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Medical Journal Review

January 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. Volatile organic compounds defining adult asthma endotypes.

Meyer N, Dallinga JW, Nuss SJ, Moonen EJC, van Berkel JJBN et al. Defining adult asthma endotypes by clinical features and patterns of volatile organic compounds in exhaled air. Respiratory Research 2014; 15(136). (doi:10.1186/s12931-014-0136-8)

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Editor’s comment: The authors found that 16 volatile organic compounds (VOCs) from the exhaled air of subjects with or without asthma could distinguish between healthy and asthma subjects with a sensitivity of 100% and a specificity of 91.1%. It is presumed that these VOCs which are released during inflammation in response to oxidative stress as a result of activated leukocytes in the airways may further aid in the classification of asthma subtypes.

2. No absolute contraindication to administration of epinephrine in the setting of anaphylaxis.

Campbell RL, Li JTC, Nicklas RA, and Sadosty AT. Emergency department diagnosis and treatment of anaphylaxis: a practice parameter. Annals of Allergy, Asthma & Immunology 2014; 113(6): 599-608. (doi:

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Editor’s comment: This practice parameter is a joint effort between emergency physicians who are often on the front line in the management of anaphylaxis, and allergists-immunologists who have a vested interest in how allergic patients are managed. This document reinforced that groups agree that the timely administration of epinephrine is essential for the effective treatment of anaphylaxis.

3. Decreasing the risk of side effects and increasing efficacy of allergen immunotherapy.

Jongejan L, van Ree R. Modified allergens and their potential to treat allergic disease. Current Allergy and Asthma Reports 2014; 14: 478. (doi:10.1007/s11882-014-0478-9)


Editor’s comment: In this review the authors summarize the recent advances regarding allergen modifications as well as new adjuvants for the treatment of allergic disease. They analyzed recombinant hypo-allergens, peptides, fusion proteins, and different routes of administration as well as the addition of new adjuvants that attempt to skew the immune system from a Th2 towards a Th1 or regulatory T cell phenotype.

4. Climate change and the increase of allergic and asthmatic symptoms through changes in pollen biology.

Albertine JM, Manning WJ, DaCosta M, Stinson KA, Muilenberg ML, and Rogers CA. Projected carbon dioxide to increase grass pollen and allergen exposure despite higher ozone levels.  PLOS One 2014; 9(11): e111712. (doi:10.1371/journal.pone.0111712)

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Editor’s comment: The results obtained through an experimental model of escalated levels of CO2 and O3 (165–202%) (felt to be in line with potential future levels) demonstrate significant increases in grass pollen production. Due to the widespread existence of grasses and their importance in eliciting allergic responses, these results indicate there will likely be a significant impact on human health worldwide as a result of future climate change.

5. Aberrations in the gut microbiome and intestinal homeostasis have multisystem effects.

West CE, Renz H, Jenmalm MC, Kozyrskyj AL, Allen KJ et al. The gut microbiota and inflammatory noncommunicable diseases: associations and potentials for gut microbiota therapies. Journal of Allergy and Clinical Immunology 2015; 125(1): 3-13. (doi:

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Editor’s comment: The authors reviewed the impact of microbial composition that is implicated in the increasing prevalence of inflammatory diseases, including: allergic disease, asthma, inflammatory bowel disease, obesity, and associated noncommunicable diseases.

6. Adverse effects of air pollution on atopic dermatitis (AD).

Ahn K. The role of air pollutants in atopic dermatitis. Journal of Allergy and Clinical Immunology 2014; 134(5): 993-999. (doi:


Editor’s comment: This review highlights epidemiologic and experimental data regarding the role of air pollution in patients with atopic dermatitis (AD). Recent evidence suggests that a variety of air pollutants, including environmental tobacco smoke, volatile organic compounds, formaldehyde, toluene, nitrogen dioxide, and particulate matter, may act as risk factors for the development or aggravation of AD.

7. First-line symptomatic therapy for chronic urticaria in children.

Fortina AB and Fontana E. Update on antihistamine treatment for chronic urticaria in children. Current Treatment Options in Allergy 2014; 1(3): 287-298. (10.1007/s40521-014-0023-z)

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Editor’s comment: The authors reviewed the long-term safety and efficacy of second-generation H1-antihistamines in children 6 months to 12 years of age. The agents examined, included: cetirizine, levocetirizine, loratadine, fexofenadine, desloratadine, and rupatadine.

8. Allergies and asthma are the result of complex gene-environment interactions.

Harb H and Renz H. Update on epigenetics in allergic disease. Journal of Allergy and Clinical Immunology 2015; 135(1): 15-24. (doi:

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Editor’s comment: In this review, the authors examine a growing literature regarding gene-environment interactions, specifically exploring the potential impact of environmental trigger factors such as allergens, microbes and microbial compounds, dietary factors, obesity, and stress on biochemical mechanisms resulting in chronic inflammatory illnesses such as allergy and asthma.

9. Significant improvement in knowledge about inhalation therapy in professionals using digital media for education.

Velasco HF, Cabral CZ, Pinheiro PB, Azambuja RdCA, Vitola LS, de Costa MR, and Amantéa SL. Use of digital media for the education of health professionals in the treatment of childhood asthma. Jornal de Pediatria 2014; in press – corrected proof; published online 26 November. (doi:10.1016/j.jped.2014.07.007)

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Editor’s comment: The authors created a digital application to teach proper inhalation technique to health professionals, and evaluated the results of its implementation compared to similar education solely through a written format. The data obtained indicate favorable responses to both forms of education and support the importance of creating strategies in continuing education for inhaler technique training among health care professionals who treat asthma.

10. Food allergy risk among infants with eczema.

Martin PE, Eckert JK, Koplin JJ, Lowe AJ, Gurrin LC et al. Which infants with eczema are at risk of food allergy? Results from a population-based cohort. Clinical & Experimental Allergy 2015; 45(1): 255-264. (doi:10.1111/cea.12406)


Editor’s comment: The authors found that infants (by age 12 months) with eczema were six times more likely to have egg allergy and 11 times more likely to have peanut allergy. These data highlight the need to consider the possibility of food allergy in children with eczema, especially those with early onset or severe disease.

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