Bibliographic updates

*The Monthly choice - October 2014
Claude MOLINA* & Jacques GAYRAUD**

1)Application of moisturizer to neonates prevents development of Atopic Dermatitis (AD) The Japanese trial (K.Horimukai et al JACI 134 4 824-830)

In a randomized study of 118 neonates , the authors demonstrate that daily application of moisturizer during the first 32 weeks of life , significantly reduces the risk of AD/eczema in infants, but not allergic sensitization ( IgE antibody against egg-white) . Moreover , the intervention group has higher level of stratum corneum hydration than the control group . Hovever , during this time period, allergic sensitization was associated with the presence of eczematous skin

2) Prevention of Atopic Dermatitis by enhancement of the skin barrier with emollients: The Anglo-American trial: Portland Nottingham , Dundee (E.L.Simpson JACI 2014 134 4 818-823)

In a randomized controlled and joint trial, performed in the USA and UK, emollient therapy from birth, on 124 neonates at high risk for AD ,significantly reduced of 50% at 6 months, the relative risk of incidence of the disease and represents a simple, feasible, safe, low-cost and effective intervention which may prevent AD and maybe allergic sensitization and the global burden of allergic diseases . Recent advances in cutaneous biology suggest skin barrier defects as key initiators of AD

3) Relationship between Pollen exposure and drug treated Seasonal Allergic Rhinoconjunctivitis (SAR) over 10 years ( D.Caillaud et al Allergy Octobre 2014 accepted articles)

In an urban area in central France the prevalence of SAR rose by about 55% in 10 years . Comparative study of Pollen concentrations and daily anti-allergic drug prescriptions (oral and local) demonstrate that the relative risk of SAR significantly increases with pollen concentration of Fraxinus, Betula Poaceae, for the whole pollen season and Urticaceae in the 1st semester , but also for Carpinus, Platanus in spite of their low pollen counts . A robust correlation with Parietaria suggests a potential role of this species in this non –Mediterranean area

4) Pathophysiological features of Asthma in the Elderly

(Hideki Inoue et al : Annals of Allergy Asthma, Immunol 2014 October in press) Comprehensive studies are scarce in this field, in spite of their clinical importance. Study of 45 asthmatic older than 65 years and 67 non elderly asthmatics, retrospectively analyzed by spirometry, computed tomography, impulse oscillation analysis , showed that elderly patients with asthma have greater involvement of small and larger airways than non elderly asthmatics. Moreover total and specific IgE levels against several allergens are significantly lower in elderly

5) Usefulness of FE NO in Asthma

Evidence is given by 3articles

Impact of FENO measurement on treatment decision in Asthma (Craig La Force et al: Annals of Allergy,Asthma Immunol Sept 2014in press)
Based on observation of fifty asthmatics 7 to 60 years old, knowledge of FENO measurement, affects medication treatment decision to augment or decrease pharmacotherapy, which has important long-term asthma management and has the potential to lower the costs and morbidity associated with asthma exacerbations

Responsiveness to metacholine correlates with FENO in Asthma
(Wei-je Guan et al Clin.Resp.Journal sept 2014 ahead of print

In 62 asthmatic patients enrolled, the Chinese group of Canton University demonstrates a significant correlation between FENO performed by a portable instrument and airways responsiveness to inhaled metacholine , particularly in non smokers and without rhinitis but not to LTD4

Occupational Asthma ( OA) phenotypes identified by increased FENO after exposure to causal agents (C.Lemière et al JACI August 2014 in press)
Increase in FENO after exposure to agents causing OA, occurs more consistently in subjects with OA caused by high molecular weight agents (ex: cereals, flour) than in those with OA due to low-molecular weight ( ex:isocyanates)

Claude Molina
Jacques Gayraud

Last updated 28 January 2015