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Medical Journal Review

July 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.

A prospective multicenter study testing the diagnostic accuracy of an automated cough sound centred analytic system for the identification of common respiratory disorders in children
Porter P, Abeyratne U, Swarnkar V, Tan J, Ng TW et al
Respiratory Research 2019;20:81. doi: 10.1186/s12931-019-1046-6.

When considering the differential diagnosis of pediatric respiratory conditions, present diagnostic algorithms are difficult and suboptimal, resulting in inappropriate use of antibiotics and unacceptable morbidity and mortality. Recent advances in acoustic engineering and artificial intelligence have shown promise in the identification of respiratory conditions based on sound analysis. In this study, Porter and colleagues present the results of a diagnostic accuracy study for pediatric respiratory disease using an automated cough-sound analyzer. Comparison was made between the automated cough analyzer diagnoses and consensus clinical diagnoses reached by a panel of pediatricians after review of hospital charts (all available investigations) in a group of 585 subjects aged 29 days to 12 years. The Positive Percent and Negative Percent Agreement values between the automated analyzer and the clinical reference were as follows: asthma (97, 91%); pneumonia (87, 85%); lower respiratory tract disease (83, 82%); croup (85, 82%); bronchiolitis (84, 81%). Overall, this indicates that this technology may have a role as a high-level diagnostic aid in the assessment of common childhood respiratory disorders.

Age at introduction to complementary solid food and food allergy and sensitization: A systematic review and meta-analysis
Burgess JA, Dharmage SC, Allen K, Koplin J, Garcia-Larsen V et al.
Clinical and Experimental Allergy 2019;49(6):754-769. doi: 10.1111/cea.13383.

Prior studies indicate that an infant's age at introduction of solid foods may contribute to food allergy. In this paper by Burgess and colleagues, the authors synthesize the literature regarding the association between age at introduction of complementary solids (excluding milk products) and food allergy and sensitization. Following a full literature search, two authors selected papers according to inclusion criteria, identifying 16 cohort studies, 1 case‐control study and 8 randomized controlled trials (RCTs). Pooled effects across studies were estimated using random‐effects meta‐analysis. They found that cohort studies—introducing complementary solids at age ≥ 4 months vs <4 months was not associated with food allergy (OR 1.22; 95% CI, 0.76‐1.96) but was with food sensitization (OR 1.93; 95% CI 1.57‐2.38). First exposure from age 4 to 6 months vs <4 months was not associated with food allergy (OR 1.01; 95% CI, 0.64‐1.60) but was with food sensitization (OR 2.46; 95% CI 1.55‐3.86). Randomized controlled trials—Egg exposure from age 4 months was associated with reduced egg allergy (OR 0.63, 95% CI, 0.44‐0.90) and sensitization (OR 0.76, 95% CI, 0.51‐0.95). Peanut exposure from age 4 months compared to delayed exposure was associated with reduced peanut allergy (OR 0.28, 95% CI 0.14‐0.57).

The role of mobile health technologies in allergy care: An EAACI Position Paper
Matricardi PM, Dramburg S, Alvarez-Perea A, Antolin-Amerigo D, Apfelbacher C et al.
Allergy 2019; published online ahead of print (22 June). doi: 10.1111/all.13953.

Mobile Health (mHealth) uses mobile communication devices such as smartphones and tablet computers to support and improve health-related services, data flow and information, patient self-management, surveillance, and disease management from the moment of first diagnosis to an optimized treatment. In this paper, the EAACI taskforce assess the state of the art and future potential of mHealth in allergology. The task force endorsed the “Be He@lthy, Be Mobile” WHO initiative and debated the quality, usability, efficiency, advantages, limitations, and risks of mobile solutions for allergic diseases. The task force assessed the design, user engagement, and content as well as potential of inducing behavioral change, credibility/accountability, and privacy policies of mHealth products. Finally, the expert panel examined the current and future potential of mHealth for specific areas of allergy, including allergic rhinitis, aerobiology, allergen immunotherapy, asthma, dermatological diseases, food allergies, anaphylaxis, insect venom, and drug allergy.

Patients with overlapping diagnoses of asthma and COPD: Is livestock exposure a risk factor for comorbidity and coexisting symptoms and infections?
Baliatsas C, Smit LAM, Duckers MLA, van Dijk CE, Heederik D, Yzermans CJ
BMC Pulmonary Medicine 2019;19:105. doi: 10.1186/s12890-019-0865-z.

Epidemiological research on health effects of livestock exposure in population subgroups with compromised respiratory health is quite limited. For this reason, this study by Baliatsas and colleagues explored the association between livestock exposure and comorbid/concurrent conditions in patients with overlapping diagnoses of asthma and COPD. Through the use of electronic health record data from general practices in The Netherlands, the authors were able to examine 425 patients diagnosed with both asthma and COPD living in rural areas with high livestock density (“study area”) and compare this group to 341 patients with the same overlapping diagnoses who lived in rural areas with lower livestock density (“control areas”). They found that pneumonia was twice as common among patients living in areas with a high livestock density (OR 2.29, 99% CI 0.96–5.47); however, there were generally no statistically significant differences in the investigated outcomes between the study and control area. Significant associations were observed between presence of goats within 1000 meters and allergic rhinitis (OR 5.71, 99% CI 1.11–29.3, p < 0.01), number of co-occurring symptoms (IRR 1.69, 99% CI 1.03–2.77, p < 0.01) and anxiety (OR 8.18, 99% 1.5–44.7, p < 0.01).  Presence of cattle within 500 meters was associated with pneumonia prevalence (OR 2.48, 99% CI 1.05–5.84, p < 0.01). Overall, this study indicates that livestock exposure is not associated with comorbid chronic conditions, but appears to be a risk factor for symptomatic effects in patients with overlapping diagnoses of asthma and COPD.

Management of suspected immediate perioperative allergic reactions: An international overview and consensus recommendations
Garvey LH, Dewachter P, Hepner DL, Mertes PM, Voltolini S et al.
British Journal of Anaesthesia 2019;123:e50-e64. doi: 10.1016/j.bja.2019.04.044.

Suspected perioperative allergic reactions are rare, although they can be life-threatening. The diagnosis is difficult to make in the perioperative setting, but prompt recognition and correct treatment is necessary to ensure a good outcome. In this paper by Garvey et al. a group of 26 international experts in perioperative allergy (anesthesiologists, allergists, and immunologists) participated in a modified Delphi consensus process, which explored areas such as differential diagnosis, management during and after anaphylaxis, allergy investigation(s), and plans for a subsequent anesthetic. This paper provides both theoretical as well as practical background regarding suspected perioperative allergic reactions, based on the current literature, expert opinion, and a modified Delphi consensus process. The recommendations developed by this group are based on the collective experiences of a large international and multidisciplinary group with longstanding perioperative allergy experience. As the authors note, presently this is the highest level of evidence possible. They hope however in the future by developing local, national, and international networks of centers investigating perioperative allergic reactions they can increase the ability to conduct larger studies which will result in an improved evidence base, and ultimately better management for patients suffering from perioperative reactions.

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