Medical Journal Review
January 2018
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 from Juan Carlos Ivancevich, MD, WAO Web Managing Editor, and summary author, John J. Oppenheimer, MD, FACAAI, FAAAAI, WAO Reviews Editor.
American College of Allergy, Asthma & Immunology Position Paper on the Use of Telemedicine for Allergists
Elliott T, Shih J, Dinakar C, Portnoy J, Fineman S
Annals of Allergy, Asthma and Immunology 2017; 119(6): 512-517. doi: 10.1016/j.anai.2017.09.052
In this position statement, the authors explore the history and future use of telemedicine services/technology to deliver health care at a distance. Not surprisingly, there has been a recent rapid expansion in the use of telemedicine, as it provides the exciting ability to increase access to care, improve health outcomes, and reduce medical costs, with better resource use and enhanced collaboration between patients and physicians. The panel urges that these potential benefits should be weighed against the risks and challenges with the use of telemedicine and this article serves to offer policy and position statements regarding the use of this tool in our specialty. In closing, the panel notes that the American College of Allergy, Asthma, and Immunology (ACAAI) advocates for incorporation of meaningful and sustained use of telemedicine in the practice of allergy and immunology.
Food allergy and atopic dermatitis: Prediction, progression, and prevention
Mastrorilli C, Caffarelli C, Hoffman-Sommergruber K
Pediatric Allergy and Immunology 2017; 28(8): 831-840. doi: 10.1111/pai.12831.
This excellent review examines our current understanding of risk factors, prediction and management of food allergy and atopic dermatitis in children and discusses how these issues may contribute to the modification of the natural history of food allergy and atopic dermatitis.
A simple prediction tool for inhaled corticosteroid response in asthmatic children
Wu YF, Su MW, Chiang BL, Yang YH, Tsai CH, Lee YL
BMC Pulmonary Medicine 2017; 17(1):176. doi: 10.1186/s12890-017-0533-0.
It is well known that there is a heterogeneity in response to therapy in asthmatic children. To better understand predictors of response, this Taiwanese study examined children aged 5 to 18 years with mild to moderate persistent asthma. Their response to inhaled corticosteroids (ICS) were assessed based upon their improvement in the asthma control test and peak expiratory flow and then stratified based upon demographic and clinical features that were available in primary care settings. Through this analysis they developed a prediction model using logistic regression and then further simplified it to formulate a practical tool.
Of the 73 asthmatic children with baseline and follow-up outcome measurements for ICS treatment, 24 (33%) were defined as non-responders. The tool they developed consisted of three predictors yielding a total score between 0 and 5, which is comprised of the following parameters: the age at physician diagnosis of asthma, sex, and exhaled nitric oxide. Sensitivity and specificity of the tool for prediction of ICS non-responsiveness, for a score of 3, were 0.75 and 0.69, respectively. The area under the receiver operating characteristic curve for the prediction tool was 0.763. The authors conclude that their tool represents a simple and low-cost method for predicting the response of asthmatic children to ICS, but acknowledge that it needs to be validated with other independent larger sample groups. Certainly, having such a tool would be very valuable to the clinician.
What can we learn in drug allergy management from World Health Organization's international classifications?
Tanno LK, Torres MJ, Castells M, Demoly P; Joint Allergy Academies
Allergy 2017; Published online before print (6 November 2016). doi: 10.1111/all.13335.
Drug hypersensitivity reactions (DHRs) are an important public health problem, affecting more than 7% of the general population. Unfortunately, epidemiological data is far from optimal and international comparable standards remain poorly accessed. Institutional databases worldwide increasingly use the World Health Organization (WHO) International Classification of Diseases (ICD) system to classify diagnoses, health services utilization and death data, but the misclassification of disorders in the ICD system results in a lack of recognition of the importance for healthcare planning and resource allocation. To further inform the allergy community and to ensure that the revision process is transparent as advised in the WHO ICD -11 revision agenda, the authors of this paper report the advances and use of the pioneering “Drug hypersensitivity” subsection of ICD -11 and implementation in the WHO International Classification of Health Interventions (ICHI). It is hoped that this new classification system will address DHRs and enable the collection of more accurate epidemiological data to support quality management of patients with drug allergies, with resultant improvement in the facilitation of health care.
Applicability of evidence from previous systematic reviews on immunotherapy in current practice of childhood asthma treatment: a GRADE (Grading of Recommendations Assessment, Development and Evaluation) systematic review
Van de Griendt EJ, Tuut MK, de Groot H, Brand PLP
BMJ Open 2017; 28;7(12):e016326. doi: 10.1136/bmjopen-2017-016326.
As most children with asthma now use inhaled corticosteroids (ICS), the added benefit of immunotherapy in asthmatic children needs to be examined. For this reason, the authors examine the effectiveness of subcutaneous immunotherapy (SCIT) and sublingual immunotherapy (SLIT) in childhood asthma treatment. They focus on studies with patient-relevant outcome measures in children using ICS, and rely upon the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to systematically search to examine the evidence using predefined critical patient-relevant outcomes (asthma symptoms, asthma control and exacerbations). Through this analysis, the authors found that the quality of the evidence for SCIT was very low, due to a large risk of bias and indirectness (dated studies in children not using ICS). Furthermore, no effect of SCIT was found for asthma symptoms; no studies reported on asthma control. For asthma exacerbations, studies did favor SCIT; but, they note little confidence in this effect estimate, due to the very low quality of evidence. For SLIT, the quality of the evidence was also very low due to a large risk of bias, indirectness and imprecision.
The outcome “asthma symptoms” could not be calculated due to lack of standardization and large clinical heterogeneity. They conclude that overall, there is an absence of evidence to properly determine the effectiveness or lack thereof of immunotherapy in asthma treatment in children using ICS.
