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Archives: Medical Journal Reviews

WAO Reviews - Editors' Choice

Posted: August 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. What is the relationship between allergy and auto-immunity?

Bogiatzi SI, Guillot-Delost M, Cappuccio A, Bichet J-C, Chouchane-Mlik O et al. Multiple-checkpoint inhibition of thymic stromal lymphopoietin-induced TH2 response by TH17-related cytokines. The Journal of Allergy and Clinical Immunology 2012; 130(1): 233-240.e5


Editor's comment: The authors found that TH17-related cytokines are negative regulators of the thymic stromal lymphopoietin response immune pathway. This might explain the decreased frequency of allergy in patients with autoimmunity and suggests new means of manipulating proallergic responses.

2. Is allergen avoidance effective in the first year of life in preventing asthma?

Scott M, Roberts G, Kurukulaaratchy RJ, Matthew S, Novel A, Arshad SH. Multifaceted allergen avoidance during infancy reduces asthma during childhood with the effect persisting until age 18 years. Thorax 2012; doi:10.1136


Editor's comment: The authors demonstrated that a comprehensive allergen-avoidance regimen in high-risk infants during infancy reduced asthma onset during childhood. This is the only primary prevention study of asthma, which shows a positive outcome throughout childhood.

3. World Allergy Organization Guidelines for anaphylaxis

Simons, FER, Ardusso LRF, Bil˛, MB, Dimov V, Ebisawa M et al for the World Allergy Organization. 2012 Update: World Allergy Organization Guidelines for the assessment and management of anaphylaxis. Current Opinion in Allergy & Clinical Immunology 2012; 12(4): 389-399.


Editor's comment: The World Allergy Organization (WAO) Guidelines for the assessment and management of anaphylaxis published in early 2011 provide a global perspective on patient risk factors, triggers, clinical diagnosis, treatment, and prevention of anaphylaxis. Now, the authors reviewed the latest clinically relevant research in these areas.

4. Association between eczema in early childhood and onset of asthma and rhinitis later in life in children

von Kobyletzki LB, Bornehag C-G, Hasselgren M, Larsson M, Lindstr÷m CB, Svensson ┼. Eczema in early childhood is strongly associated with the development of asthma and rhinitis in a prospective cohort. BMC Dermatology 2012; 12:11. Posted July 2012. doi:10.1186/1471-5945-12-11.

Provisional PDF

Editor's comment: This prospective cohort population-based Swedish study found that eczema in early childhood was strongly associated with the development of asthma and rhinitis during the following 5-year period. Eczema was one of the strongest independent risk factors. Children with early onset of eczema, moderate to severe eczema, and persistence of eczema had the highest odds of developing asthma and rhinitis.

5. Recommendations for the diagnosis and management of suspected cow's-milk protein allergy (CMPA) in Europe

Koletzko S, Niggemann B, Arato A, Dias JA, Heuschkel R et al. Diagnostic approach and management of cow's-milk protein allergy in infants and children: ESPGHAN GI Committee Practical Guidelines. Journal of Pediatric Gastroenterology & Nutrition 2012; 55(2): 221-229.


Editor's comment: This guideline presents a practical approach with a diagnostic algorithm and is based on recently published evidence-based guidelines on CMPA. Particular emphasis is placed on gastrointestinal manifestations and the role of diagnostic tools and elimination/challenge procedures.

6. First outcome data on a well characterized cohort of adults with severe refractory asthma

Sweeney J, Brightling CE, Menzies-Gow A, Niven R, Patterson CC, Heane LG, on behalf of the British Thoracic Society Difficult Asthma Network. Clinical management and outcome of refractory asthma in the UK from the British Thoracic Society Difficult Asthma Registry. Thorax 2012; 67(8): 754-756.

Full Text, Open Access

Editor's comment: This audit demonstrates improved outcomes with reduced exacerbation rates and healthcare utilization, but at the cost of increased numbers of subjects on systemic steroids. In omalizumab responders, there is the suggestion of a significant steroid-sparing effect in some but not all subjects.

7. Effects of Respiratory Syncytial Virus (RSV) on different aspects of the immune response

Lotz MT and Stokes Peebles Jr. R. Mechanisms of Respiratory Syncytial Virus Modulation of Airway Immune Responses. Current Allergy and Asthma Reports 2012; 67(8): 754-756. doi:10.1007/s11882-012-0278-z

Full Text, Free

Editor's comment: This open access article reviews the long-lasting effect of RSV via an alteration of the immune response, and the RSV as an indication of inherent differences in an individual's immune system, which leaves it not only vulnerable to serious RSV infection, but also to other, chronic respiratory conditions (e.g., recurrent wheeze and asthma).

8. Key role in atopic dermatitis (AD) development of genetic predisposition and environmental factors including microorganisms

Pastuszka M, Matych M, Kaszuba A, Poznanska-Kurowska K, Kaszuba A. Microorganisms in the etiopathogenesis of atopic dermatitis. Postępy Dermatologii i Alergologii 2012; 29(3): 215-221.

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Editor's comment: The authors reviewed the role of different microorganisms in the etiopathogenesis of AD, including S. aureus, M. species, Candida species and Herpes simplex.

9. Superantigen enterotoxin B (SEB) from S. aureus have a role in the development of atopic march involving IL-17 immunity

Yu J, Oh MH, Park J-U, Myers AC, Dong C, Zhu Z, Zheng T. Epicutaneous Exposure to Staphylococcal Superantigen Enterotoxin B enhances allergic lung inflammation via an IL-17A Dependent Mechanism. PLoS ONE 2012; 7(7): e39032.

Full Text, Open Access

Editor's comment: The findings of this interesting investigation suggest that chronic heavy colonization of enterotoxin producing S. aureus in the skin of patients with atopic dermatitis may have an important role in the development of atopic march via an IL-17A dependent mechanism.

10. Susceptibility to rhinovirus (HRV)-induced wheezing and asthma exacerbations in allergic children

Durrani SR, Montville DJ, Pratt AS, Sahu S, DeVries MK. Innate immune responses to rhinovirus are reduced by the high-affinity IgE receptor in allergic asthmatic children. The Journal of Allergy and Clinical Immunology 2012; 130(2): 489-495.


Editor's comment: The authors have identified a mechanism that might link allergic asthma in childhood to deficient antiviral responses. Increased expression and cross-linking of the high-affinity IgE receptor, FcεRI, before HRV infection inhibits IFN-α and IFN-λ1 secretion from PBMCs.

11. Effect of aerobic exercise on cellular, molecular, and functional measures in adults with mild-moderate asthma

Boyd A, Yang CT, Estelle K, Tuggle C, Gerald LB et al. Feasibility of exercising adults with asthma: a randomized pilot study. Allergy, Asthma & Clinical Immunology 2012; 8:13. doi:10.1186/1710-1492-8-13

Provisional Abstract
Provisional PDF

Editor's comment: Results from this pilot study suggest that aerobic exercise training at a moderate intensity may improve asthma control and fitness levels in the absence of asthma exacerbations in adult asthmatics. Strong adherence to the exercise protocol demonstrates the feasibility of the protocol in preparation for a larger, clinical trial that will test the effects of exercise on the cellular, molecular, and functional outcome measures of the asthmatic response.

12. Available data indicate that omalizumab is an effective and well tolerated drug in antihistamine-resistant chronic urticaria

Metz M, Maurer M. Omalizumab in chronic urticaria. Current Opinion in Allergy & Clinical Immunology 2012; 12(4): 406-411.

Full Text, Free

Editor's comment: This review showed that 50% of patients with chronic spontaneous urticaria and a large proportion of patients with inducible urticarias such as solar or cold urticaria are resistant to standard antihistamine treatment. In these patients, treatment with the monoclonal anti-IgE antibody omalizumab has been found to be a highly effective and well tolerated therapy.

13. 25-hydroxycholesterol (25-HC) affects the release of cytokines and modulates the responses of toll-like receptor 3 (TLR3) in airway epithelial cells

Koarai A, Yanagisawa S, Sugiura H, Ichikawa T, Kikuchi T et al. 25-hydroxycholesterol enhances cytokine release and toll-like receptor 3 response in airway epithelial cells. Respiratory Research 2012; 13: 63. doi:10.1186/1465-9921-13-63

Provisional Abstract
Provisional PDF

Editor's comment: The authors demonstrated that 25-HC stimulated the release of IL-8 and IL-6, mainly via NF-kB pathway, and enhanced the release of IL-8 and IFN-β after stimulation of TLR3 in human airway epithelial cells suggesting that 25-HC may be involved in the neutrophilic airway inflammation.

14. Long-acting beta2 agonists are only one option for children whose asthma is not adequately controlled with inhaled corticosteroids alone

van Asperen PP. Long-acting beta2 agonists for childhood asthma. Australian Prescriber 2012; 35(4): 111-113.

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Editor's comment: The author reviewed the efficacy and safety of long-acting beta2 agonists currently overprescribed in children and concluded that the evidence for their efficacy and safety is limited. There is little evidence that they reduce the risk of severe exacerbations and some evidence that they may actually increase the risk. The regular use of long-acting beta2 agonists may also result in a loss of protection against exercise-induced bronchoconstriction, and the development of tolerance to short-acting beta2 agonists.

15. Understanding the mechanisms of airway tolerance could help to improve the therapy of allergic asthma and lung cancer

Andreev K, Graser A, Maier A, Mousset S, Finotto S. Therapeutical measures to control airway tolerance in asthma and lung cancer. Frontiers in Immunology 2012; 3(216). doi:0.3389/fimmu.2012.00216

Full Text, Free

Editor's comment: This review updates current understandings on the effect of the cytokines TGF-β, IL-10, and IL-17A on the lung immune responses to antigen, and it analyzes their involvement in allergic asthma and lung cancer.

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