Bibliographic updates

The Monthly choice
Claude MOLINA* and Jacques GAYRAUD**

1. Omalizumab in Asthma and risk of malignancy
2. Prognostic value of Component-resolved diagnosis in peanut allergy
3. Oral Immunotherapy for peanut allergy
4. Asthma and Depression
5. Clinical problems: Angioedema, Anaphylaxis

1. Omalizumab (O) in Asthma and risk of malignancy

Theme: Treatment in Allergy
Key words: Omalizumab, Asthma, Malignancy

(A.Long et al : JACI in press 2014 27 March)
A long term (O) safety and clinical effectiveness in moderate to severe asthma in 2 prospective observational cohorts (with and without O) suggest that O therapy, after 5 years, is not associated with an increased risk of malignancy.

2. Prognostic value of Component-resolved diagnosis in infants with peanut-allergy

Theme: Food allergy - Allergens
Key words: Pronostic in Allergy – Component-resolved diagnosis – Peanut allergy.

(Philippe Bégin et al ,Ped.Allergy, Immunol 2014 early view, 18 March).
Using a longitudinal cohort of peanut allergic infants and toddlers (110; mean age 14 months), the authors show that Ara h1, Ara h2 and Ara h3 are the dominant allergens, confirm the diagnostic value of component-resolved diagnosis. However the results are redundant with specific IgE and do not provide additional independent predictive value at 13 years.

3. Oral Immunotherapy for peanut allergy

Theme: Treatment in Allergy – Immunotherapy - Allergens
Key words: Peanut allergy – Oral Immunotherapy

(K.Anagnostou et al : The Lancet 2014 383 9925 1297-1304)
In a randomized controlled crossover trial of Oral Immunotherapy (OIT) in 99 children, age 7-16 years, the team of Cambridge (UK) demonstrates that OIT successfully induced desensitization in most children (62% in active group and none of the control group) with a clinically meaningful threshold (800mg : approximately five peanuts), improvement of quality of life, a good safety profile and corresponding immunological features. Wider studies in specialist’s settings are recommended.

4. Asthma and Depression

Theme: Asthma
Key words: Asthma - Depression

(T.D Trojan et al : Annals of Allergy Asthma Immunol 2014 April in press)
A cross-sectional study of 12.944 adults conducted from 2000 and 2012 at the Cooper Clinic (Dallas Texas) has shown that Asthma was significantly associated with an increase of current depressive symptoms. A lifetime depression was observed in a large sample of adults, predominantly white and well educated. Likelihood of depression is not exclusively related to poorly controlled or severe asthma. Asthmatics may benefit from depression screening in clinical settings.

5. Clinical problems: Angioedema Anaphylaxis Isolated Uvular Angioedema

Theme: Anaphylaxis
Key words: Angioedema – Angiotensin converting enzyme inhibitor.

(A.V.Tejedor NEJM 2014 April 10 e24)
A 59 years old man is admitted to the coronary care unit for myocardial infarction. A bare-metal stent was successfully implanted in the circumflex coronary artery, followed 6 hours later, by injection of 6.25 mg of Captopril: an Angiotensin converting enzyme inhibitor (ACE). After 30 minutes the patient reported throat pain and difficulty swallowing. On examination, only the uvula was markedly edematous: Improvement was obtained within 24 hours by antihistamines and glucocorticoids. The clinician must be aware of this uncommon response to ACE.

In this connection: an excellent review: Anaphylaxis to bee sting: a common problem for allergists: (T.B Casale and W.Burks :NEJM 2014 370 1432-9).

Cl. Molina

Analysis and comments in French are available on
Last updated 31 October 2014