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Archives: Medical Journal Reviews

WAO Reviews - Editors' Choice

May 2014

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 Dana Wallace MD, Deputy Editor WAO Web.

1. Genetics in the development, progression and treatment of asthma.

Meyers DA, Bleecker ER, Holloway JW and Holgate ST. Asthma genetics and personalised medicine. The Lancet Respiratory Medicine 2014; 2(5): 405-415. (doi:10.1016/S2213-2600(14)70012-8)


Editor’s comment: This excellent review shows that asthma is a good example of how personal genetic information is now beginning to impact disease management. The challenge will be how to integrate the massive data available from such diverse sources as genome-wide association and interaction studies, epigenetic research, and pharmacogenetics so that the physician can provide truly personalized health care for an individual patient.

2. Asthma diagnosis, epidemiology, pathogenesis, and treatment linked with chronic rhinosinusitis (CRS)

Frieri M. Asthma linked with rhinosinusitis: An extensive review. . Allergy Rhinology 2014; 5:1-9. (doi:10.2500/ar.2014.5.0083)

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Editor’s comment: This extensive article reviews the linkage of asthma and chronic rhinosinusitis (CRS) exploring the pathogenesis, epidemiology, diagnosis and treatment of both diseases. Common disease concepts addressed include: altered innate immunity, adaptive immunity, asthma remodeling, the airway epithelium, the role of airway smooth muscle cells, the “united allergic airway”, genetic patterns, and shared treatments.

3. Interventions to modify the short-term and long-term outcomes of preschool wheeze.

Ducharme FM, Tse SM, Chauhan B. Diagnosis, management, and prognosis of preschool wheeze. The Lancet 2014; 383(9928): 1593-1604. (doi:10.1016/S0140-6736(14)60615-2)

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Editor’s comment: Preschool children with wheeze have deficits in lung function that persist into adulthood, suggesting increased susceptibility during the first years of life that might lead to persistent sequelae. Daily inhaled corticosteroids seem to be the most effective therapy and intermittent high-dose corticosteroids are effective in moderate-to-severe viral-induced wheezing. Interventions to modify the short-term and long-term outcomes of preschool wheeze should be a research priority.

4. Peptide immunotherapy (PIT) offers realistic prospects for the treatment of allergic diseases, including allergic asthma.

Mackenzie KJ, Nowakowska DJ, Leech MD, McFarlane AJ, Wilson C, Fitch PM, O’Connor RA et al. Effector and central memory T helper 2 cells respond differently to peptide immunotherapy. PNAS 2014; published online before print, 10 February (doi:10.1073/pnas.131617811)

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Editor’s comment:: Based upon murine studies, the authors concluded that PIT can control allergic lung disease more effectively when the disease is driven by effector memory T helper 2 cells (Tem) rather than by central memory T helper 2 cells (Tcm). PIT-treated Tcm cells remain more responsive to allergen, with a greater capacity to produce inflammatory Th2 cytokines. In contrast the Tem cells are effective in suppressing cytokines released in the lungs. These differences are important for clinical translation of PIT, as Tcm cells may be particularly dominant in some seasonal allergic conditions, such as hay fever.

5. Recent advances in the prevention, diagnosis and management of food allergy in children.

Turner, PJ, Boyle RJ. Food allergy in children: what is new? Current Opinion in Clinical Nutrition and Metabolic Care 2014; 17(3): 285-293. (doi:10.1097/MCO.0000000000000052)


Editor’s comment: This comprehensive review highlights that component resolved diagnostics can be helpful for understanding a child’s food allergy. However, a good clinical history supplemented by skin prick testing using appropriate allergen extracts/whole foods is still the most reliable outpatient diagnostic test. Specific oral tolerance induction, often requested by patients, is a promising treatment, but it is not yet ready for routine clinical use.

6. Fungal allergy in asthma.

Denning DW, Pashley C, Hartl D, Wardlaw A, Godet C, Del Giacco S, Delhaes L, and Sergejeva S. Fungal allergy in asthma-state of the art and research needs. Clinical and Translational Allergy 2014; (4)14. (doi. 1186/2045-7022-4-14)

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Editor’s comment: In this paper the authors attempt to summarize the key evidence supporting the role of fungal exposure, sensitization, and infection in asthmatics. Admitting that the evidence for management strategies is weak, they review our understanding of fungal-associated asthma pathogenesis and natural history and identify the numerous areas for which research studies are needed.

7. Mesenchymal stem cell infusion in murine experimental asthma.

Mariñas-Pardo L, Mirones I, Amor-Carro O, Fraga-Iriso R, Lema-Costa B, Cubillo I, Rodriguez MA et al. Mesenchymal stem cells regulate airway contractile tissue remodeling in murine experimental asthma.Allergy 2014; 69(6): 730-740. (doi:10.1111/all.12392)

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Editor’s comment: The authors concluded that therapeutic mesenchymal stem cell infusion in murine experimental asthma is free of unwanted pro-remodeling effects and ameliorates airway hyper-responsiveness and contractile tissue remodeling. These findings add to the preclinical data that may serve the basis for the development of mesenchymal stem cell-based asthma therapies.

8. Outdoor air pollution can cause exacerbations of pre-existing asthma as well as a contribution to new-onset asthma.

Guarnieri M and Balmes JR. Outdoor air pollution and asthma. The Lancet 2014; 383(9928): 1581-1592. (doi:10.1016/S0140-6736(14)60617-6)

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Editor’s comment: Through this comprehensive review the authors concluded that short-term exposures to ozone, nitrogen dioxide, sulphur dioxide, PM2•5, and TRAP are thought to increase the risk of exacerbations of asthma symptoms. They suggest that long-term exposures to air pollution, especially TRAP and its surrogate, nitrogen dioxide, can contribute to new onset asthma in both children and adults.

9. A new tool for clinicians to characterize asthma based on cellular function.

Karl-Heinz Sackmann E , Berthier E, Schwantes EA, Fichtinger PS, Evans MD et al. Characterizing asthma from a drop of blood using neutrophil chemotaxis. PNAS 2014; 111(16): 5813-5818, published ahead of print 7 April. (doi:10.1073/pnas.1324043111)


Editor’s comment: Could diagnosing asthma really be this easy? The authors describe a handheld microfluidic device that uses a drop of blood to measure the velocity of neutrophil chemotaxis. Studying an atopic group of patients, the neutrophil chemotactic velocity, used to characterize neutrophil physiology, discriminated patients with asthma from those without asthma, many of whom reportedly had diagnosed allergic rhinitis. With reported sensitivity and specificity being 96% and 73%, respectively, if more extensive research confirms these findings, this 5-minute test could be the perfect diagnostic tool for which allergists worldwide have been searching. This provocative article must make your bucket list.

10. Current knowledge on cashew nut allergy.

van der Valk JPM, Dubois AEJ , Gerth van Wijk R, Wichers HJ, and de Jong NW. Systematic review on cashew nut allergy. Allergy 2014; 69(6): 692-698. (doi:10.1111/all.12401)

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Editor’s comment: This systematic review focuses on the clinical aspects of allergy to cashew nut. Topics covered include the characteristics of cashew nut, the prevalence, allergenic components, cross-reactivity, diagnosis and management of cashew nut allergy.

11. Results and safety of drug provocation tests (DPTs) during childhood.

Vezir E, Erkocoglu M, Civelek E, Kaya A, Azkur D, Akan A, Ozcan C, Toyran M et al. The evaluation of drug provocation tests in pediatric allergy clinic: A single center experience. Allergy and Asthma Proceedings 2014; 35(2): 156-162. (doi:10.2500/aap.2014.35.3744)


Editor’s comment: The authors concluded from their results that a positive clinical history is not sufficient to make a diagnosis of drug allergy. This highlights the significance of undertaking a thorough diagnostic evaluation, including drug provocation testing.

12. Transforming growth factor-beta 1-induced signaling pathways in airway diseases.

Yang Y, Zhang N, Lan F, Van Crombruggen K, Fang L, Hu G, Hong S, and Bachert C. Transforming growth factor-beta 1 pathways in inflammatory airway diseases. Allergy 2014; 69(6): 699-707. (doi: 10.1111/all.12403)

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Editor’s comment: Transforming growth factor-beta 1, often described as the two-edged sword, is implicated both in remodeling as well as in immunosuppression of inflammatory airway diseases; TGF-(beta symbol) is responsible for persistent epithelial activation and structural remodeling but on the other hand exerts an immunomodulatory role by inhibiting T-cell activation and down-regulating inflammatory responses.

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