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Medical Journal Review

December 2019

WAO Reviews – Editors' Choice

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. They select articles for their importance to clinicians who care for patients with asthma and allergic/immunologic diseases, and whenever possible, for their accessibility to everyone.

30 years of sublingual immunotherapy
Passalacqua G, Bagnasco D, Canonica, GW
Allergy 2019; published online before print (23 December). DOI:10.1111/all.14113

In this excellent review of sublingual Immunotherapy (SLIT), Passalacqua and colleagues explore the origin and evolution of SLIT for respiratory allergy, examining recent developments as well as future perspectives and unmet needs.

Oral immunotherapy for multiple foods in a pediatric allergy clinic setting
Eapen AA, Lavery WJ, Siddiqui JS, Lierl MB
Annals of Allergy Asthma & Immunology 2019;123(6):573-581.e3. DOI:10.1016/j.anai.2019.08.463

In this article, Eapen et al. share their experience with oral immunotherapy (OIT) for multiple foods in a pediatric allergy clinic setting. Forty-five patients aged 1.5 to 18 years undertook OIT for up to 12 foods including peanut, tree nuts, seeds, legumes, and egg. Thirty-five patients were receiving daily maintenance dosing, 4 had completed OIT and were continuing to eat their foods 3 times weekly, and 6 had discontinued OIT (anxiety, inconvenience, or allergy symptoms). A total of 49% of patients had reactions during the up-dosing process, mostly oral itching (33%), perioral hives (40%), and abdominal pain (35%). The authors found no correlation between baseline skin prick test (SPT)/sIgE test results and the reaction threshold for baseline food challenge, lowest dose causing reactions during up-dosing, or time to reach maintenance. Higher baseline sIgE level but not baseline SPT result was associated with an increased number of allergic reactions during OIT. Baseline SPT however correlated with stopping OIT.

The International/Canadian Hereditary Angioedema guideline
Betschel S, Badiou J, Binkley K, Borici-Mazi R, Hébert J et al.
Allergy Asthma & Clinical Immunology 2019;15:72. DOI:10.1186/s13223-019-0376-8

The International/Canadian Hereditary Angioedema Guideline is an update to the 2014 Canadian Hereditary Angioedema Guideline with an expanded scope to include the management of hereditary angioedema (HAE) patients worldwide. It is a collaboration of Canadian and international HAE experts and patient groups led by the Canadian Hereditary Angioedema Network with the goal of providing evidence‑based recommendations, using the GRADE system, for the management of patients with HAE. This includes the treatment of attacks, short‑term prophylaxis, long‑term prophylaxis, and recommendations for self‑administration, individualized therapy, quality of life, and comprehensive care. New additions to this publication include sections covering the diagnosis and recommended therapies for acute treatment in HAE patients with normal C1‑INH, as well as sections on pregnant and pediatric patients.

The 2019 report of The Lancet Countdown on Health and Climate Change: Ensuring that the health of a child born today is not defined by climate change
Watts N, Amann M, Arnell N, Ayeb-Karlsson S, Belesova K et al.
Lancet 2019;394(10211):1836-1878. DOI:10.1016/S0140-6736(19)32596-6

The Lancet Countdown is an international, multi­disciplinary collaboration, dedicated to monitoring the evolving health profile of climate change and providing an independent assessment of the delivery of the commitments made by governments worldwide under the Paris Agreement. This 2019 report presents an   annual update of 41 indicators across five key domains: climate change impacts, exposures, and vulnerability; adaptation, planning, and resilience for health; mitigation actions and health benefits; economics and finance; and public and political engagement. The report represents the findings and consensus of 35 leading academic institutions and UN agencies from every continent and highlight the ongoing trends of a warming world with effects that threaten human wellbeing.

Feather duvet lung
Liu-Shiu-Cheong P, RuiWen Luo C, Wilkie SWA, Dempsey O
BMJ 2019;12(11):e231237. DOI:10.1136/bcr-2019-231237

The authors of this paper share a case of “feather duvet lung”, involving a male 43-year-old non-smoker who was referred with a 3-month history of malaise, fatigue, and breathlessness. Blood avian precipitins were strongly positive. Lung function testing demonstrated a restrictive pattern with impaired gas transfer. A “ground glass” mosaic pattern was seen on CT imaging, suggestive of hypersensitivity pneumonitis. Although he had no pet birds, further questioning revealed that he had recently acquired a duvet and pillows containing feathers. His symptoms, chest radiograph, and lung function tests improved after removal of all feather bedding, and he was also started on oral corticosteroid therapy. The authors reinforce that this case highlights the importance of taking a meticulous exposure history, which includes asking about domestic bedding in patients with unexplained breathlessness. Prompt recognition and cessation of antigen exposure may prevent the development of irreversible lung fibrosis. The authors use this case to illustrate our understanding of the diagnosis and treatment of hypersensitivity pneumonitis.

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