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Medical Journal Review

November 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. Fish and polyunsaturated fat intake and development of allergic and nonallergic rhinitis.

Magnusson J, Kull I, Westman M, Hakansson N, Wolk A et al. Fish and polyunsaturated fat intake and development of allergic and nonallergic rhinitis. Journal of Allergy & Clinical Immunology 2015; 136(5): 1247-1253. (doi:10.1016/j.jaci.2015.05.030)

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Changes in dietary habits over the last several decades have been suggested to play a role in the increase of allergic diseases. Oily fish, which is rich in long-chain n-3 polyunsaturated fatty acids (PUFAs) and vitamin D, has been suggested to decrease the risk of allergic disease through their immunomodulatory properties, whereas n-6 PUFAs and an increased n-6/n-3 ratio has been suggested to increase the risk. To better understand this issue, Magnusson et al. explored the association between consumption of fish, dietary n-3 and n-6 PUFAs, and vitamin D at age 8 years and the development of allergic rhinitis (AR) and nonallergic rhinitis (NAR) between the ages of 8 and 16 years through the use of a birth cohort of 1970 participants. The authors found that regular consumption of oily fish and dietary long-chain n-3 PUFAs in childhood might decrease the risk of rhinitis, especially NAR, between the ages of 8 and 16 years. Specifically, regular intake of oily fish and higher long-chain n-3 PUFA intake were associated with a reduced risk of cumulative incidence of NAR (adjusted odds ratio, 0.52 [95% CI, 0.32-0.87] for oily fish; odds ratio, 0.45 [95% CI, 0.30-0.67] for highest vs lowest tertile of long-chain n-3 PUFAs; P trend < .001). The authors suggest that this effect may be secondary to the fact that long-chain n-3 PUFAs have been shown to decrease the production of inflammatory mediators and increase the level of anti-inflammatory mediators, whereas n-6 PUFAs promote formation of inflammatory mediators.

2. Sublingual grass and ragweed immunotherapy: Clinical considerations – a PRACTALL consensus report

Li JT, Bernstein DI, Calderon MA, Casale TB, Cox L et al. Sublingual grass and ragweed immunotherapy: Clinical considerations – a PRACTALL consensus report. Journal of Allergy & Clinical Immunology 2015; Article in press; published online ahead of print, 11 September. (doi:

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In this PRACTALL consensus report by Li et al., the authors provide a wonderful exploration of Sublingual Immunotherapy (SLIT) for ragweed and grass allergy. This document is amazingly practical, discussing such topics as the clinical indications for SLIT, efficacy of SLIT vs. SCIT, how to deal with missed doses of SLIT, combining multiple allergens of SLIT tablets, adverse events from SLIT, the long-term benefits of SLIT, where it fits in our treatment armamentarium, as well as ways to improve adherence. This is a must read for all practicing allergists.

3. Latest developments in allergic rhinitis in Allergy for clinicians and researchers.

Chew Lip Ng and De Yun Wang. Latest developments in Allergic Rhinitis in Allergy for Clinicians and Researchers. Allergy 2015; Accepted article, published online before print, 7 October. (doi:10.1111/all.12782)

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This article by Ng et al. summarizes the key research advances made in the field of allergic rhinitis (AR) from 2013 to 2015. This review of AR is quite complete, exploring the recent literature regarding prevalence, costs, comorbidities, and risk factors as well as therapy. The authors close with a discussion of novel targets for AR therapy. 

4. European Society of Contact Dermatitis guideline for diagnostic patch testing – recommendations on best practice.

Johansen JD, Aalto-Korte K, Agner T, Andersen KR, Bircher A et al. European Society of Contact Dermatitis guideline for diagnostic patch testing – recommendations on best practice. Contact Dermatitis 2015; 73(4): 195-221. (doi:10.1111/cod.12432)

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The European Society of Contact Dermatitis formed a working group to develop an up-to-date patch test guideline. This very complete parameter provides information regarding the indications for testing, test materials (including vehicles), site for testing, chambers to be used, as well as occlusion and reading times. There is also a section focusing on special groups, including children, occupational contact dermatitis, and testing for drug eruption. They even provide guidance regarding education and avoidance, once a cause for contact dermatitis has been found. This is a wonderful resource for those performing contact dermatitis patch testing.

5. Environmental exposure to pesticides and respiratory health.

Mamane A, Raherison C, Tessier JF, Baldi I, Bouvier G. Environmental exposure to pesticides and respiratory health. European Respiratory Review 2015; 24(137): 462-473. (doi:10.1183/16000617.00006114)

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We know that viruses and bacteria can induce or exacerbate airway inflammation. Likewise, environmental risk factors are also known exacerbates, such as allergens, tobacco smoke, gaseous or particulate air pollutants, and exposure to certain chemicals, including potentially pesticides. The authors performed a PRISMA based meta-analyses, noting 20 studies dealing with respiratory health and non-occupational pesticide exposure that met criteria, 14 carried out on children and six on adults.

In four of the 9 studies in children with biological measurements, mothers’ dichlorodiphenyldichloroethylene blood levels during pregnancy were associated with asthma and wheezing in young children. An association was also found between permethrin in indoor air during pregnancy and wheezing in children. A significant association was seen between asthma and DDE measured in children’s blood (aged 7–10 years) in one study. However, in three studies, no association was found between asthma or respiratory infections in children and pesticide levels in breast milk and/or infant blood. Lastly, in three out of four studies where post-natal pesticide exposure of children was assessed by parental questionnaire an association with respiratory symptoms was found.

Results of the fewer studies on pesticide environmental exposure and respiratory health in adults were much less conclusive, as the associations observed were weak and often not significant. The authors conclude by reinforcing that further studies are needed to confirm whether there is a respiratory risk associated with environmental exposure to pesticides.

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