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Archives: Medical Journal Reviews

WAO Reviews - Editors' Choice

Posted: July 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. Update on the epidemiology, comorbidities, pathophysiology, current treatment, and future direction of pediatric allergic rhinitis (AR).

Gentile D , Bartholow A, Valovirta E, Scadding G, Skoner D. Current and future directions in pediatric allergic rhinitis. The Journal of Allergy and Clinical Immunology: In Practice, 2013; 1(3): 214-226.

 Full Text, Free

Editor’s comment: In this comprehensive review, the authors conclude that AR is a common pediatric problem that significantly affects sleep, learning, performance, and quality of life. The prevalence of AR is increasing in the pediatric population and is associated with significant morbidity, comorbidities, and complications. In the future, diagnosis will be improved by microarrayed recombinant allergen testing and therapy will be expanded to include emerging treatments such as sublingual immunotherapy and combination products.

2. A new paradigm for asthma pathogenesis.

Holgate ST. Mechanisms of asthma and implications for its prevention and treatment: A personal journey. Allergy, Asthma and Immunology Research, 2013; e174, posted online 25 June.

Full Text, Open Access

Editor’s comment: In this excellent review, the author proposes a new preventative and therapeutic approach to asthma focused on increasing airway resistance to environmental insults rather than suppressing downstream inflammation once it is established.

3. Schnitzler Syndrome: not as rare as previously thought.

Jain T, Offord CP, Kyle R, Dingli D. Schnitzler syndrome – an under diagnosed clinical entity. Haematologica, 2013; published online ahead of print. (doi: 10.3324/haematol.2013.084830)

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Editor’s comment: The authors performed a retrospective search of the dysproteinemia database at Mayo Clinic as well as the medical records of all patients with chronic urticaria to determine the true incidence of the disease. They concluded that Schnitzler Syndrome is under recognized and many patients are deprived of a highly effective therapy as anakinra.

4. Topical calcineurin inhibitors (TCIs) and the theoretical risk of increased malignancy.

Segal AO, Ellis AK, Kim HL. CSACI position statement: safety of topical calcineurin inhibitors in the management of atopic dermatitis in children and adults. Allergy, Asthma and Clinical Immunology, 2013; 9:24. (doi:10.1186/1710-1492-9-24)

Full Text, Open Access

Editor’s comment: The authors concluded that TCIs are effective treatments for atopic dermatitis, and the benefits of their use in the appropriately selected patient population outweigh the theoretical risk of increased malignancy.  The benefits should be carefully weighed against the theoretical risks in advising patients. Long-term studies in progress should further our knowledge of the risk/benefit analysis.

5. Selective cyclooxygenase (COX) 2 inhibitors as an alternative to aspirin and other NSAIDs for patients with aspirin-exacerbated respiratory disease (AERD).

Koschel D, Ninck Weber C, Höffken G. Tolerability to etoricoxib in patients with aspirin-exacerbated respiratory disease. Journal of Investigational Allergology and Clinical Immunology, 2013; 23(4): 275-280.

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Editor’s comment: The authors conducted a retrospective review of patients with suspected aspirin intolerance and found that etoricoxib was tolerated in most but not all patients; therefore, they recommend an oral provocation test before prescribing etoricoxib for patients with AERD.

6. Effect of daily inhaled corticosteroids (ICSs) on the height of children with asthma.

Raissy HH and Blake K. Does use of inhaled corticosteroid for management of asthma in children make them shorter adults? Pediatric Allergy, Immunology and Pulmonology, 2013; 26(2): 99-101. (doi:  10.1089/ped.2013.0244)

Full Text, Free in PubMed

Editor’s comment: The authors discuss the effects of ICSs on the height of children according to the data obtained from the CAMP study and others. They conclude that new data suggest that if growth suppression occurs with the use of ICSs in children, it is sustained, but not cumulative over the years, and the reduction in the final adult height is small and does not outweigh the benefits. This effect may be minimized by use of newer ICSs.

7. Maternal obesity is associated with increased risk of childhood inhaled corticosteroid (ICS) use

Lowe AJ, Ekeus C, Bråbäck L, Rajaleid K, Forsberg B, Hejm A. Impact of maternal obesity on inhaled corticosteroid use in childhood: A registry based analysis of first born children and a sibling pair analysis. PLoS ONE, 2013; 8(6): e67368. (doi:10.1371/journal.pone.0067368)

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Editor’s comment: The authors examined the relationship between maternal Body Mass Index and risk of ICS use (as a proxy for asthma) in Swedish children. They found a clear, dose response relationship between the degree of maternal over-weight and obesity during early pregnancy and the increased risk of asthma in the child.

8. Understanding the mechanisms driving airway remodeling in asthma.

Berair R, Saunders R and Brightling CE. Origins of increased airway smooth muscle mass in asthma. BMC Medicine, 2013; 11:145. (doi:10.1186/1741-7015-11-145)

Full Text, Open Access

Editor’s comment: In this review article the authors explore the natural history of airway remodeling in asthma. They  discuss the possible contribution of progenitors, stem cells and epithelial cells, in the mesenchymal cell changes associated with remodeling, namely the increase in airway smooth muscle hyperplasia seen in  asthmatic airways.

9. Role of eosinophils in the prognosis of patients with drug eruptions.

Yang J, Yang X, Li M. Peripheral blood eosinophil counts predict the prognosis of drug eruptions. Journal of Investigational Allergology and Clinical Immunology, 2013; 23(4): 248-255.

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Editor’s comment: The authors investigated the correlation between circulating eosinophil counts and the prognosis of patients with drug eruption and found that circulating eosinophil counts were positively correlated with severity. Most patients with eosinophilia had poor liver function, prolonged corticosteroid use, and extended hospitalization, indicating more severe disease.

10. Clinical presentations of young children with anaphylaxis.

Dosanjh A. Infant anaphylaxis: the importance of early recognition. Journal of Asthma and Allergy; 2013(6): 103-107. (

Abstract (Open Access, PDF Available)

Editor’s comment: The author highlights the differential clinical presentations of young children with anaphylaxis and concludes that early recognition of the signs and symptoms is crucial to effective diagnosis and treatment, especially among infants 12 months of age or younger who are nonverbal and who may have subtle signs and symptoms of a life-threatening reaction to allergens.

11. Investigating possible risk factors for developing atopic dermatitis (AD).

Giwercman Carson C. Risk factors for developing atopic dermatitis. Danish Medical Journal, 2013; 60(7): B4687.

Full Text PDF, Free (PhD Thesis)

Editor’s comment: This review has been accepted as a thesis together with three previously published papers by University of Copenhagen. The aim was to investigate possible risk factors affecting the development of AD based on data collected as part of the ongoing COPSAC cohort, a longitudinal, prospective birth cohort following 411 children born from mothers with asthma.

12. Review about the influence of cocoa or its flavonoids on the innate and adaptive immunity.

Pérez-Cano FJ, Massot-Cladera M, Franch A, Castellote C, Castell M. The effects of cocoa on the immune system. Frontiers in Pharmacology, 2013; 4(71). (doi:10.3389/fphar.2013.00071)

Full Text, Open Access

Editor’s comment:  A cocoa diet has been shown to influence the immune system in the innate inflammatory response as well as in adaptive immunity. It does so in both systemic and intestinal compartments.

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