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Archives: Medical Journal Reviews

WAO Reviews - Editors' Choice

Posted: September 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. Adjusting inhaled corticosteroid therapy in patients with asthma

Calhoun WJ, Ameredes BT, King TS, Icitovic N, Bleecker ER et al, for the Asthma Clinical Research Network of the National Heart, Lung, and Blood Institute. Comparison of physician-, biomarker-, and symptom-based strategies for adjustment of inhaled corticosteroid therapy in adults with asthma. The BASALT randomized controlled trial. JAMA 2012; 38(10): 987-997. (doi:10.1001/2012.jama.10893)

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Editor's comment:The Best Adjustment Strategy for Asthma in the Long Term (BASALT) trial was conducted to determine if adjustment of inhaled corticosteroid therapy based on exhaled nitric oxide or day-to-day symptoms is superior to guideline-informed, physician assessment-based adjustment in preventing treatment failure in adults with mild to moderate asthma. The authors found that among adults with asthma controlled with low-dose inhaled corticosteroid therapy, the time to treatment failure was not significantly different among patients who received corticosteroid dose adjustment based on physician assessment, a biomarker, or symptom occurrence.

2. Association between pet keeping and asthma and allergies

Lødrup Carlsen KC, Roll S, Carlsen K-H, Mowinckel P, Wijga AH et al, as part of the GA2LEN WP 1.5 'Birth Cohorts' working group. Does pet ownership in infancy lead to asthma or allergy at school age? Pooled analysis of individual participant data from 11 European birth cohorts. PLoS ONE 2012; 7(8): e43214. (doi:10.1371/journal.pone.0043214)

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Editor's comment:Through a pooled analysis of individual participant data of 11 prospective European birth cohorts that recruited a total of over 22,000 children in the 1990s, the authors examined the associations between pet keeping in early childhood and asthma and allergies in children aged 6-10 years. They concluded that pet ownership in early life did not appear to either increase or reduce the risk of asthma or allergic rhinitis symptoms in children.

3. Patients with severe and uncontrolled chronic urticaria should be evaluated for metabolic syndrome

Ye YM, Jin HJ, Hwang EK et al. Co-existence of chronic urticaria and metabolic syndrome: Clinical implications. Acta Dermato Venereologica 2012; 92, published online before print 4 September. (doi:10.2340/00015555-1443)

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Editor's comment:To investigate the prevalence and clinical impact of the metabolic syndrome in patients with chronic urticaria, the authors performed a hospital-based cross-sectional study of 131 patients. 29.8% had metabolic syndrome compared to 17.8% in a matched control group. Patients with chronic urticaria and metabolic syndrome were older, had a higher mean urticaria activity score and serum levels of eosinophil cationic protein, tumor necrosis factor-α, and complement, and showed a higher rate of negative autologous serum skin tests than those without metabolic syndrome.

4. Allergen immunotherapy might result in the production of high-affinity allergen-specific blocking IgG4

James LK, Bowen H, Calvert RA, Dodev TS, Shamji MH et al. Allergen specificity of IgG4-expressing B cells in patients with grass pollen allergy undergoing immunotherapy. The Journal of Allergy and Clinical Immunology 2012; 130(3): 663-670.e3. (doi:10.1016/j.jaci.2012.04.006)


Editor's comment:The authors identified an IgG4 induced during immunotherapy that binds with extremely high affinity to grass pollen allergen and found that this single specific monoclonal antibody can block IgE-mediated facilitated allergen presentation, as well as IgE-mediated basophil activation.

5. Many disease and non-disease related factors affect the fraction of exhaled nitric oxide (FeNO) levels

Jartti T, Wendelin-Saarenhovi M, Heinonen I, Hartiala J, Vanto T. Childhood asthma management guided by repeated FeNO measurements: a meta-analysis. Paediatric Respiratory Reviews 2012; 13(3): 178-183. (doi:10.1016/j.prrv.2011.11.002)


Editor's comment:The authors performed a meta-analysis to assess the clinical value of FeNO in paediatric asthma management. Their data suggest that utilizing FeNO to tailor the dose of inhaled corticosteroids in children cannot be recommended for routine clinical practice because many disease and non-disease related factors (most importantly atopy, height/age and infection) affect FeNO levels which can easily confound the interpretation.

6. Relationship between domestic endotoxin and asthma or wheeze among rural school-aged children

Lawson JA, Dosman JA, Rennie DC, Beach JR, Newman SC, Crowe T, Senthilselvanet A. Endotoxin as a determinant of asthma and wheeze among rural dwelling children and adolescents: A case--control study. BMC Pulmonary Medicine 2012; 12:56. (doi:10.1186/1471-2466-12-56)

Provisional PDF, Open Access

Editor's comment:The authors conducted a case-control study of children 6-18 years in the rural region of Humboldt, Canada, to study the relationship between domestic endotoxin and asthma or wheeze among rural school-aged children (6-18 years) and assessed the interaction between endotoxin and these outcomes. The results suggest that endotoxin exposure might be protective for asthma or wheeze in younger school-aged children, and this protection may be more effective earlier in life.

7. Is it possible to desensitize patients allergic to latex?

Nettis E, Delle Donne P, Di Leo E, Fantini P, Passalacquaet G et al. Latex immunotherapy: state of the art. Annals of Allergy, Asthma & Immunology 2012; 109(3): 160-165. (doi:10.1016/j.anai.2012.07.004)


Editor's comment:The authors conducted a systematic review on the treatment of latex allergy with subcutaneous (SCIT) or sublingual (SLIT) immunotherapy selecting 11 clinical trials (3 with SCIT and 8 with SLIT) from literature databases (PubMed, Embase, Google Scholar). They concluded that at least SLIT may represent a valuable option to be used in selected patients, with severe symptoms, and who cannot avoid latex.

8. A 12-week treatment with daily, oral montelukast in children with nonsevere obstructive sleep apnea (OSA)

Goldbart AD, Greenberg-Dotan S, Tal A. Montelukast for children with obstructive sleep apnea: A double-blind, placebo-controlled study. Pediatrics 2012; 130(3): e575-580, published online ahead of print August 6. (doi:10.1542/peds.2012-0310)


Editor's comment:The authors found that montelukast effectively reduced polysomnographic findings, symptoms, and the size of the adenoidal tissue in children with nonsevere OSA. The findings support the potential of a leukotriene modifier as a novel, safe, noninvasive alternative for children with mild to moderate OSA.

9. Impact of saline nasal irrigation (SNI) on symptoms of allergic rhinitis (AR)

Hermelingmeier, KE, Weber RK, Hellmich M, Heubach CP, Mösges R. Nasal irrigation as an adjunctive treatment in allergic rhinitis: A systematic review and meta-analysis. American Journal of Rhinology & Allergy 2012; 26(5): e119-125(7). (doi:10.2500/ajra.2012.26.3787)

Abstract (Click on PDF for free full text.)

Editor's comment:The authors conducted a systematic literature analysis and a meta-analysis of relevant publications to verify the effectiveness of SNI in AR based on the criteria of evidence-based medicine. They concluded that SNI using isotonic solution could be recommended as complementary therapy in AR. It is well tolerated, inexpensive, easy to use, and there is no evidence showing that regular, daily SNI adversely affects the patient's health or causes unexpected side effects.

10. Antibody response to antigenic challenge with vaccines can provide substantive insight into the status of human immune function

Orange JS, Ballow M, Stiehm ER, Ballas ZK, Chinen J et al. Use and interpretation of diagnostic vaccination in primary immunodeficiency: A working group report of the Basic and Clinical Immunology Interest Section of the American Academy of Allergy, Asthma & Immunology. The Journal of Allergy and Clinical Immunology 2012; 130(3): S1-S24 (doi:10.1016/j.jaci.2012.07.002)

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Editor's comment:This document represents an attempt of a working group of the American Academy of Allergy, Asthma & Immunology to provide further guidance and synthesis in this use of vaccination for diagnostic purposes in consideration of primary immunodeficiency diseases, as well as to identify key areas for further research.

11. Increasing understanding of systemic mast cell activation disease pathophysiology

Haenisch B, Nöthen MN, Molderings GJ. Systemic mast cell activation disease: the role of molecular genetic alterations in pathogenesis, heritability, and diagnostics. Immunology 2012; Accepted Article, 7 September. (doi:10.1111/j.1365-2567.2012.03627.x)

Accepted Article, Full Text, Free

Editor's comment:This interesting article on the topic of systemic mast cell activation disease (MCAD) reviews molecular genetic research into the identification of disease-associated genes and their mutational alterations. It also presents novel data on familial systemic mast cell activation disease and reviews the associated literature.

12. Cockroach is a source of inhalant allergens in allergic rhinitis and asthma

Sohn MH, Kim KE. The cockroach and allergic diseases. Allergy Asthma Et Immunology Research 2012; 4(5): 264-269. (doi:10.4168/aair.2012.4.5.264)

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Editor's comment:This excellent review describes the demographics of cockroach exposure and sensitization, characteristics of cockroach allergens, and inflammatory responses against cockroach allergens initiated through protease-dependent pathways.

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