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Archives: Medical Journal Reviews

WAO Reviews - Editors' Choice

August 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 John J. Oppenheimer, MD - FACAAI - FAAAAI, WAO Reviews Editor.

1. Estimating the socio-economic costs of allergic diseases to the European Union.

Zuberbier T, Lötvall J, Simoens S, Subramanian SV, and Church MK. Economic burden of inadequate management of allergic diseases in the European Union: a GA2LEN review. Allergy 2014, published online ahead of print 1 August. (doi:10.1111/all.12470)

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Editor’s comment:  The authors explored the published literature and online statistical information from Eurostat and Eurofound to assess the costs of allergic disease to society. They found that for the EU, avoidable indirect costs per patient who were insufficiently treated for allergy range between €55 and €151 billion per annum, largely as a consequence of absenteeism and presenteeism. These indirect costs translate to €2405 per untreated patient per year and reinforce the importance of treatment of allergic illness.

2. Factors that contribute to an increased risk of osteoporosis/osteopenia in patients with asthma.

Aljubran SA, Whelan GJ, Glaum MC and Lockey RF. Osteoporosis in the at-risk asthmatic. Allergy 2014, published online before print 21 July. (doi:10.1111/all/12438)

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Editor’s comment: This comprehensive review discusses factors that contribute to an increased risk of osteoporosis/osteopenia in patients with asthma and provides evidence-based recommendations for diagnosis, prevention and its treatment.

3. Novel therapeutic agents and strategies for hereditary and acquired angioedema.

Bork K. An evidence based therapeutic approach to hereditary and acquired angioedema.  Current Opinion in Allergy & Clinical Immunology 2014; 14(4): 354 – 362. (doi:10.1097/ACI.0000000000000082)


Editor’s comment: In light of the recent development of new medications to treat angioedema, the author reviewed these new strategies to provide an evidence based approach to preventing as well as treating acute attacks.

4. Examining deaths caused by anaphylaxis.

Xu YS, Kastner M, Harada L, Xu A, Salter J, and Waserman S. Anaphylaxis-related deaths in Ontario: a retrospective review of cases from 1986 to 2011. Allergy, Asthma & Clinical Immunology 2014; 10:38. 26 July 2014 (doi:10.1186/1710-1492-10-38)

Provisional Text, Open Access

Editor’s comment: In this article, the authors reviewed all causes of anaphylaxis-related deaths using data from the Ontario Coroner's database and found a decline in the frequency of food-related deaths but an increase in iatrogenic causes between 1986 and 2011. They also found that factors associated with fatal anaphylaxis included delayed epinephrine administration, asthma, allergy to peanut, food ingestion outside the home, and teenagers with food allergies.

5. Lung function in bronchial asthma: new perspectives.

Papa GFS, Pellegrino GM and Pellegrino R. Asthma and respiratory physiology: putting lung function into perspective. Respirology 2014, published online before print 24 July. (doi:10.1111/res.12355)

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Editor’s comment: To improve our knowledge regarding the pathogenesis of asthma, the authors explored the literature regarding the role of airway smooth muscle, specifically examining topographical/patchy ventilation, volume, and time domains of the lung.  They conclude that the airway smooth muscle likely plays an important role in asthma and that the use of the forced oscillation and multiple breath nitrogen washout may, alone or in combination,  help address questions unsolvable until now.

6. BCG vaccination protects against Mycobacterium tuberculosis infection as assessed by interferon γ release assays in children.

Roy A, Eisenhut M, Harris RJ, Rodrigues LC, Sridhar S et al.  Effect of BCG vaccination against Mycobacterium tuberculosis infection in children: systematic review and meta-analysis. BMJ 2014; 349:g4643. (5 August 2014) (doi:

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Editor’s comment: Via performing a systematic review and meta-analysis (which included 14 studies with 3855 participants), the authors concluded that BCG protects against M tuberculosis infection as well as progression from infection to disease.

7. Dupilumab: marked and rapid improvement in atopic dermatitis.

Beck LA, Thaçi D, Hamilton JD, Graham NM, Bieber T et al. Dupilumab treatment in adults with moderate-to-severe atopic dermatitis. New England Journal of Medicine 2014;371:130-139. (doi.10.1056/NEJMoa1214768)


Editor’s comment:

The authors performed a randomized, double-blind, placebo-controlled trial involving adults with moderate-to-severe atopic dermatitis with dupilumab, a fully human monoclonal antibody that blocks interleukin-4 and interleukin-13 as monotherapy. They found dupilumab demonstrated marked and rapid improvement in all the evaluated measures of disease activity.

8. Understanding the role played by microbes in airways disease.

Rogers GB, Shaw D, Marsh RL, Carroll MP, Serisier DJ, Bruce KD. Respiratory microbiota: addressing clinical questions, informing clinical practice. Thorax 2014, published online before print 17 July. (doi:10.1136/thoraxjnl-2014-205826)

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Editor’s comment: The authors provide an excellent review of the microbiota research in the context of respiratory disease, highlighting how best to design, execute, and interpret these studies. They further note that our present understanding of the respiratory microbiota both challenges fundamental assumptions and provides novel clinical insights into lung disease.

9. Effect of atopic conditions on the risk of microbial infections.

Juhn, YJ. Risks for infection in patients with asthma (or other atopic conditions): is asthma more than a chronic airway disease? Journal of Allergy and Clinical Immunology 2014;134(2):247-257. (doi:

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Editor’s comment: Presently there has been a great deal of research exploring the impact of infection on asthma; however, there are also limited data that the presence of asthma can influence patients’ susceptibility to infections. In the article, the authors examine this literature and find a great deal of controversy. Their overall conclusions are that improved understanding of the effects of asthma or other atopic conditions on the risk of microbial infections will bring important and new perspectives to clinical practice, research, and public health concerning atopic conditions and that research efforts regarding the causes and effects of asthma must be juxtaposed because they are likely to guide each other.

10. Use of the Asthma Control Questionnaire (ACQ) as an endpoint in clinical trials.

Barnes PJ, Casale TB, Dahl R, Pavord ID, and Wechsler ME. The Asthma Control Questionnaire as a clinical trial endpoint: past experience and recommendations for future use. Allergy 2014;69(9):1119-1140. (doi:10.1111/all.12415)

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Editor’s comment: This analysis provides a summary of the use of the Asthma Control Questionnaire (ACQ) in phase II, III, and IV asthma trials. Comparisons between the ACQ and other instruments are also presented. The authors’ analysis suggests that the ACQ is a valid and robust measure for use as a primary or secondary endpoint in future clinical trials.

11. Scientific history of spacer devices.

Nikander K, Nicholls C, Denyer J, and Prichard J. The evolution of spacers and valved holding chambers. Journal of Aerosol Medicine and Pulmonary Drug Delivery 2014; 27(S1):s4-s23. (doi:10.1089/jamp.2013.1076).

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Editor’s comment: This paper provides a review of the clinical and laboratory evidence and commercial developments, with enjoyable anecdotes regarding the evolution of spacers, from their origins, up to the present day.

12. Efficacy and safety of sublingual immunotherapy (SLIT) with birch allergens.

Klimek L, Sperl A, van Twuijver E, van Ree R, Kleinjans H, Boot JD, and Pfaar O. A prospective study comparing the efficacy and safety of two sublingual birch allergen preparations. Clinical and Translational Allergy 2014; 4:23. (doi:10.1186/2045-7022-4-23)

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Editor’s comment: The authors report on a prospective, randomized, open, blinded endpoint, controlled, single-center study in 74 birch allergic adults comparing two different preparations of SLIT to Birch (SUBLIVAC FIX Birch10,000 AUN/ml vs. Staloral Birch initial phase 10 I.R./ml and maintenance phase 300 I.R./ml). They found both preparations to be effective as manifest by improvement in threshold dose of nasal provocation with good safety profiles

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