Medical Journal Review
December 2015
WAO Reviews - Editors' Choice
The Editors select articles for their importance to clinicians who care for patients with asthma and allergic/immunologic diseases, and whenever possible they seek articles that everyone can access freely. The Editors' Choice comes to you each month from Juan Carlos Ivancevich, MD, WAO Web Editor-in-Chief, and summary author, John J. Oppenheimer, MD, FACAAI, FAAAAI, WAO Reviews Editor.
1. Childhood asthma prediction models- a systematic review.
Smit HA, Pinart M , Antó JM, Keil T, Bousquet J et al. Childhood asthma prediction models: a systematic review. The Lancet Respiratory Medicine 2015; 3(12): 973-984. (doi:10.1016/S2213-2600(15)00428-2)
For those caring for young children with potential asthma, we are all clamoring for an early indicator of children at risk of developing asthma at school. Unfortunately, presently the usefulness of childhood asthma prediction models in clinical practice is still unclear. To better understand this issue, the authors systematically reviewed all existing prediction models to identify preschool children with asthma-like symptoms at risk of developing asthma at school age. The authors found 12 prediction models in four types of cohorts of preschool children: those with health-care visits, those with parent-reported symptoms, those at high risk of asthma, or children in the general population. They identified four “basic models” which included non-invasive, and easy-to-obtain predictors (family history, allergic disease comorbidities or precursors of asthma, and severity of early symptoms). They also identified eight extended models, which included additional clinical tests, most often associated with specific IgE determination. Overall, they found that some models could better predict asthma development, while other models could better rule out asthma development. Sadly, the predictive performance of no single model stood out in both aspects simultaneously. They thus concluded that there are a large proportion of preschool children with wheeze for which prediction of asthma development is “difficult”.
2. Exposure to air pollution and development of asthma and rhinoconjunctivitis.
Gehring U, Wijga AH, Hoek G, Bellander T, Berdel D et al. Exposure to air pollution and development of asthma and rhinoconjunctivitis throughout childhood and adolescence: a population-based birth cohort study. The Lancet Respiratory Medicine 2015; 2(12): 933-942. (doi:10.1016/S2213-2600(15)00426-9)
Although prior studies have demonstrated an effect of air pollution on asthma and rhino-conjunctivitis throughout early and middle childhood, the role of exposure to air pollution in the development of childhood and adolescent asthma as well as rhino-conjunctivitis is unclear. Thus, the authors examined the longitudinal association between exposure to air pollution and development of asthma and rhino-conjunctivitis throughout childhood and adolescence via a population-based birth cohort study of 14,126 participants from four prospective European birth cohort studies. The authors found that overall, the risk of incident asthma up to age 14–16 years increased with increasing exposure to NO2 (adjusted meta-analysis odds ratio [OR] 1•13 per 10 μg/m³ [95% CI 1•02–1•25]) and PM2•5 absorbance (1•29 per 1 unit [1•00–1•66]) at the birth address. They further found that these associations with asthma were more consistent after age 4 years compared to before that age. Interestingly they found that there was no indication of an adverse effect of air pollution on rhino-conjunctivitis. The authors conclude that reduction in the levels of air pollution could help to prevent the development of asthma in children.
3. Guidelines on the management of IgE-mediated food allergies
Worm M, Reese I, Ballmer-Weber B, Beyer K, Bischoff SC et al. Guidelines on the management of IgE-mediated food allergies. Allergo Journal International 2015; 24(7): 256-293. (doi:10.1007/s40629-015-0074-0)
An interdisciplinary panel of German-speaking experts, through an extensive systematic literature review, developed this evidence-based guideline on the management of IgE-mediated food allergies. This is a very well written and referenced document, exploring the epidemiology, prevention, diagnosis and treatment of food allergy. The latter section is dedicated to gaps and important areas of research, stressing the recent literature regarding immunotherapy.
4. House dust mite respiratory allergy: an overview of current therapeutic strategies
Calderón MA, Kleine-Tebbe J, Linneberg A, De Blay F, Fernandez de Rojas DH, Virchow JC, Demoly P. House dust mite respiratory allergy: An overview of current therapeutic strategies. JACI: In Practice 2015; 3(6): 843-855. (doi: 10.1016/j.jaip.2015.06.019)
Despite the fact that house dust mite (HDM) allergy is a major cause of respiratory allergic disease, there remain many unresolved challenges regarding both the specific diagnosis as well as effective treatment of this allergen. To better understand the literature regarding diagnosis, treatment and knowledge gaps concerning this allergen and its impact on allergic rhinitis and asthma, this multinational group of authors performed an extensive literature search regarding this topic. They concluded that there was need for improvement in the diagnosis, demonstrating a paucity of data regarding avoidance maneuvers, as well as pharmacotherapy. Furthermore, they noted there was a need for deeper knowledge among physicians regarding the extent and impact of HDM allergy in respiratory disease. In the case of diagnosis they felt further development and standardization of access to molecular allergy diagnosis was needed. They also stressed the need for robust, better designed clinical trials to explore the utility of allergy-specific approaches.
5. MACVIA-ARIA Sentinel NetworK for allergic rhinitis (MASK-rhinitis): the new generation guideline implementation
Bousquet J, Schunemann HJ, Fonseca J, Samolinski B, Bachert C et al. MACVIA-ARIA Sentinel NetworK for allergic rhinitis (MASK-rhinitis): the new generation guideline implementation. Allergy 2015; 70(11): 1372-1392. (doi:10.1111/all.12686)
Several unmet needs have been identified in allergic rhinitis, including: attaining optimal control of rhinitis and comorbidities, patient stratification, implementation of a multidisciplinary team for integrated care pathways, innovation in clinical trials and, above all, patient empowerment. In this document, MASK-rhinitis (MACVIA-ARIA Sentinel NetworK for allergic rhinitis) the authors develop a simple system centered on the patient. Their ultimate goal was to devise a plan to fill many of these gaps using Information and Communications Technology (ICT) tools and a clinical decision support system based on the ARIA 2015 guideline. It relies on three tools used for the electronic monitoring of allergic diseases: a cell phone-based daily visual analogue scale assessment of disease control, the Control of Allergic Rhinitis and Asthma Test and e-Allergy screening (premedical system of early diagnosis of allergy and asthma based on online tools). It is hoped that this will be a global and integrated ICT answer for many of the unmet needs in allergic diseases which will result in improved policies and standards.
