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Archives: Medical Journal Reviews

WAO Reviews - Editors' Choice

June 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, WAO Web Deputy Editor.

1. Wheeze and atopy in young children at risk of developing asthma are associated with defective antiviral responses.

Spann KM, Baturcam E, Schagen J, Jones C, Straub CP et al. Viral and host factors determine innate immune responses in airway epithelial cells from children with wheeze and atopy. Thorax 2014; published online before print, 7 May. (doi:10.1136/thoraxjnl-2013-204908)

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Editor’s comment: The authors found that wheeze and atopy in young children are associated with a defect in the antiviral response of airway epithelial cells that is not dependent upon innate interferon production, results in elevated viral replication, and is largely regulated by the specific infecting virus.

2. Study finds limited benefit for Vitamin D in asthma treatment.

Castro M, King TS, Kunselman SJ, Cabana MD, Denlinger L et al. Effect of Vitamin D3 on asthma treatment failures in adults with symptomatic asthma and lower Vitamin D levels: The VIDA Randomized Clinical Trial. JAMA 2014;311(20): 2083-2091. (doi:10.1001/jama.2014.5052)

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Editor’s comment: This is the first randomized controlled trial to investigate whether taking vitamin D3 supplements can improve asthma control. The investigators found that adult persistent asthmatics on inhaled corticosteroids with Vitamin D insufficiency who added oral supplements of vitamin D3 (4000 IU/day for 28 wks) did not have a reduced rate of first treatment failure or asthma exacerbation. There was also no significant improvement in airway function, quality of life, or airway inflammation.

3. Anti-thymic stromal lymphopoietin (TSLP) monoclonal immunoglobulin reduced allergen-induced bronchoconstriction.

Gauvreau GM, O'Byrne PM, Boulet LP, Wang Y, Cockcroft D et al. Effects of an anti-TSLP antibody on allergen-induced asthmatic responses. New England Journal of Medicine 2014; 370: 2102-2110. (doi:10.1056/NEJMoa1402895)


Editor’s comment: AMG 157 is a human anti-TSLP monoclonal immunoglobulin G2? that binds human TSLP and prevents receptor interaction. The authors found that treatment with AMG 157 reduced allergen-induced bronchoconstriction (decrease in FEV1) and indexes of airway inflammation (eNO and blood/sputum eosinophils) before and after allergen challenge with attenuation of both early and late asthmatic responses.

4. Underlying allergies in patients with chronic rhinosinusitis (CRS).

Georgalas C, Vlastos I, Picavet V, van Drunen C, Garas G, and Prokopakis E. Is chronic rhinosinusitis related to allergic rhinitis in adults and children? Applying epidemiological guidelines for causation. Allergy2014; 69(7): 828-833. (doi:10.1111/all.12413)

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Editor’s comment: In this review the authors attempted the synthesis and evaluation of CRS using the modified Bradford Hill guidelines for causation. Although there was no proof of causation, especially in the pediatric literature, they recommended an evaluation of underlying allergies especially for patients not easily controlled with intranasal treatment and for patients for whom surgery is being considered.

5. Prognosis and treatment options of angiotensin-converting enzyme inhibitor-induced (ACEi) angioedema.

Rasmussen ER, Mey K and Bygum A. Angiotensin-converting enzyme inhibitor-induced angioedema A dangerous new epidemic. Acta Dermato Venereologica 2014; 94(3): 260-264. (doi:10.2340/00015555-1760)

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Editor’s comment: The use of ACEi has thus increased significantly over recent years and more adverse reactions have been reported including severe angioedema of the upper airways and even death due to asphyxiation. This comprehensive review focus on epidemiology, clinical presentation, pathophysiology, and evolving treatments of ACEi-induced angioedema. The article highlights the risk of concomitant therapy with dipeptidyl peptidase inhibitors as well as the risk of switching to an ACE II receptor-blocker.

6. Determinants associated with allergic rhinitis in a cohort of young children with asthma.

Moussu L, Saint-Pierre P, Panayotopoulos V, Couderc R, Amat F, and Just J. Determinants of allergic rhinitis in young children with asthma. PLoS ONE 2014; 9(5): e97236. (doi:10.1371/journal.pone.0097236)

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Editor’s comment: This study reveals that in young children with asthma, allergic rhinitis could be a signal symptom of a severe allergic phenotype with a particular association with peanut sensitization (OR=6.75) and raise the hypothesis that peanut could be considered as an inhaled allergen. In addition, the study showed a significant association of food allergy (OR=4.31) and mold exposure (OR=3.81) and the development of AR in this age group.

7. Indirect comparison of SLIT and symptomatic medication on symptom relief in pollen-induced seasonal allergic rhinitis.

Devillier P, Dreyfus JF, Demoly P and Calderon MA. A meta-analysis of sublingual allergen immunotherapy and pharmacotherapy in pollen-induced seasonal allergic rhinoconjunctivitis. BMC Medicine 2014; 12: 71 (doi:10.1186/1741-7015-12-71)

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Editor’s comment: In an indirect comparison meta-analysis, grass pollen SLIT tablets had a greater mean relative clinical impact than second-generation antihistamines and montelukast and much the same mean relative clinical impact as nasal corticosteroids.

8. Effects of Cesarean delivery and prenatal exposure to antibiotics on the development of atopic dermatitis.

Lee S-Y, Yu J, Ahn K-M, Kim KW, Shin YH et al. Additive effect between IL-13 polymorphism and Cesarean section delivery / Prenatal antibiotics use on atopic dermatitis: A Birth Cohort Study (COCOA). PLoS ONE 2014; 9(5): e96603. (doi:10.1371/journal.pone/0096603)

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Editor’s comment: The authors found that Cesarean section, prenatal antibiotic exposure, and unfavorable risk alleles of IL-13 and CD14 acted additively to promote the development of atopic dermatitis in infancy, possibly by modifying the gut microbiome, in a cohort for childhood of asthma and allergic diseases (COCOA) from the general Korean population.

9. Hypoallergenic properties of an extensively hydrolyzed casein formula (eCH) on cow's milk protein allergy (CMPA).

Vandenplas Y, De Greef E and ALLAR study group. Extensive protein hydrolysate formula effectively reduces regurgitation in infants with positive and negative challenge tests for cow's milk allergy. Acta Paediatrica 2014; 103(6): e243-e250. (doi:10.1111/apa/12615)

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Editor’s comment: The authors found that all confirmed CMPA cases tolerated eCH. The efficacy of the two eCH formula, a nonthickened version (NT-eCH) and a thickened version (T-eCH), were equally effective in reducing regurgitation in infants with a positive challenge test, while the T-eCH was more effective in the infants with regurgitation but a negative CMPA challenge.

10. Effective add-on therapy to anti-histamines for chronic urticaria.

de Silva NL, Damayanthi H, Rajapakse AC, Rodrigo C and Rajapakse S. Leukotriene receptor antagonists for chronic urticaria: a systematic review. Allergy, Asthma & Clinical Immunology 2014; 10:24. (doi:10.1186/1710-1492-10-24)

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Editor’s comment: The authors performed a systematic review concluding that leukotriene receptor antagonists (LTRA) are not superior to placebo as monotherapy; however, combination therapy of LTRA and antihistamines appears to be more efficacious than monotherapy with antihistamines.

11. Is the needle length of a standard allergy syringe appropriate for patients receiving subcutaneous immunotherapy?

Kim L, Nevis I, Potts R, Eeuwes C, Dominic A and Kim HL. Patients on subcutaneous allergen immunotherapy are at risk of intramuscular injections. Allergy, Asthma & Clinical Immunology 2014; 10:22. (doi:10.1186/1710-1492-10-22)

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Editor’s comment: The authors found that 80% of the 200 adult patients included in the study had a posterolateral upper arm skin-to-muscle depth =13 mm and 91% had a skin-to-muscle depth >4 mm. Patients receiving SCIT with the standard 13 mm needle length allergy syringe are at risk of receiving injections intramuscularly, which may increase the risk of anaphylaxis.

12. Key role for activin-A in the suppression of allergen-driven T helper (Th) 2 cell responses.

Tousa S, Semitekolou M, Morianos I, Trochoutsou AI and Xanthou G. Activin-A: A new piece in the puzzle of tolerance in asthma. . Clinical Anti-Inflammatory & Anti-Allergy Drugs 2014: 1(1): 45-56. (doi:10.2174/2212703801666140221004020)


Editor’s comment: In a comprehensive review the authors provide an overview of the biology of activin-A and review the recent studies implicating this member of the transforming growth factor beta (TGF-) superfamily in the modulation of experimental and human allergic asthma.

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