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Medical Journal Review

February 2015

WAO Reviews - Editors' Choice

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. Development of allergies and asthma is not related to cleaning activities.

Weber J, Illi S, Nowak D, Schierl R, Holst O, von Mutius E, and Ege MJ. Asthma and the Hygiene Hypothesis – Does cleanliness matter? American Journal of Respiratory and Critical Care Medicine 2015; published online before print, 13 January. (doi:10.1164/rccm.201410-1899OC)


Editor’s comment: The authors concluded that neither personal nor home cleanliness were associated with protection from asthma and allergies. Other microbial components in house dust not affected by personal hygiene are likely to play a role.

2. Sensitization to aminopenicillin may develop within infectious mononucleosis.

Ónodi-Nagy K, Kinyó A, Meszes A, Garaczi E, Kemény L, and Bata-Csörgo Z. Amoxicillin rash in patients with infectious mononucleosis: evidence of true drug sensitization. Allergy, Asthma & Clinical Immunology 2015; 11(1). (doi:10.1186/1710-1492-11-1)

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Editor’s comment: The aim of this study was to determine whether true amoxicillin sensitization could develop in patients with infectious mononucleosis who developed maculopapular exanthems following treatment with aminopenicillin. Like other infectious illnesses, they found that drug sensitization can indeed occur during the infection. Lastly, they demonstrate that in vitro testing is not sensitive enough in determining drug sensitization to penicillin but could be confirmed with skin testing.

3. Biologic medications in asthma and allergic disease.

Fajt, ML and Wenzel SE. Asthma phenotypes and the use of biologic medications in asthma and allergic disease: The next steps toward personalized care. Journal of Allergy and Clinical Immunology 2015; 135(2): 299-301. (doi:

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Editor’s comment: This review analyzes randomized double-blind, placebo-controlled trials of molecularly targeted therapies in defined allergic disease and asthma phenotypes and shows that therapies targeting the canonical type 2 cytokines IL-4, IL-5, and IL-13 show consistent efficacy, especially in asthmatic patients with evidence of TH2/type 2 inflammation.

4. Opportunities and challenges that have arisen from electronic health records (EHRs).

Kuhn T, Basch P, Barr M, and Yackel T. Clinical Documentation in the 21st Century: Executive Summary of a Policy Position Paper from the American College of Physicians. Annals of Internal Medicine 2015; published online before print, 13 January. (doi:10.7326/M14-2128)

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Editor’s comment: In this document, the Medical Informatics Committee of the American College of Physicians review the literature regarding clinical documentation, in an effort to clarify the broad range of issues surrounding clinical documentation, and they suggest a path forward, such that care and clinical documentation in the 21st century will “best serve” the needs of our patients.

5. New clinical practice guideline on allergic rhinitis.

Seidman MD, Gurgel RK, Lin SY, Schwartz SR, Baroody FM et al. Clinical Practice Guideline: Allergic Rhinitis. Otolaryngology – Head and Neck Surgery 2015; 152(1): S1-S43. (doi:10.1177/0194599814561600)

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Editor’s comment: Following an extensive evidence-based review of the literature, a multidisciplinary panel of 21 experts created a series of actionable recommendations regarding the evaluation and treatment of allergic rhinitis.

6. Use of human tissue studies to provide more relevant models for asthma research.

Edwards J, Belvisi M, Dahlen SE, Holgate S, and Holmes A. Audit, research and guideline update. Human tissue models for a human disease: what are the barriers? Thorax 2015; published online before print, 28 January. (doi:10.1136/thoraxjnl-2014-206648)

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Editor’s comment: This survey illustrates the views of a representative proportion of the asthma research community. It provides important evidence that a more concerted effort is needed to support asthma researchers in adopting human tissue-based approaches. Many barriers exist to this, and some of these may be more easily overcome than others, but the potential benefits to the science base, drug development and the 3Rs (the replacement, reduction, and refinement of animals in research) are many, and this reinforces the importance of consensus.

7. The aim of PRISMA-P 2015 is to improve the quality of systematic review protocols.

Moher D, Shamseer L, Clarke M, Ghersi D, Liberati A et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Systematic Reviews 2015; 4:1. (doi:10.1186/2046-4053-4-1)

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Editor’s comment:  Journals, granting agencies, and systematic review organizations are encouraged to endorse PRISMA-P 2015 in their “Instructions to Authors” and guidance for applicants and to implement its use during their peer review process of systematic review proposals. Reviewers are encouraged to use the PRISMA-P checklist and Explanation and Elaboration document to guide them through the documentation of a protocol.

8. Reducing the risk of accidental peanut exposure.

Watson WTA, Woodrow AM and Stadnyk AW. Removal of peanut allergen Ara h 1 from common hospital surfaces, toys and books using standard cleaning methods. Allergy, Asthma & Clinical Immunology 2015; 11:4. (doi:10.1186/s13223-015-0069)

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Editor’s comment: The authors concluded that simple but thorough cleaning of toys, books, and surfaces of many items that could be found in a hospital using common household or hospital cleaning wipes will remove the peanut allergen Ara h 1. This data should reduce concern in families of children with peanut allergy when they leave their home environment.

9. Relationships between allergic rhinitis and obstructive sleep apnea.

Chirakalwasan N, Ruxrungtham K. The linkage of allergic rhinitis and obstructive sleep apnea. Asian Pacific Journal of Allergy and Immunology 2014; 32(4): 276-286.

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Editor’s comment: The authors reviewed relationships between allergic rhinitis and obstructive sleep apnea – their pathogenesis as well as the impact of allergic rhinitis treatment on obstructive sleep apnea.

10. CARAT is a valid and reliable tool to monitor control of asthma and allergic rhinitis.

van der Leeuw S, van der Molen T, Dekhuijzen PNR, Fonseca JA, van Gemert FA et al. The minimal clinically important difference of the control of allergic rhinitis and asthma test (CARAT): Cross-cultural validation and relation with pollen counts. NPJ Primary Care Respiratory Medicine 2014; 25: 14107.  (doi:10.1038/npjpcrm.2014.107)

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Editor’s comment: The authors established the minimal clinically important difference (MCID) for the interpretation of CARAT scores and evaluated the internal consistency, cross-sectional validity, longitudinal validity and test–retest reliability for the Dutch CARAT version. They concluded that CARAT is a reliable tool that is applicable to the Dutch population with a MCID of 4 points.

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