Bibliographic updates

The Monthly choice - September 2015
Claude MOLINA* & Jacques GAYRAUD**

1.    Cockroach sensitization as surrogate of microbial exposure and mitigation of Allergic Rhinitis.
2.    Conversely, are rigorous personal or home cleanliness a risk for Asthma or Allergy?
3.    Early-term birth and respiratory morbidity.                      
4.    Mode of delivery and Childhood Asthma.                                      
5.    Omalizumab is an effective and safe therapy in Chronic Spontaneous and Inducible Urticaria in Adults and Children.

1.    Cockroach sensitization ( C+) as surrogate of microbial exposure and mitigation of Allergic Rhinitis (AR)
W.He et al :JACI sept 2015 136  3 658-666                      
Theme: Rhinitis – Respiratory allergy
Key words: Cockroach sensitization – Hygiene hypothesis

C+ assayed by skin prick tests in  patients with AR,  in natural settings or  allergen challenges ( 21 to HDM, 21 to mountain cedar , 34 to oak, 23 to ragweed) revealed mitigation of symptom severity and more rapid resolution of inflammation induced by aero-allergens,  which confirms that C+ may serve as proxy for prior microbial exposure and argue the concept of hygiene hypothesis. However cockroach allergens are not well known.

2.    Conversely, Are rigorous personal or home cleanliness a risk for Asthma or Allergy?
J.Weber et al (AJRCCM 2015 191 n°5 522-529 )                           
Theme: Asthma – Respiratory allergy
Key words: Home cleanliness – Allergy risk – Asthma risk – Hygiene hypothesis

In a comprehensive study of a German cohort  (399 children), the authors showed that, if bacterial exposure (or microbial biomarkers in house dust) is associated with reduced prevalence of  atopic sensitization or  childhood asthma, neither personal nor home cleanliness  (reflected by dust parameters) was associated with a risk for asthma or allergies. This is a limit to the interpretation of hygiene hypothesis

3.    Early-term birth and respiratory morbidity           
M.O.Edwards et al JACI :2015 Sept  136  3 581-587                
Huan .E et al : AJRCCM 2015 August 192  520-521                    
Theme: Asthma – Respiratory allergy
Key words: Early-term birth – Asthma risk

Two epidemiologic studies, the 1st from United Kingdom, the 2nd from USA tried to assess whether early-term born children (ETB) have greater respiratory symptoms
(Wheezing or Asthma) compared with full-term born (FTB) ones. EB births are defined as birth at 37 to 38 weeks’ gestation compared with 39 to 42 for FTB. In UK, of 2845children, surveyed 1-to 10years, EB birth lead to increased admissions to the neo-natal units and hospital  in the first year. In children less to 5 years old there was a higher rate of wheeze (49% versus 39%). Similarly children older than 5 years reported higher rate ever or recent wheezing over the last 12 months, than FTB subjects. these symptoms persisted even  when stratified by family atopic history or mode of delivery.                                                                               
As for Asthma, of 2540 American children surveyed 5 to-7,8 years, an increased prevalence was observed in ET birth subjects,  compared with FTB ones, whatever the age range of Asthma  or length of  follow-up.     
ET birth is for the authors an important risk of Asthma and early delivery should be avoided where possible.

4.    Mode of delivery and Childhood Asthma                    
A.C.Van Berkel et al :Ped.All.Immunol 26 330-33
Theme: Asthma – Respiratory allergy
Key words:  Mode of delivery – Asthma risk.

The authors examine the associations of different modes of delivery with childhood wheezing patterns, asthma, FeNO and airways resistance, up to school age. In a cohort of 6128 children from Netherlands, increased risk of early and persistent wheezing  was associated  with caesarean section , whether the process is elective or emergency.

Only elective cesarean was associated with a higher Fe NO level.         
The other modes of delivery (vaginal, forceps-assisted) were not associated with any asthma or related outcomes.                                  
In conclusion, elective and emergency caesarean section are associated with increased risks of early and persistent wheezing up to school age. This is probably due to airways inflammation reflected by higher FeNO level.

5.    Omalizumab is an effective and safe therapy in Chronic Spontaneous and Inducible Urticaria in Adults and Children.
Theme: Urticaria – Skin allergy
Key words: Omalizumab – Chronic urticaria

In Adults, recent trials came to the conclusion that O is an effective and rapidly active therapy in randomized and real life cases of CSU or CindU. when standard of care with H-1-antihistamines, even at-up to 4 times the approved dose,  is inefficient. The optimal dose of 300mg by subcutaneous injections at 4 weeks intervals, during 12 to 24 weeks confirms rapid resolution, and good tolerance , (A.Kaplan US, M.Metz : Germany),  even longer than 1 year (D.Har US). Periodic attempts at weaning patients should be performed to test a chance of remission. Anyway after retreatment, patients experienced complete response (M.Metz).                        
In children, due to the low prevalence of CU, O has not be studied in large cohorts (U. Wahn : Germany) except in Thailand (S. Chansakulporn: 92 children) and O has been only used after the age of six in asthma. However recent reports of refractory solar and physical Cind U (S.Arasi:  Italia  or A.Levi : Israël or l E .Netchiporouk  Caanada) have shown beneficial effects and good tolerance of O in children of 6 to 16 years.

*All the references may be found in PubMed or sent on demand to:
Claude Molina                    
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Jacques Gayraud
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Last updated 19 October 2015