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Archives: Medical Journal Reviews

WAO Reviews - Editors' Choice

Posted: August 2011

Each month as a service to WAO members and other readers, the editors select recently published articles for their importance to clinicians who care for patients with asthma and allergic/immunologic diseases. Please enjoy this month's selections by Juan Carlos Ivancevich, MD, WAO Web Editor-in-Chief, and Phillip Lieberman, MD, WAO Reviews Editor.

1. The Molecular basis of the histamine H1 receptor antagonist specificity.

Shimamura T, Shiroishi M, Weyand S et al. Structure of the human histamine H1 receptor complex with doxepin. Nature 2011; 475(7354):65-70.

Editor’s comment: Knowing exactly how histamine and histamine antagonists bind to H1 receptors at the molecular level may facilitate the design of "third generation" antihistamines, which have the potential of greater efficacy with reduced side effects.

2. The role of epigenetics in food allergy provides an insight into etiological and biological disease mechanisms.

Tan THT, Ellis JA, Saffery R et al. The role of genetics and environment in the rise of childhood food allergy. Clinical & Experimental Allergy 2011; early view; doi: 10.111/j.1365-2222.2011.03823.x.

Editor’s comment: This is an excellent review of the current state of knowledge of genetic and environmental factors impacting the risk of the development of food allergy. This review summarizes the role that epigenetics plays in this regard.

3. The power of placebo and sham therapy on patients’ perception. There was no difference in patient-rated improvement in response to albuterol versus placebo and sham therapy even though only albuterol improved lung function. 

Wechsler ME, Kelley JM, Boyd IOE et al. Active Albuterol or Placebo, Sham Acupuncture, or No Intervention in Asthma. New England Journal of Medicine 2011; 365(2):119-126.

Editor’s comment: In asthma studies, it's difficult to determine whether responses to placebo treatments are different from the natural physiological changes that occur without treatment. Because of this, there may be a need for the inclusion of an untreated control group in studies of asthma therapies. Albuterol inhaled bronchodilator produces significant and measurable improvement in lung function and provides a good model for the evaluation of placebo effects in asthma.

4. The Contrast Medium Safety Committee of the European Society of Urogenital Radiology reviewed the literature on late adverse reactions to intravascular iodine and updated their guidelines.

Bellin MF, Stacul F, Webb JAW et al. Late adverse reactions to intravascular iodine based contrast media: an update. European Radiology 2011; online first; doi: 10.1007/s00330-011-2200-9.

Editor’s comment: Patch and delayed intradermal tests can be useful to confirm the etiology and possibly the mechanism of production of late skin reactions to contrast medium. These tests may also clarify the patterns of cross-reactivity with between different contrast agents.

5. The systemic inflammatory component in neutrophilic asthma.

Baines KJ, Simpson JL, Woodet LG et al. Systemic upregulation of neutrophil {alpha}-defensins and serine proteases in neutrophilic asthma. Thorax 2011; online first; doi: 10.1136/thx.2010.157719.

Editor’s comment: Evaluation of the systemic inflammatory component of asthmatics may allow the distinction between neutrophilic and other asthma phenotypes and improve our understanding of differing underlying mechanisms.

6. Simultaneous occurrence of two supposedly antagonistic diseases, psoriasis and atopic eczema.

Eyerich S, Onken AT, Weidinger S et al. Mutual Antagonism of T Cells Causing Psoriasis and Atopic Eczema. New England Journal of Medicine 2011; 365(3):231-238.

Editor’s comment: The authors describe 3 patients in which distinct subpopulations of T cells were found to infiltrate the same organ: Th1 and Th17 cells in psoriasis and Th2 cells in atopic eczema.

7. Allergic rhinitis: frequently ignored, underdiagnosed, misdiagnosed, and mistreated.

Greiner AN, Hellings PW, Rotiroti G et al. Allergic rhinitis. The Lancet 22 July 2011; early online publication; doi: 10.1016/S0140-6736(11)60130-X.

Editor’s comment: Excellent, concise and comprehensive review of our current knowledge of allergic rhinitis.

8. Chronic, localized, or even generalized pruritus is the diagnostic hallmark of atopic dermatitis.

Hong J, Buddenkotte J, Berger TG et al. Management of itch in atopic dermatitis. Seminars in Cutaneous Medicine and Surgery 2011; 30(2):71-86.

Editor’s comment: Full review on how we can help our patients with atopic dermatitis control itch.

9. Inhibitory effects of apocynin on pulmonary airway inflammation using a murine model of asthma.

Kim SY, Moon KA, Jo HY et al. Anti-inflammatory effects of apocynin, an inhibitor of NADPH oxidase, in airway inflammation. Immunology and Cell Biology 28 June 2011; advanced online publication; doi: 10.1038/icb.2011.60.

Editor’s comment: Apocynin as an effective inhibitor of NADPH oxidases could be a candidate for the treatment of airway inflammatory lung diseases related to oxidative stress.

10. Current or long-term asthma control to evaluate asthma treatment outcomes.

Koster ES, Raaijmakers JAM, Vijverberg SJH et al. Limited agreement between current and long-term asthma control in children: the PACMAN cohort study. Pediatric Allergy and Immunology 2011; early view; doi: 10.1111/j.1399-3038.2011.01188.x.

Editor’s comment: The congruence between asthma control in the short and long term is limited, so it is important to assess asthma control over a longer period of time both in research and in daily practice.

11. Genetic interactions with sex and its effects on childhood asthma risk.

Loisel DA, Tan Z, Tisler CJ et al. IFNG genotype and sex interact to influence the risk of childhood asthma. Journal of Allergy and Clinical Immunology 2011 28(3):524-531.

Editor’s comment: IFNG polymorphisms are associated with the occurrence of childhood asthma in a sex-specific manner. The effect of these polymorphisms was limited to children who experienced early-life wheezing due to respiratory viral infections.

12. House dust mite extract affects the behavior of bronchial smooth muscle cells of asthma patients.

Miglino N, Roth M, Tamm M et al. House dust mite extract downregulates C/EBPα in asthmatic bronchial smooth muscle cells. European Respiratory Journal 2011; 38(1):50-58.

Editor’s comment:  House dust mite may be able to elicit an inflammatory response and induce remodeling of the airways as a result of a direct action on lung cells, regardless of the immunological compartment.

13. Evaluation of patients with local allergic rhinitis to multiple sensitizing allergens.

Rondón C, Campo P, Herrera R et al.  Nasal allergen provocation test with multiple aeroallergens detects polysensitization in local allergic rhinitis. Journal of Allergy and Clinical Immunology 25 July 2011; online ahead of print; doi: 10.1016/j.jaci.2011.06.012

Editor’s comment: A nasal allergen provocation test using multiple allergens was useful to differentiate between local allergic rhinitis and non-allergic rhinitis and to identify monosensitized and polysensitized patients.

14. Relationship between salivary IgA levels and late-onset wheezing in children.

Sandin A, Björkstén B, Böttcher MF et al. High salivary secretory IgA antibody levels are associated with less late-onset wheezing in IgE-sensitized infants. Pediatric Allergy and Immunology 2011; 22(5):477-481.

Editor’s comment: This study supports a protective effect of salivary IgA antibodies on development of asthmatic symptoms in children.

15. Marked imbalances in the Th1/Th2 and Th17/Treg ratios in patients with allergic asthma.

Shi YH, Shi GCh, Wan HY et al. Coexistence of Th1/Th2 and Th17/Treg imbalances in patients with allergic asthma. Chinese Medical Journal 2011; 124(13):1951-1956.
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Editor’s comment: The authors found an exaggerated response of Th17 cells and a deficiency in Treg cells in patients with moderate to severe allergic asthma. Both severity and asthma control can be affected by the imbalance in Th17/Treg cells.

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