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Medical Journal Review

March 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. Skin Prick Test: Relating the allergen wheal response to histamine.

Dreborg S. Allergen skin prick test should be adjusted by the histamine reactivity. International Archives of Allergy and Immunology 2015;166:77-80 (doi:10.1159/000371848)


Editor’s comment: In this study the authors compared two methods of skin test interpretation – the method of Nordic Guidelines using histamine as a reference and the method of Brighton et al., not using histamine as a reference. They found that the influence of skin test assistants’ technique could be reduced when using the Nordic Guideline technique.

2. Microbial exposure during early life may prevent, or reduce, the risk of allergy development.

Hesselmar B, Hicke-Roberts A, Wennergren G. Allergy in children in hand versus machine dishwashing. Pediatrics 2015;135(3):e590-e597. (doi:10.1542/peds.2014-2968)

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Editor’s comment: In families who use hand dishwashing, allergic disease in children is less common than in children from families who use machine dishwashing. The authors speculate that a less-efficient dishwashing via the hand dishwashing method may induce tolerance secondary to increased microbial exposure.

3. Improvements in air quality over time are associated with better development of lung function in children.

Gauderman WJ, Urman R, Avol E, Berhane K, McConnell R et al. Association of improved air quality with lung development in children. New England Journal of Medicine 2015;372:905-913. (doi:10.1056/NEJMoa1414123)

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Editor’s comment: The authors found that long-term improvements in air quality were associated with statistically and clinically significant positive effects on lung-function growth in boys and girls, Hispanic white and non-Hispanic white children, as well as those with asthma and without asthma.  This suggests that all children have the potential to benefit from improvement in air quality.

4. Managing asthma and exercise-induced bronchoconstriction in athletes.

Boulet L-P and O’Byrne PM. Asthma and exercise-induced bronchoconstriction in athletes. New England Journal of Medicine 2015;372:641-648. (doi:10.1056/NEJMra1407552)


Editor’s comment: The authors reviewed the current management of asthma and exercise-induced bronchoconstriction in athletes, particularly in athletes who engage in endurance sports, and they provide specific recommendations for high-level athletes.

5. New clinical practice guideline on chronic urticaria and angioedema by the British Society for Allergy and Clinical Immunology.

Powell RJ, Leech SC, Till S, Huber PAJ, Nasser SM, Clark AT. BSACI guideline for the management of chronic urticaria and angioedema. 2015;45(3):547-565. (doi:10.1111/cea.12494)

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Editor’s comment: The authors provide a very thorough guideline regarding the clinical classification, etiology, diagnosis, and treatment guidance with special sections focused on children with urticaria and the use of antihistamines in women who are pregnant or breastfeeding. They also provide recommendations for potential areas of future research.

6. Use of ecallantide has been associated with a risk of hypersensitivity reactions, including anaphylaxis.

Craig TJ, Li HH, Riedl M, Bernstein JA, Lumry WR et al. Characterization of anaphylaxis after ecallantide treatment of Hereditary Angioedema attacks. Journal of Allergy and Clinical Immunology: In Practice 2015;3(2):206-212.e4. (doi:10.1016.j.jaip.2014.09.001)

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Editor’s comment: This article is a comprehensive retrospective review of documented cases of hypersensitivity reactions observed in the ecallantide clinical development program that meet the criteria of anaphylaxis. The authors reinforce the importance of ecallantide administration by a health care provider who is knowledgeable and prepared to treat anaphylaxis.

7. Therapeutic doses of intranasal corticosteroids (INCS) and their effects on the boosts of systemic allergen-specific IgE production following nasal allergen exposure.

Egger C, Lupinek C, Ristl R, Lemell P, Horak F et al. Effects of nasal corticosteroids on boosts of systemic allergen-specific IgE production induced by nasal allergen exposure. PLoS ONE 2015;10(2):e0114991. (doi:10.1371/journal.pone.0114991)

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Editor’s comment:  In this double-blind, placebo-controlled study the authors examined whether therapeutic doses of intranasal corticosteroids (NCS) had an effect on allergen-specific IgE following nasal allergen exposure. The authors found no significant effect on allergen-specific IgE production following challenge, when comparing those receiving NCS vs. placebo.

8. Assessing the treatment-related expectations and benefits provided in patients with allergic rhinitis treated with H1-antihistamines.

Demoly P, Aubier M, de Blay F, Wessel F, Clerson P, Maigret P. Evaluation of patients’ expectations and benefits in the treatment of allergic rhinitis with a new tool: the patient benefit index – the benefica study. Allergy, Asthma & Clinical Immunology 2015;11:8. (doi:10.1186/s13223-015-0073-1)

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Editor’s comment: In this study, the authors validate the French language version of the AR-Patient Benefit Index, which is a specific self-assessment tool developed to examine treatment-related benefit. In this study, they further assess the treatment-related expectations and benefits provided in patients with allergic rhinitis who are treated with H1-antihistamines in a real-life study. Through this study, the authors conclude that this new tool may help physicians to better understand patients’ expectations and may serve as a catalyst to discuss treatment issues with their patients.

9. Current scientific evidence linking exposure to occupational triggers and the risk of anaphylaxis.

Siracusa A, Folletti I, Gerth van Wijk R, Jeebhay MF, Moscato G et al. Occupational anaphylaxis – an EAACI task force consensus statement. Allergy 2015;70(2):141-152. (doi:10.1111/all.12541)

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Editor’s comment: This consensus document was prepared by an EAACI Task Force expert panel, which consisted of allergologists, dermatologists, occupational physicians, and epidemiologists. It summarizes current scientific evidence linking the exposure to occupational triggers and the risk of anaphylaxis and suggests possible preventive measures and management.

10. Most effective strategy of consumption and avoidance in preventing the development of peanut allergy in infants at high risk.

Du Toit G, Roberts G, Sayre PH, Bahnson HT, Radulovic S et al. Randomized trial of peanut consumption in infants at risk for peanut allergy. New England Journal of Medicine 2015;372:803-813. (doi:10.1056/NEJMoa1414850)

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Editor’s comment: The authors concluded that the early introduction of peanuts significantly decreased the frequency of the development of peanut allergy among children at high risk for this allergy.

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