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Archives: Medical Journal Reviews

WAO Reviews - Editors' Choice

Posted: June 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. Mechanisms underlying chronicity in allergic inflammation

Masuoka M, Shiraishi H, Ohta S, Suzuki S, Arima K et al. Periostin promotes chronic allergic inflammation in response to Th2 cytokines. The Journal of Clinical Investigation 2012; doi:10.1172/JCI58978

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Editor's comment: The authors, using a mouse model of skin inflammation, demonstrated that periostin, a recently characterized matricellular protein, is a critical mediator for the amplification and persistence of allergic inflammation.

2. Impact of the diagnosis and rationale for action against cow's milk allergy (DRACMA) guidelines on the decision process in the therapy of cow's milk allergy

Terracciano L, Schünemann H, Brożek J, Agostoni C, Fiocchi A, on behalf of the DRACMA Implementation Committee, World Allergy Organization. How DRACMA changes clinical decision for the individual patient in CMA therapy. Current Opinion in Allergy & Clinical Immunology 2012; 12(3): 316-322. (doi: 10.1097/ACI.0b013e3283535bdb)


Editor's comment: The authors report the experience of a 2-year application of the DRACMA guidelines worldwide. Variations in the socioeconomic profile of cow's milk allergy sufferers and their context can modify the application of DRACMA recommendations.

3. Increased expression of IL-19 in the epithelium of patients with chronic rhinosinusitis and nasal polyps

Pace E, Scafidi V, Di Bona D, Siena L, Chiappara G et al. Increased expression of IL-19 in the epithelium of patients with chronic rhinosinusitis and nasal polyps. Allergy 2012; 67(7): 878-886.


Editor's comment: Asthma gene array demonstrated that IL-19 is up-regulated, and real-time PCR analysis confirmed that IL-19 gene expression was increased in chronic rhinosinusitis with nasal polyps (CRSwNP) in comparison with normal subjects. In addition, IL-19 protein expression was increased in the epithelium of patients with CRSwNP in comparison with normal subjects.

4. Individual variation in antiviral response at birth determines the risk for acute respiratory tract illness in the first year of life

Sumino K, Tucker J, Shahab M, Jaffee KF, Visness CM et al. Antiviral IFN-γ responses of monocytes at birth predict respiratory tract illness in the first year of life. The Journal of Allergy and Clinical Immunology 2012; 129(5): 1267-1273.e1.


Editor's comment: A decrease in production of IFN-γ in response to respiratory syncytial virus infection of monocytes at birth was associated with a significant increase in the frequency of upper respiratory tract infections and the prevalence of ear and sinus infections, pneumonias, and respiratory-related hospitalizations in the first year of life.

5. Atopic children are depleted in specific members of the intestinal microbiota

Candela M, Rampelli S, Turroni S, Severgnini M, Consolandi C et al. Unbalance of intestinal microbiota in atopic children. BMC Microbiology 2012; 12:95, doi:10.1186/1471-2180-12-95.

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Editor's comment: The decrease of key immunomodulatory symbionts in the gastrointestinal tract as well as the corresponding increase in relative abundance of pro-inflammatory Enterobacteriaceae support the immune deregulation of the atopic host. Since this atopy-related dysbioses of the intestinal microbiota can contribute to the severity of the disease, atopy treatment may be facilitated by redressing these microbiological unbalances.

6. Comparison of school allergen exposure to home exposure in a cohort of children with asthma

Permaul P, Hoffman E, Fu C, Sheehan W, Baxi S et al. Allergens in urban schools and homes of children with asthma. Pediatric Allergy and Immunology 2012; Early View (doi: 10.1111/j.1399-3038.2012.01327.x)


Editor's comment: Mouse allergen levels in schools were substantial, and aerosolization of mouse allergen in classrooms may create a clinically significant exposure for students. The authors concluded that further studies are needed to evaluate the effect of indoor allergen exposure in schools.

7. Hypersensitivity reactions to common vaccines and the choice of vaccines in patients with suspected hypersensitivity

Leventhal JS, Berger EM, Brauer JA, Cohen DE. Hypersensitivity reactions to vaccine constituents: a case series and review of the literature. Dermatitis 2012; 23(3): 102-109. (doi: 10.1097/DER.0b013e31825228cf)


Editor's comment: The authors report three cases of cutaneous delayed hypersensitivity to aluminum contained in vaccines and present a comprehensive review of major constituents in vaccines that have elicited immediate-type or delayed-type hypersensitivity reactions. The authors include a table of the Food and Drug Administration-approved vaccines, which lists the quantities of major components including ovalbumin (egg protein), gelatin, aluminum, neomycin, 2-phenoxyethanol, thimerosal, and formaldehyde.

8. Comparison of nasal mediator and cytokine patterns between persistent allergic rhinitis (PAR) and nonallergic rhinitis with eosinophilia (NARES)

Gröger M, Klemens C, Wendt S, Becker S, Canis M et al. Mediators and Cytokines in persistent allergic rhinitis and nonallergic rhinitis with eosinophilia syndrome. International Archives of Allergy and Immunology 2012; 159(2): 171-178. (doi: 10.1159/000336169)


Editor's comment: In patients with NARES and PAR, eosinophils and mast cells seem to be the most important cells of inflammation, reflected by high levels of tryptase and ECP as well as IL-5 and GM-CSF. The elevated levels of proinflammatory cytokines in NARES, especially IL-17, are a reflection of a chronic, self-perpetuating process of inflammation and remodelling in which neutrophilic infiltration may play a role.

9. Children living in urban centers have a much higher prevalence of food allergies than those living in rural areas

Gupta RS, Springston EE, Smith B, Warrier MR, Pongracic J, Holl JL. Geographic variability of childhood food allergy in the United States. Clinical Pediatrics 2011; published online before print, doi: 10.1177/0009922812448526.

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Editor's comment: In urban centers, 9.8 percent of children have food allergies, compared to 6.2 percent in rural communities. Peanut and shellfish allergies were twice as prevalent in urban centers and nearly 40 percent of food-allergic children in the study had already experienced a severe, life-threatening reaction to food.

10. Identification of factors associated with outcomes of occupational asthma

Maestrelli P, Schlünssen V, Mason P, Sigsgaard T, on behalf of the ERS Task Force on the Management of World-related Asthma. Contribution of host factors and workplace exposure to the outcome of occupational asthma. European Respiratory Review 2012; 21(124): 88-96. (doi:10.1183/09059180.00004811)

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Editor's comment: This systematic literature review establishes that older age, high-molecular-weight agents, impaired lung function and longer duration of exposure to the offending agent at the time of diagnosis had a negative role on the outcome of occupational asthma.

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