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Medical Journal Review

March 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.

Study of atopic multimorbidity in subjects with rhinitis using multiplex allergen component analysis
Blöndal V, Sundbom F, Borres MP, Hogman M, Alving K et al.
Clinical and Translational Allergy 2020;10:6. doi: 10.1186/s13601-020-0311-6.
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Many patients with rhinitis also have other atopic illnesses such as asthma and eczema. The purpose of this study was to compare subjects with only rhinitis to those that have rhinitis, asthma, and/or eczema in relation to IgE sensitization, inflammatory markers, family history, lung function, and body mass index. Of the 216 participants in this study with rhinitis, 89 also had asthma and/or eczema. The authors found that patients with rhinitis who also had asthma or eczema were more likely to be IgE-sensitized (3.44, odds ratio, OR: 95% CI 1.62–7.30), adjusted for sex, age, mother’s allergy, total IgE and FEV1. The number of IgE-positive components was independently associated with atopic multimorbidity (1.11, OR: 95% Cl 1.01–1.21) adjusted for sex, age, mother’s allergy, total IgE and FEV1. Maternal allergy (2.75, OR: 95% CI 1.15–4.46), high total IgE (2.38, OR: 95% CI 1.21–4.67), and lower FEV1 (0.73, OR: 95% CI 0.58–0.93) were also independently associated with atopic multimorbidity, while no association was found with any of the other inflammatory markers. The authors opine that their findings indicate that disease-modifying treatment that targets IgE sensitization may be of value when decreasing the risk of developing atopic multimorbidity.

Systematic literature review of systemic corticosteroid use for asthma management
Bleecker ER, Menzies-Gow AN, Price DB, Bourdin A, Sweet S et al.
American Journal of Respiratory and Critical Care Medicine 2020; 201(3):276-293. doi:10.1164/rccm.201904-0903SO.
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Systemic corticosteroid is used to manage uncontrolled asthma; however, its associated healthcare burden may account for important health related adverse effects. To better understand this potential cost, the authors undertook systematic literature review to investigate the real-world extent and burden of systemic corticosteroid use in asthma. It should come as no surprise that they found that oral/systemic corticosteroids were commonly used for asthma management and more frequently used in patients with severe asthma compared to those with milder disease. They also found that long-term oral/systemic corticosteroid use was, in general, less frequent than short-term use. Compared with no use, long-term and repeated short-term oral/systemic corticosteroid use were associated with an increased risk of acute and chronic adverse events, even when doses were comparatively low. In the end, greater oral/systemic corticosteroid exposure was associated with increased costs and healthcare

Caspase-11 promotes allergic airway inflammation
Zasłona Z, Flis E, Wilk MM, Carroll RB, Palsson-MacDermott EM et al.
Nature Communication 2020;11:1055. doi:10.1038/s41467-020-14945-2
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Activated caspase-1 and caspase-11 induce inflammatory cell death in a process termed pyroptosis. In this study, Zasłona and colleagues demonstrate that Prostaglandin E2 (PGE2) inhibits caspase-11-dependent pyroptosis in murine and human macrophages. Furthermore, PGE2 suppresses caspase-11 expression in murine and human macrophages and in the airways of mice with allergic inflammation. It is interesting to note that caspase-11-deficient mice are strongly resistant to developing experimental allergic airway inflammation, where PGE2 is known to be protective, and expression of caspase-11 is increased in the lung of wild type mice with allergic airway inflammation. Blocking PGE2 production with indomethacin enhances, whereas the prostaglandin E1 analog misoprostol inhibits, lung caspase-11 expression. Finally, the authors found that alveolar macrophages from asthma patients exhibit increased expression of caspase-4, a human homologue of caspase-11. Overall, these data indicate that PGE2 is a negative regulator of caspase-11-driven pyroptosis and implicate caspase-4/11 as a critical contributor to allergic airway inflammation, with implications for pathophysiology of asthma.

Association of use of cleaning products with respiratory health in a Canadian birth cohort
Parks J, McCandless L, Dharma C, Brook J, Turvey SE et al.
Canadian Medical Association Journal 2020;192(7):E154-E161. doi:10.1503/cmaj.190891
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Through the use of a parental questionnaire analyzing the frequency of use of 26 household cleaning products in the homes of 2022 children via mining of the Canadian Healthy Infant Longitudinal Development Cohort Study, the authors found that frequent use of household cleaning products in early life was associated with an increased risk for childhood wheeze and asthma, but not atopy, at age 3 years. As the authors note, this adds to the understanding of how early life exposures to cleaning products may be associated with the development of allergic airway disease and helps to identify household behaviors as a potential area for intervention.

Asia Pacific Association of Allergy Asthma and Clinical Immunology White Paper 2020 on climate change, air pollution, and biodiversity in Asia-Pacific and impact on allergic diseases
Pawankar R, Wang JY, Wang IJ, Thien F, Chang YS et al.
Asia Pacific Allergy 2020;10(1):e11. doi:10.5415/apallergy.2020.10.e11.
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This white paper stresses that the Asia-Pacific region, which is the post populated continent in the world, has a huge burden of both outdoor and indoor pollutants, including PM2.5, PM10, SPM, CO, O3, NO2, SO2, NO, and household pollutants, including biomass and tobacco. The authors highlight that the risk factors for the epidemic rise of allergic diseases in the region are due to increasing urbanization, environmental factors of air pollution, and lack of environmental awareness programs or pollution control regulations in many countries. Because of the varied environmental exposures in different countries of this region, strategies to combat allergic disease in the Asia-Pacific region should be focused on active government policies to fight air pollution based upon local data. The authors stress that substantial efforts need to be implemented with a concerted strategy at the legislative and administrative as well as community levels to improve air quality.

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