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Archives: Medical Journal Reviews

WAO Reviews - Editors' Choice

Posted: November 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. Asthma as a heterogeneous group of conditions.

Martinez FD, Vercelli D. Asthma. The Lancet 2013; 382(9901): 1360-1372. [doi:10.1016/S0140-6736(13)61536-6]


Editor’s comment: In this interesting and comprehensive Asthma Seminar the authors reviewed the literature on asthma since 2002, when the last Lancet Seminar on the disease was published. They performed a non-systematic review of articles giving priority to randomized controlled trials when available, larger studies, and articles published in high-quality journals.

2. The atopic march hypothesis linking atopic dermatitis (AD) as the initial manifestation of atopy with progression to asthma and allergic rhinitis.

Dharmage SC, Lowel AJ, Matheson MC, Burgess JA, Allen KJ, Abramson MJ. Atopic dermatitis and the atopic march revisited. Allergy 2013; published online before print, 14 October. (doi:10.1111/all.12268)

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Editor’s comment: In this excellent review the authors concluded that the atopic march is relevant for counseling the parents of children with AD about the increased risk of developing asthma and allergic rhinitis later in childhood or even adulthood. They identify interventions that can be implemented for primary and secondary prevention.

3. Level of allergy training and the characteristics of the use of immunotherapy in Latin America.

Baena-Cagnani CE, Larenas Linnemann D, Gómez M, González Díaz S, Solé D, Sánchez-Borges M, Bousquet J et al. Allergy training and immunotherapy in Latin America: results of a regional overview. Annals of Allergy, Asthma & Immunology 2013; 111(5): 415-419. (doi:10.1016/j.anai.2013.08.011)


Editor’s comment: The present report is the first document available in the international literature providing a detailed and up-to-date description of the level of allergy training and application of specific immunotherapy in Latin America. The authors include a discussion of the regulatory and legal aspects relating to these topics.

4. Airway dysfunction in elite athletes should be classified as an occupational lung disease.

Price OJ, Ansley L, Menzies-Gow A, Cullinan P, Hull JH. Airway dysfunction in elite athletes – an occupational lung disease? Allergy 2013; 68(11): 1343-1352 (doi:10.1111/all.12265)

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Editor’s comment: In this comprehensive review the authors concluded that evidence is currently sufficient to afford elite athletes the same considerations for their airway health as other individuals with potential and relevant occupational exposures.

5. Potential role of allergy in chronic hyperplastic eosinophilic sinusitis (CHES).

Kennedy JL, Borish L Chronic sinusitis pathophysiology: The role of allergy. American Journal of Rhinology and Allergy 2013; 27(5): 367-371. (doi:10.2500/ajra.2013.27.3906)

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Editor’s comment: This is an interesting review of chronic hyperplastic eosinophilc sinusitis (CHES). The authors discuss this as an inflammatory disease characterized by an “allergic” inflammatory process with prominent eosinophil infiltration. Aeroallergen sensitization in CHES occurs regularly, but the causality between allergen sensitivity, exposure, and disease is unclear. They review the evidence regarding therapeutic efficacy of omalizumab, which has shown promise even in patients without obvious allergen sensitization.

6. Lifetime prevalence and overall characteristics of anaphylaxis in USA.

Wood RA, Camargo CA Jr, Lieberman P, Sampson HA, Schwartz LB, Zitt M, Collins C et al. Anaphylaxis in America: The prevalence and characteristics of anaphylaxis in the United States. Journal of Allergy and Clinical Immunology 2013; published online before print, 21 October. (doi:10.1016/j.jaci.2013.08.016)

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Editor’s comment: Two independent, nationwide, cross-sectional random-digit-dial (RDD) landline telephone surveys were conducted between July and November 2011, using screening questions and standardized questionnaires. The prevalence of anaphylaxis in the general population was at least 1.6% and probably higher. Patients did not appear adequately equipped to deal with future episodes, indicating the need for public health initiatives to improve anaphylaxis recognition and treatment.

7. Systematic review to understand and describe the epidemiology of anaphylaxis and describe how these characteristics vary by person, place and time in Europe.

Panesar SS, Javad S, de Silva D, Nwaru BI, Hickstein L et al. The epidemiology of anaphylaxis in Europe: A systematic review. Allergy 2013; 68(11): 1353-1361. (doi:10.1111/all.12272)

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Editor’s comment: The population-based incidence of anaphylaxis in Europe was estimated at 1.5–7.9 per 100,000 person-years. This review also found that foods, drugs/therapeutic agents, stinging insects, and latex are the most common triggers of anaphylaxis. Overall, the case fatality ratio from anaphylaxis was low, estimated at under 0.0001%.

8. United airway disease in asthma and allergic rhinitis.

Kim YH, Park HB, Kim MJ, Kim HS, Lee HS, Han YK, Kim KW et al. Fractional exhaled nitric oxide and impulse oscillometry in children with allergic rhinitis. Allergy Asthma & Immunology Research 2013; 5(e191), 22 August. (doi:10.4168/aair.2013.5.5.e191)

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Editor’s comment: Children with allergic rhinitis (AR) have mild reversible airway obstruction that can be detected using IOS, in addition to elevated airway inflammation as indicated by higher FeNO. FeNO may be a useful tool for assessing bronchial hyper-responsiveness in AR.

9. No association between blood total maternal 25-hydroxy vitamin D (25[OH]D) concentrations in pregnancy and offspring asthma, atopy and lung function.

Wills AK, Shaheen SO, Granell R, Henderson AJ, Fraser WD, Lawlor DA. Maternal 25-hydroxyvitamin D and its association with childhood atopic outcomes and lung function. Clinical & Experimental Allergy 2013; 43(10): 1180–1188. (doi:10.1111/cea.12172)

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Editor’s comment: There was no evidence to suggest that maternal 25(OH)D concentration in pregnancy was associated with any respiratory or atopic outcome in the offspring. These findings remained after adjustment for season of measurement and for other potential confounders.

10. Previous exacerbations strongly predict future exacerbations in patients with COPD or asthma.

Al-ani S, Spigt M, Hofset P, Melbye H. Predictors of exacerbations of asthma and COPD during one year in primary care. Family Practice 2013; published online 10 October. (doi:10.1093/fampra/cmt055).

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Editor’s comment: In this multicenter prospective cohort study with a 12 months follow-up period, carried out at seven general practice offices in Norway, the authors found that the major determinant of future exacerbations, regardless of lung function, was an exacerbation the previous year, severe enough to be hospitalized or be treated with antibiotics or systemic corticosteroids.

11. Inflammation in asthma and rhinitis and persistence in periods without allergen exposure.

Panzner P, Malkusová I, Vachová M, Liška M, Brodská P, Růžičková O, Malý M. Bronchial inflammation in seasonal allergic rhinitis with or without asthma in relation to natural exposure to pollen allergens. Allergologia et Immunopathologia 2013; 41(5). (doi:10.1016/j.aller.2013.06.009).


Editor’s comment: Persistent inflammation of lower airway in periods without allergen exposure was proven in seasonal asthma by means of both sputum eosinophil count and sputum ECP level. This may have implications for the therapy of seasonal allergic rhinitis with and without asthma in terms of promoting long-term anti-inflammatory treatment.

12. A systematic review about the predictive value of Skin prick test (SPT) and serum-specific IgE levels (sIgE) in development of tolerance in children with a previous diagnosis of peanut, egg and milk allergy.

Peters RL, Gurrin LC, Dharmage SC, Koplin JJ, Allen KJ. The natural history of IgE-mediated food allergy: Can skin prick tests and serum-specific IgE predict the resolution of food allergy? International Journal of Environmental Research and Public Health 2013; 10(10): 5039–5061. (doi:10.3390/ijerph10105039)

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Editor’s comment: The authors concluded that the studies confirm that food allergy is a transient condition for some children and that SPT and sIgE evolve with the progression of the disease. Most studies reported thresholds that increased a patient’s probability of tolerance, but the data on persistence are biased. There is a need for population-based, prospective studies that use the gold standard, oral food challenge (OFC) to diagnose food allergy at baseline, and follow-up to develop SPT and sIgE thresholds that predict the course of food allergy.

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