Bibliographic updates

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

1. Mite specific extracts suitable for worldwide immunotherapy
2. Sublingual mite-specific immunotherapy in asthma
3. A new faster and safe nasal provocation test for mite allergic rhinitis
4. Nocturnal Eczema: sleep and circadian rhythms in children  
5. Asthma and pregnancy

I - Mite specific extracts suitable for worldwide immunotherapy
T.Batard et al :Allergy :2015 October  Accepted articles

To design such products appropriate to treat children and adult Dermatophagoides allergic patients, the authors had explored the patterns of IgE sensitization from cohorts living in various geographical areas (1302 patients).  
IgE specific for 12 purified allergens from D. pteronyssinus  or D. farinae were assessed in sera by microarray assay and mass spectrometric. It appears that all patients have IgEs to allergens present in mite bodies and feces. So a mixture of D. pt and D. f  manufactured from these two sources is suitable for Mite specific immunotherapy in Europe, Asia and North America.

II - Sublingual Mite-Specific Immunotherapy in Asthma
P.Devilliers et al Allergy  October 2015   Accepted articles                      

In a clinical, randomized trial, 484 French adults 16 to 50 years of age, suffering from moderate persistent asthma, were submitted to a daily treatment   by a sublingual solution of D. pt and D. f extracts during 12 months. This is one of the largest studies in such cases. Analysis of the efficacy data revealed a significant active versus placebo difference, in both well or totally controlled moderate asthma. No serious adverse events were reported. However a high incidence of abdominal pain was noted, surprisingly in active as well as in placebo groups, usually rare in sublingual therapy.
In conclusion, in patients allergic asthma to house dust mite (HDM) sublingual immunotherapy is safe, well tolerated and of value for asthma, requiring low to moderate doses of inhaled glucocorticoids.

III - A new faster and safe nasal provocation test for mite allergic rhinitis Blay et al.  Annals of All.Asthma Immun 2015 115 5 385-390.

Nasal Provocation Test (NPT) is the gold standard of diagnosis in allergic rhinitis, but it is time-consuming and its use is limited because it requires a skin end-point titration  and measurement of nasal patency by rhinomanometry. The French authors suggest a faster and easier alternative (NPT-R) which was evaluated in 88 patients with rhinitis (49 allergic to HDM and 39 controls with and without atopy). The NPT-R was performed 4 weeks after the classic NPT and only the clinical score was measured.                                         The study population was young (mean 27.7) composed mostly of women (61 vs 27), 24% reported asthma. The sensitivity and specificity of NPT-R were 83,7% and 100% respectively. The correlation with NPT was statistically significant (P≤ 0.0001); the two tests were completely safe. Performing NPT-R was more rapid (22+/-8 minutes vs 97 +/- 20minutes).                 
This new method appears to be useful in case of uncertain diagnosis or before immunotherapy.

IV - Nocturnal Eczema: sleep and circadian rhythms in children
A.B.Fishbein et al : JACI 2015 136 5 1170-1177        

Children with atopic dermatitis (AD) experience significant sleep disruption and the disease worsens in a circadian manner, at night with negative consequences and impaired linear growth. Assessing sleep is a crucial parameter of disease control with appropriate treatment. The mechanism of the nocturnal and the role of sleep cycle and circadian rhythms (assessed by Polysomnography and Actigraphy) are discussed, as well as treatment options, future directions for research.

V - Asthma and Pregnancy
S.Kim :JACI 2015 November 136 5 1215-122

Uncontrolled maternal asthma is associated with a range of adverse perinatal outcomes. The effect of pregnancy on health care use and prescriptions patterns had been evaluated in an epidemiologic randomized study of Corean National Health Insurance data, between 2009 and 2013.
3,357 pregnant asthmatic patients (PAP) were compared with 50,355 non pregnant asthmatics ( NPA ) and 10,311 pregnant patients (PP). The results are surprising :            
- PAP underwent more hospitalizations but significant fewer drug prescriptions and outpatient visits,  than NPA.
- The prevalence of asthma exacerbations during pregnancy was 5,3% but the risk of perinatal outcomes  afterwards was not increased , except for cases of cesarian section.                            
That is precisely what Finnish authors studied in a cohort of 60,069 children, followed during 21 years, underlining increased frequency  of cesarian section rates worldwide  and the risk of “non communicable diseases” ( NCD ). (R.Miettinen et al JACI 2015 Nov 136 5 1398-1399).

In fact the prevalence of NCDs was significantly greater in children born by means of cesarian section than in children born by vaginally delivery due to heigthened cases  of asthma, obesity and celiac disease. The role of mother’s intestinal microbiome is discussed.

Comments and remarks may be sent to:
Claude Molina                    
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Jacques Gayraud
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Last updated 18 January 2016