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Medical Journal Review

February 2020

WAO Reviews – Editors' Choice

The Editors’ Choice comes to you from Juan Carlos Ivancevich, MD, and John J. Oppenheimer, MD, FACAAI, FAAAAI. 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.

The need for clean air: The way air pollution and climate change affect allergic rhinitis and asthma
Eguiluz-Gracia I, Mathioudakis AG, Bartel S, Vijverberg SJH, Fuertes E et al.
Allergy 2020; Published online ahead of print (9 January) DOI:10.1111/all.14177

This review summarizes the effects of indoor and outdoor air pollution, as well as the impact of climate change on asthma and allergic rhinitis, in both children and adults and addresses the policy and lifestyle changes required to mitigate the deleterious effects. Climate change impacts the availability and distribution of plant- and fungal-derived allergens. Air pollution and climate change have a significant impact on human health, including the development, onset, and aggravation of allergic rhinitis and asthma among other chronic respiratory diseases. Indoor issues include exposure to indoor allergens (house dust mites, pets, molds, etc.), tobacco smoke, and other pollutants, which have an impact on respiratory health, while outdoor air pollution derived from traffic and other human activities not only has a direct negative effect on human health, but it also can enhance the allergenicity of some plants and contribute to global warming.

Clinical management of seafood allergy
Davis CM, Gupta RS, Aktas ON, Diaz V, Kamath SD, Lopata AL
JACI In Practice 2020;8(1):37044. DOI:10.1016/j.jaip.2019.10.019

This is a wonderful review of seafood allergy, reinforcing that a good patient workup and sensitive diagnostic analysis of IgE antibody reactivity can distinguish between a true seafood allergy and other adverse reactions, such as toxins or parasites contaminating ingested seafood. Seafood can be stratified into two general classes: fish and shellfish. Shellfish represents a diverse group of species which can be further subdivided into crustaceans and mollusks. The prevalence of shellfish allergy appears to be higher than that of fish allergy, with an estimate of up to 3% in the adult population and fin fish allergy prevalence of approximately 1%. Evaluation of the seafood-allergic patient includes obtaining a detailed history as well as in vivo and/or in vitro testing with careful interpretation of results with consideration of cross-reactivity features of the major allergens. Oral food challenge is useful not only for the diagnosis, but also for avoiding unnecessary dietary restrictions. In this review, the authors provide clinical and laboratory tools for the differentiation of fish allergy from shellfish allergy to optimize management of these patients.

A new generation of treatments for itch
Fowler E, Yosipovitch G
Acta Dermato-Venereologica 2020;100(2):adv00027. DOI:10.2340/00015555-3347.

Antihistamines have long been the mainstay of treatment for chronic pruritus, yet they often only make patients drowsy and forgetful of their itch. A new era of antipruritic drugs is quickly approaching, presenting more effective treatments for patients suffering from chronic itch. The authors focus on several new treatments that have been developed targeting various receptors in the nervous system, including: transient receptor potential channels, sodium channels, neurokinin-1 receptors, opioid receptors, and many more. Additionally, antipruritic therapies developed to work on the immune system have become more targeted, leading to greater safety and efficacy measures. These include crisaborole, several interleukin antagonists, and janus kinase inhibitors.  In the end, there is hope that new and more effective options will soon be available for our patients suffering from pruritus.

Exposure to diesel exhaust particles increases susceptibility to invasive pneumococcal disease
Shears RK, Jacques LC, Naylor G, Miyashita L, Khandaker S et al.
Journal of Allergy and Clinical Immunology 2020; Published online ahead of print (20 January). DOI:10.1016/j.jaci.2019.11.039.

In this set of studies, the authors utilized a mouse model and in vitro assays to provide a mechanistic understanding of the link between diesel exhaust particle (DEP) exposure and pneumococcal disease risk, and they further confirmed their findings by using induced sputum macrophages isolated from healthy human volunteers. Overall, they found that lung inhaled DEPs increase susceptibility to pneumococcal disease through loss of immunological (reduced phagocytic function of alveolar macrophages) control of pneumococcal colonization, increased inflammation, tissue damage, and systemic bacterial dissemination. The authors conclude that their data reinforce the need for coordinated global efforts to reduce airborne pollution and transition toward more sustainable energy sources that produce cleaner air.

Persistent asthma from childhood to adulthood presents a distinct phenotype of adult asthma
To M, Tsuzuki R, Katsube O, Yamawaki S, Soeda S et al.
JACI In Practice 2020; Published online ahead of print (22 January). DOI:10.1016/j.jaip.2020.01.011.

In this study, the authors compared the clinical characteristics among patients differing in onset and duration of asthma, by performing a cross-sectional study of adult patients with asthma who attended their hospital, stratifying them into three groups: those with adult-onset asthma (adult onset), those who had remitted childhood asthma which relapsed (relapsed), and those who had asthma that had persisted since childhood (persistent). When comparing the clinical characteristics of these groups, they found that adult patients with asthma that persisted from childhood to adulthood had poorer lung function and more severe asthma in adulthood than those with adult onset. They conclude that asthma that persists from childhood to adulthood seems to present a distinct clinical phenotype of adult asthma, and this should be considered when clinicians attempt to optimize treatment of their adult patients with asthma.