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Archives: Medical Journal Reviews

WAO Reviews - Editors' Choice

Posted: May 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. Arguments to suggest that allergic immunity has an important role in host defense against noxious environmental substances.

Palm NW, Rosenstein RC, Medzhitov R. Allergic host defences. Nature 2012; 484(7395): 465-472. Published online 25 April 2012, doi:10.1038/nature11047.


Editor's comment: In an interesting review article in which the authors propose that allergic reactivity may provide an important defense mechanism that protects the host from at least four different classes of environmental challenges, including: helminthes, noxious xenobiotics, venoms and haematophagous fluids and environmental irritants.

2. Hot air-induced bronchoconstriction in asthmatics.

Hayes D Jr, Collins PB, Khosravi M, Lin R-L, Lee L-Y. Bronchoconstriction triggered by breathing hot humid air in asthmatics: role of cholinergic reflex. American Journal of Respiratory and Critical Care Medicine 2012; Published online ahead of print on 13 April 2012, doi: 10.1164/rccm.201201-0088OC.


Editor's comment: Hyperventilation of hot humid air triggered cough and a reflex bronchoconstriction in patients with mild asthma. These effects were mediated through the cholinergic reflex, suggesting that the airway sensory nerves, presumably the bronchopulmonary C-fibers, are activated by an increase in airway tissue temperature.

3. Potential role for autoreactivity in the pathogenesis of atopic dermatitis (AD).

Tang TS, Bieber T, Williams HC. Does "autoreactivity" play a role in atopic dermatitis? The Journal of Allergy and Clinical Immunology, 2012; 129(5): 1209-1215.e2.

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Editor's comment: The authors performed a systematic review of studies from MEDLINE and found 31 experiments that described autoreactivity in patients with atopic dermatitis (AD). They suggest that autoreactivity might be playing a causative role in AD based on the magnitude and specificity of the associations found.

4. Role of overweight as a comorbidity factor in childhood asthma.

Mahut B, Beydon N, Delclaux C. Overweight is not a comorbidity factor during childhood asthma: the GrowthOb study. European Respiratory Journal 2012; 39(5): 1120-1126, doi: 10.1183/09031936.00103311.


Editor's comment: This cross-sectional study showed slight relationships between functional indices on pulmonary function testing and being overweight, while characteristics of asthma were not altered by being overweight in a pediatric population. These changes were not specific for asthma.

5. First update of the Canadian Thoracic Society Asthma Guidelines following a new guideline development process.

Lougheed MD, Lemiere C, Ducharme FM, Licskai C, Dell SD et al. Canadian Thoracic Society 2012 guideline update: Diagnosis and management of asthma in preschoolers, children and adults. Canadian Respiratory Journal 2012; 19(2): 127-164.

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Editor's comment: The updated guideline recommendations outline a role for sputum eosinophils to guide adjustment of controller therapy. They also review evidence to aid in the selection of which controller therapy to add to inhaled corticosteroids (ICS) and suggest at what ICS dose to begin adjunct therapy in children and adults with poor asthma control. Finally they review new recommendations for the adjustment of controller medication and identify priority areas for future research.

6. A Th2-driven epithelial phenotype common to all children with dust mite allergic rhinitis.

Giovannini-Chami L, Marcet B, Moreilhon C, Chevalier B, Illie MI et al. Distinct epithelial gene expression phenotypes in childhood respiratory allergy. European Respiratory Journal 2012; 39(5): 1197-1205. doi: 10.1183/09031936.00070511


Editor's comment: The authors established gene expression signatures using nasal brushings from children with dust mite allergic rhinitis, associated or not associated, with controlled or uncontrolled asthma. Their goal was to identify epithelial pathways that are dysregulated in different phenotypes of respiratory allergy. They found a Th2-driven epithelial phenotype in children with dust mite allergic rhinitis distinguishing them from controls. They also could distinguish controlled vs uncontrolled asthma with a 75% accuracy using these techniques.

7. Identifying genetic variants associated with earlier onset of childhood asthma.

Forno E, Lasky-Su J, Himes B, Howrylak J, Ramsey C et al. Genome-wide association study of the age of onset of childhood asthma. The Journal of Allergy and Clinical Immunology 2012; Article in press, published online 4 May 2012, 10.1016/j.jaci.2012.03.020.


Editor's comment: The authors reported the first genome wide association study (GWAS) of the age of onset of asthma in children and found 2 SNPs (rs9815663 and rs7927044) were significantly associated with an earlier age of onset of asthma in a combined analysis of 4 different cohorts.

8. Unable to make any recommendations for the use of glucocorticoids in the treatment of anaphylaxis.

Choo KJL, Simons FER, Sheikh A. Glucocorticoids for the treatment of anaphylaxis. Cochrane Database of Systematic Reviews 2012; Issue 4, Article CD007596, Published online before print, 18 April 2012, doi:10.1002/14651858.CD007596.pub3.


Editor's comment: The authors conducted a systematic review of the literature on the use of steroids for the emergency treatment of anaphylaxis and were unable to find any randomized controlled trials on this subject. They concluded that there is no evidence from high quality studies supporting the use of steroids in the emergency management of anaphylaxis. Therefore, they can neither support nor refute the use of these drugs for this purpose.

9. Multidimensional impact of allergic rhinitis on the health related quality of life in children.

Mir E, Panjabi C, Shah A. Impact of allergic rhinitis in school going children. Asia Pacific Allergy 2012; 2(2): 93-100.


Editor's comment: The authors concluded that allergic rhinitis in children has a significant impact on the quality of life, negatively affects the family and impairs the process of learning. This is especially true for school going children in whom timely and appropriate treatment could possibly avoid the immense morbidity encountered with this disease.

10. Nebulized salbutamol vs. combined budesonide/formoterol in a single inhaler in acute exacerbation of mild to moderate asthmatic attack in an emergency department.

Chew KS, Kamarudin H, Hashim CW. A randomized open-label trial on the use of budesonide/formoterol (Symbicort®) as an alternative reliever medication for mild to moderate asthmatic attacks. International Journal of Emergency Medicine 2012; 5(1): 16. doi:10.1186/1865-1380-5-16

Full text, Open Access

Editor's comment: This randomized, open-label study demonstrated that both nebulized salbutamol and combined budesonide/formoterol in a single inhaler produce objective and subjective clinical improvements in the first 15 minutes. Despite the methodological weaknesses, this study may pave the way for larger studies to confirm whether budesonide / formoterol can be used as an alternative reliever in asthmatic exacerbations.

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