Editorial
Within this issue
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his issue of the Proceedings features four review articles, eight original manuscripts and a “Patient-Oriented Problem Solving (POPS)” case report, all of which focus on allergic and respiratory disease. In the lead review article, Bartholow et al1 provide a comprehensive, up to date appraisal of the effects of inhaled corticosteroids on growth in children. This is an important topic, not only for physicians who care for pediatric patients with asthma, but also for the parents of children with asthma who oftentimes, because of deep concerns of growth retardation, may question the use of these effective agents for the treatment of asthma. As such, the substance of this article is featured in this issue’s “For the Patient” section. This newly introduced section, found in the back of this issue and also available on line, consists of a one-page synopsis of Bartholow’s review, written in a readily comprehensible fashion to help patients better understand the content of the full article and its diagnostic and therapeutic implications. It is printed in a format to allow reproduction on the practitioner’s letterhead for distribution to patients. Evidence based medicine is defined as the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. In this spirit, Bielory et al2 have authored a comprehensive review of evidence-based pharmacologic management of allergic conjunctivitis. This is followed by a timely review of non-surgical treatments for eosinophilic esophagits by Reddy and Ghaffari3. In this issue’s final review, Madeo et al4, address the current state of research on the topic of asthma in the geriatric population. Specific obstacles encountered in caring for these patients are described in comparison with a younger population. In keeping with the theme of Madeo’s review, the lead original article in this issue, by Hsu et al5 describes the utility of novel FeNO measurements in elderly asthmatic patients. Although fractional exhaled nitric oxide (FeNO) measurement is an important non-invasive tool for evaluating eosinophilic inflammation of the airways, elderly patients may be unable to properly perform the expiratory maneuver required for FeNO measurement. As an alternative method, the investigators studied the effectiveness of offline FeNO testing and suggest that it may potentially obviate the need for the required expiratory maneuver in this population.
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Allergy and Asthma Proceedings
In the article by Clark et al6, the trends in U.S. emergency department visits for food allergy are reported. Their findings suggest that the number of U.S. emergency department visits for food-related acute allergic reactions is significantly higher than previously reported. An analysis of the efficacy of omalizumab in chronic refractory urticaria is reported by Viswanathan et al7. Although omalizumab has been shown to be effective in chronic urticaria patients, it remains unknown whether there are specific phenotypic variations seen in patients with chronic urticaria that are more responsive to omalizumab therapy. This retrospective chartreview analysis of refractory chronic urticaria patients demonstrates that omalizumab has robust efficacy in these patients regardless of their autoimmune status, age, gender, IgE levels, or dosing protocol. In a novel study, Olivier et al8 report on the utility of nasal provocation testing (NPT) combined with spirometry in the evaluation of vocal fold motility in allergic subjects. Vocal cord dysfunction (also called paradoxical vocal cord motion) or paradoxical vocal fold motion (PVFM) is a clinical disorder elicited by specific and non-specific triggers, the diagnosis of which is limited by the restricted number of available functional tests. The authors conclude that allergenspecific NPT combined with spirometry may provide a useful diagnostic tool for allergen-specific laryngeal hyperresponsiveness in allergic subjects with PVFM. This issue also features two additional epidemiologic reports. Santillan et al9 report on atopic conditions other than asthma in association with the 2009 H1N1 infection in children. In a case control analysis, their results suggest an association between H1N1 infection and atopic dermatitis and/or allergic rhinitis. Tsai at al10 report on the association between Kawasaki Disease and allergic diseases. This matched case control study, using the National Health Insurance Research Database of Taiwan as its data source, reports that children with Kawasaki Disease were more likely to suffer from allergic rhinitis and asthma than controls. Published exclusively on line, but with abstracts included in the print issue, are two studies. Hernández et al11 report on prenatal determinants of cord blood total immunoglobulin E levels in Mexican newborns. Their results demonstrate maternal atopy and pesticide use during pregnancy to be strong predictors of cord blood
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IgE levels in newborns. Boonpiyathad et al12, building on previous evidence that interleukin-2 (IL-2) and interleukin-10 (IL-10) in the airways play important roles in regulating the asthmatic inflammatory response, report that whereas levels of both IL-2 and IL-10 in exhaled breath condensate (EBC) are increased in asthmatic patients, only IL-2 levels significantly correlate with the Asthma Control Test score and % predicted FEV1 in non-allergic asthma. Rounding out the issue is the most recent installment of the POPS series which, as per tradition, is written by an allergy-immunology fellow-in-training from one of the 73 U.S. allergy-immunologyapproved training programs. The purpose of the POPS series is to provide an innovative and practical learning experience for the allergist-immunologist using a format of clinical presentation, physical findings, appropriate laboratory studies and differential diagnosis. Scott et al13 lead the reader through this process, describing the immunologic and genetic evaluation of an infant with recurrent fevers and failure to thrive. In summary, the constellation of manuscripts found within the pages of this issue of the Proceedings provides a comprehensive assortment of current topics related to several important allergic and respiratory disorders. In keeping with the mission of the Proceedings to distribute timely information important in the advancement of knowledge and practice of allergy, asthma and immunology for clinicians entrusted with the care of patients, it is our hope that the new knowledge contained within these communications will contribute to efficient workup and optimal therapy for a wide array of clinical problems seen by the clinician on a daily basis. These papers elucidate the magnitude of allergic and respiratory conditions in various populations, ranging from infancy to the elderly and from various regions around the world. On behalf of the editorial board, through whose unstinting efforts of manuscript review
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and recommendations the Proceedings subsists, we hope you will enjoy this diversity of literature. Joseph A. Bellanti, M.D. Russell A. Settiane, M.D.
Y P
REFERENCES 1.
2.
3.
4. 5.
6.
Bartholow AK, Deshaies DM, Skoner JM, and Skoner DP. A critical review of the effects of inhaled corticosteroids on growth. Allergy Asthma Proc 34:391– 407, 2013. Bielory L, Meltzer EO, Nichols KK, et al. An algorithm for the management of allergic conjunctivitis. Allergy Asthma Proc 34:408 – 420, 2013. Reddy V, and Ghaffari G. Eosinophilic esophagitis: Review of nonsurgical treatment modalities. Allergy Asthma Proc 34: 421– 426, 2013. Madeo J, Li Z, and Frieri M. Asthma in the geriatric population. Allergy Asthma Proc 34:427– 433, 2013. Hsu JY, Huang WC, Huang PL, et al. Usefulness of offline fractional exhaled nitric oxide measurements in the elderly asthmatic patients. Allergy Asthma Proc 34:434 – 438, 2013. Clark S, Espinola JA, Rudders SA, et al. Favorable trends in the frequency of U.S. emergency department visits for food allergy, 2001–2009. Allergy Asthma Proc 34:439 – 445, 2013. Viswanathan RK, Moss MH, and Mathur SK. Retrospective analysis of the efficacy of omalizumab in chronic refractory urticaria. Allergy Asthma Proc 34:446 – 452, 2013. Olivier CE, Pinto Argentaõ DG, dos Santos Lima RP, et al. The nasal provocation test combined with spirometry establishes paradoxical vocal fold motion in allergic subjects. Allergy Asthma Proc 34:453– 458, 2013. Santillan Salas CF, Mehra S, Pardo Crespo MR, and Juhn YJ. Atopic conditions other than asthma and risk of the 2009 novel H1N1 infection in children: A case-control study. Allergy Asthma Proc 34:459 – 466, 2013. Tsai YJ, Lin CH, Fu LS, et al. The association between Kawasaki disease and allergic diseases, from infancy to school age. Allergy Asthma Proc 34:467– 472, 2013. Hernández E, Barraza-Villarreal A, Escamilla-Núñez MC, et al. Prenatal determinants of cord blood total immunoglobulin E levels in Mexican newborns. Allergy Asthma Proc 34:e27–e34, 2013. Boonpiyathad S, Pornsuriyasak P, Buranapraditkun S, and Klaewsongkram J. Interleukin-2 levels in exhaled breath condensates, asthma severity, and asthma control in nonallergic asthma. Allergy Asthma Proc 34:e35– e41, 2013. Scott DR, Chan S, Chang J, et al. Recurrent fevers and failure to thrive in an infant. Allergy Asthma Proc 34:473– 479, 2013.
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8.
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10.
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12.
13.
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Within this issue
Y P
T
his issue of the Proceedings features four review articles, eight original manuscripts and a “Patient-Oriented Problem Solving (POPS)” case report, all of which focus on allergic and respiratory disease. In the lead review article, Bartholow et al1 provide a comprehensive, up to date appraisal of the effects of inhaled corticosteroids on growth in children. This is an important topic, not only for physicians who care for pediatric patients with asthma, but also for the parents of children with asthma who oftentimes, because of deep concerns of growth retardation, may question the use of these effective agents for the treatment of asthma. As such, the substance of this article is featured in this issue’s “For the Patient” section. This newly introduced section, found in the back of this issue and also available on line, consists of a one-page synopsis of Bartholow’s review, written in a readily comprehensible fashion to help patients better understand the content of the full article and its diagnostic and therapeutic implications. It is printed in a format to allow reproduction on the practitioner’s letterhead for distribution to patients. Evidence based medicine is defined as the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. In this spirit, Bielory et al2 have authored a comprehensive review of evidence-based pharmacologic management of allergic conjunctivitis. This is followed by a timely review of non-surgical treatments for eosinophilic esophagits by Reddy and Ghaffari3. In this issue’s final review, Madeo et al4, address the current state of research on the topic of asthma in the geriatric population. Specific obstacles encountered in caring for these patients are described in comparison with a younger population. In keeping with the theme of Madeo’s review, the lead original article in this issue, by Hsu et al5 describes the utility of novel FeNO measurements in elderly asthmatic patients. Although fractional exhaled nitric oxide (FeNO) measurement is an important non-invasive tool for evaluating eosinophilic inflammation of the airways, elderly patients may be unable to properly perform the expiratory maneuver required for FeNO measurement. As an alternative method, the investigators studied the effectiveness of offline FeNO testing and suggest that it may potentially obviate the need for the required expiratory maneuver in this population.
O D
Allergy and Asthma Proceedings
In the article by Clark et al6, the trends in U.S. emergency department visits for food allergy are reported. Their findings suggest that the number of U.S. emergency department visits for food-related acute allergic reactions is significantly higher than previously reported. An analysis of the efficacy of omalizumab in chronic refractory urticaria is reported by Viswanathan et al7. Although omalizumab has been shown to be effective in chronic urticaria patients, it remains unknown whether there are specific phenotypic variations seen in patients with chronic urticaria that are more responsive to omalizumab therapy. This retrospective chartreview analysis of refractory chronic urticaria patients demonstrates that omalizumab has robust efficacy in these patients regardless of their autoimmune status, age, gender, IgE levels, or dosing protocol. In a novel study, Olivier et al8 report on the utility of nasal provocation testing (NPT) combined with spirometry in the evaluation of vocal fold motility in allergic subjects. Vocal cord dysfunction (also called paradoxical vocal cord motion) or paradoxical vocal fold motion (PVFM) is a clinical disorder elicited by specific and non-specific triggers, the diagnosis of which is limited by the restricted number of available functional tests. The authors conclude that allergenspecific NPT combined with spirometry may provide a useful diagnostic tool for allergen-specific laryngeal hyperresponsiveness in allergic subjects with PVFM. This issue also features two additional epidemiologic reports. Santillan et al9 report on atopic conditions other than asthma in association with the 2009 H1N1 infection in children. In a case control analysis, their results suggest an association between H1N1 infection and atopic dermatitis and/or allergic rhinitis. Tsai at al10 report on the association between Kawasaki Disease and allergic diseases. This matched case control study, using the National Health Insurance Research Database of Taiwan as its data source, reports that children with Kawasaki Disease were more likely to suffer from allergic rhinitis and asthma than controls. Published exclusively on line, but with abstracts included in the print issue, are two studies. Hernández et al11 report on prenatal determinants of cord blood total immunoglobulin E levels in Mexican newborns. Their results demonstrate maternal atopy and pesticide use during pregnancy to be strong predictors of cord blood
O N
T
O C
389
IgE levels in newborns. Boonpiyathad et al12, building on previous evidence that interleukin-2 (IL-2) and interleukin-10 (IL-10) in the airways play important roles in regulating the asthmatic inflammatory response, report that whereas levels of both IL-2 and IL-10 in exhaled breath condensate (EBC) are increased in asthmatic patients, only IL-2 levels significantly correlate with the Asthma Control Test score and % predicted FEV1 in non-allergic asthma. Rounding out the issue is the most recent installment of the POPS series which, as per tradition, is written by an allergy-immunology fellow-in-training from one of the 73 U.S. allergy-immunologyapproved training programs. The purpose of the POPS series is to provide an innovative and practical learning experience for the allergist-immunologist using a format of clinical presentation, physical findings, appropriate laboratory studies and differential diagnosis. Scott et al13 lead the reader through this process, describing the immunologic and genetic evaluation of an infant with recurrent fevers and failure to thrive. In summary, the constellation of manuscripts found within the pages of this issue of the Proceedings provides a comprehensive assortment of current topics related to several important allergic and respiratory disorders. In keeping with the mission of the Proceedings to distribute timely information important in the advancement of knowledge and practice of allergy, asthma and immunology for clinicians entrusted with the care of patients, it is our hope that the new knowledge contained within these communications will contribute to efficient workup and optimal therapy for a wide array of clinical problems seen by the clinician on a daily basis. These papers elucidate the magnitude of allergic and respiratory conditions in various populations, ranging from infancy to the elderly and from various regions around the world. On behalf of the editorial board, through whose unstinting efforts of manuscript review
O D
390
and recommendations the Proceedings subsists, we hope you will enjoy this diversity of literature. Joseph A. Bellanti, M.D. Russell A. Settiane, M.D.
Y P
REFERENCES 1.
2.
3.
4. 5.
6.
Bartholow AK, Deshaies DM, Skoner JM, and Skoner DP. A critical review of the effects of inhaled corticosteroids on growth. Allergy Asthma Proc 34:391– 407, 2013. Bielory L, Meltzer EO, Nichols KK, et al. An algorithm for the management of allergic conjunctivitis. Allergy Asthma Proc 34:408 – 420, 2013. Reddy V, and Ghaffari G. Eosinophilic esophagitis: Review of nonsurgical treatment modalities. Allergy Asthma Proc 34: 421– 426, 2013. Madeo J, Li Z, and Frieri M. Asthma in the geriatric population. Allergy Asthma Proc 34:427– 433, 2013. Hsu JY, Huang WC, Huang PL, et al. Usefulness of offline fractional exhaled nitric oxide measurements in the elderly asthmatic patients. Allergy Asthma Proc 34:434 – 438, 2013. Clark S, Espinola JA, Rudders SA, et al. Favorable trends in the frequency of U.S. emergency department visits for food allergy, 2001–2009. Allergy Asthma Proc 34:439 – 445, 2013. Viswanathan RK, Moss MH, and Mathur SK. Retrospective analysis of the efficacy of omalizumab in chronic refractory urticaria. Allergy Asthma Proc 34:446 – 452, 2013. Olivier CE, Pinto Argentaõ DG, dos Santos Lima RP, et al. The nasal provocation test combined with spirometry establishes paradoxical vocal fold motion in allergic subjects. Allergy Asthma Proc 34:453– 458, 2013. Santillan Salas CF, Mehra S, Pardo Crespo MR, and Juhn YJ. Atopic conditions other than asthma and risk of the 2009 novel H1N1 infection in children: A case-control study. Allergy Asthma Proc 34:459 – 466, 2013. Tsai YJ, Lin CH, Fu LS, et al. The association between Kawasaki disease and allergic diseases, from infancy to school age. Allergy Asthma Proc 34:467– 472, 2013. Hernández E, Barraza-Villarreal A, Escamilla-Núñez MC, et al. Prenatal determinants of cord blood total immunoglobulin E levels in Mexican newborns. Allergy Asthma Proc 34:e27–e34, 2013. Boonpiyathad S, Pornsuriyasak P, Buranapraditkun S, and Klaewsongkram J. Interleukin-2 levels in exhaled breath condensates, asthma severity, and asthma control in nonallergic asthma. Allergy Asthma Proc 34:e35– e41, 2013. Scott DR, Chan S, Chang J, et al. Recurrent fevers and failure to thrive in an infant. Allergy Asthma Proc 34:473– 479, 2013.
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