Bibliographic updates

The Monthly choice
Claude MOLINA* and Jacques GAYRAUD**

1. History of Allergic diseases and Lung Cancer risk
2. Competitive swimming and airways inflammation :a 3 years longitudinal study
3. Best response to step-up asthma therapy
4. Stress ad Atopy
5. A new target for the treatment of Allergic Asthma
6. Acquired Angioedema(A.A.E) :short term prophylaxis

1. History of Allergic diseases and Lung Cancer risk

Item: Physiopathology of Allergy
Key words : Allergy – Lung cancer

M.El-Zein et al: Annals of Allergy Asthma Immunol 2014 112 230-236.
Using data from a population (based case-control), in this study conducted in the Montreal metropolitan area (1996-2002) from 1169 incident lung cancer cases (1486 controls) and their possible association with a history of allergy, the authors found that the 3 main allergic diseases are inversely associated with lung cancer, although the protective effect after consideration of potential confounders, including life-time smoking history, is weaker for asthma, of moderate strength for eczema and strongest for hay fever.

2. Competitive swimming and airways inflammation :a 3 years longitudinal study

Item: Physiopathology of Asthma
Key words : Airways inflammation – Competitive swimming

M.Couto et al : Ped Allergy Immunol 2014 25 193-195).
In 120 non elite young swimmers from two main Portuguese teams, a prospective study at 3 years follow-up, showed that those who remained active (high level of competitive swimming) significantly increased their levels of airway inflammation measured by exhaled NO, independently of their gender, age, atopy or asthma status. Nevertheless asthma incidence did not increase in this group and physical training is still recommended in asthmatic children as long as the disease is controlled.

3. Best response to step-up asthma therapy

Item: Asthma, Paediatrics allergy
Key words : Asthma – Inhaled corticosteroids – Long acting 2 agonists – Anti Leukotrienes

(J.Malka et al JACI 2014 May in press Letter to the editor).
In 163 children inadequately controlled to low-dose of inhaled corticosteroids (ICS ) the addition of a Long-Acting-β2-agonist is compared to increasing the ICS dose or adding a leukotriene receptor antagonist (LTRA) in a randomized triple cross over trial of 16 weeks. The best response for the entire study was LABA step-up. A post-hoc analysis showed that eczema and race are determinants for differential response: a best response to LABA in asthmatics without history of eczema; in asthmatics with history of eczema : black children are more likely to respond to ICS step-up; white Hispanic to LTRA and white non Hispanic to LABA or LTRA.

4. Stress ad Atopy

Item: Psychology allergy
Key words : Stress – Atopy - Pregnancy

(I.RV Hartwig and all: JACI 2014 in press 23/04)
In a study of 1587 Australian children, the authors found a significant association between prenatal maternal stress (adverse life events) during the second half of gestation and increased likelihood of asthma and eczema at age 6 years or 14 years. A stronger increase in the odds to develop asthma was present in children of mothers without asthma compared with mothers with asthma (which is all the more plausible that the pre-existing maternal hereditary component is absent).

5. A new target for the treatment of Allergic Asthma

Item: Physiopathology of asthma – Asthma treatment
Key words : Thymic Stromal Lymphöpoietin – AMG 157

(G.M.Gauvreau et al : NEJM 2014 May 29 370 2102-2110)
A monoclonal antibody against Thymic Stromal Lymphöpoietin (TSLP): AMG 157, an epithelial derived cytokine, randomly assigned to 31patients with mild allergic asthma, significantly reduced allergen-induced bronchoconstriction (early and late response) and airways inflammation (decrease of blood and sputum eosinophils and fraction of exhaled NO ) . The clinical value of this anti-TSLP therapeutic deserves further and extensive work.

6. Acquired Angioedema(A.A.E) : short term prophylaxis

Item: Physiopathology of Allergy – Immune deficiency
Key words : Acquired angioedema – C1. Inhibitor - Angiotensin-Converting-Enzyme Inhibitors

(H.Farkas JACI April 24 in press Letter to editor): 1 case*
A.Tohani : Annals of Allergy Asthma Immunol 2014 265-266: 3 cases**
A.A.E resulting from the deficiency of the C1-Inhibitor associated with lympho proliferative or auto-immune disorders is rare and differs from drug-induced AAE due to ACEI (Angiotensin-Converting-Enzyme Inhibitors) cured by corticoids and anti-histamines and elimination of the trigger factor.
Here the diagnosis is established by clinical symptoms: (edematous cutaneous and subcutaneous attacks, onset after 40 years, negative family history, and Complement testing: C1-INH normal or low, C1q level strongly reduced. Plasma derived C1-INH concentrate (Berinert® is used in small observational studies before surgery for short term prophylaxis, but for the first time, in this single case*, recombinant human rh-C1-INH (Ruconest®) intravenously was successful. However therapy of underlying disease is essential** (chemotherapy, rituximab).

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Last updated 31 October 2014