining cross-reactivity among sulfonamide-containing medications.  Journal of Clinical Pharmacy and Therapeutics. 2013; published online before print, 13 March. (doi:10.1111/jcpt.12048)

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Editor’s comment: The authors identified significant discrepancies in cautionary recommendations ranging from no warning or precaution to contraindication included in drug-labels and drug compendia. The consensus evidence-based grading instrument developed may be useful for deriving cautionary recommendations for sulfonamide-allergic patients.

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