Bibliographic updates

The Monthly choice - June 2016

Claude Molina & Jacques Gayraud

1.      Patterns of growth and decline in lung function in persistent childhood asthma
2.      Serious events with Fluticasone+ Salmeterol versus Fluticasone alone  
3.      Clinical relevance of molecular diagnosis of pet allergy
4.      Higher omega-3 Fatty-acid levels contribute to the asthma-protective effect of farm milk                                            

1. Patterns of Growth and Decline in Lung Function in persistent Childhood Asthma
M.J.McGeechie et al NEJM 2016 12 May  3741842-1852    
Looking for links between childhood asthma and subsequent chronic airflow obstruction in the 3th decade of life, the authors classified asthmatic children in 4 patterns of lung function growth and decline on the basis of graphs showing values of FEV 1.
Of the 684 study participants 514 (75%) had abnormal patterns:
-         176 had reduced growth and early decline,
-         160 (23%) had reduced growth only
-         and 178 (26%) normal growth and a early decline.

Lower baseline values for FEV1 and airways responsiveness with smaller bronchodilator response and male sex are associated with reduced growth. At the last spirometric measurement 73 participants 11% met criteria for COPD.                                          
In conclusion children with persistent asthma and reduced lung function are at increased risk for fixed airways obstruction and possibly COPD in early adulthood.

2. Serious events with Fluticasone (F) + Salmeterol (S) versus Fluticasone alone
D.A.Stempel NEJM 2016 374 1822-30
A multicenter randomized trial was designed to evaluate the risk of administering LABA  S in  a fixed dose combination with F in a single inhaler,  compared with F alone.     
11,679 patients,12 to 64 years of age, with persistent Asthma were treated during 26 weeks. The primary safety end-point was the 1st serious asthma event; the efficacy end point was the 1st severe exacerbation.  At the end of this study:
-         34 patients had serious asthma related events in S+F group,
-         38 in the F group.

There were no asthma- related death.  2 patients in the F group underwent hospitalization and intubation. The risk of severe exacerbation was 21% lower in the S+F group than in the F group with at least 1 severe exacerbation in 480 of 5834 S+F as compared with 597 of 5845 patients in the F group.                                                                              
In conclusion the treatment of persistent asthma by a fixed dose combination of S+F in a single inhaler did not have a significantly higher risk of serious asthma-related events that did those who received F alone. There were fewer exacerbations in the 1st group.

3. Clinical relevance of molecular diagnosis of pet allergy:  
A.Uriarte et J.Sastre: Allergy 20164 may Accepted Articles

Sensitization to pets are present in up to 60% of European households. The Spanish authors describe the patterns of specific pet IgE to whole extracts and recombinant allergens and their association with clinical symptoms.
159 patients with Rhinitis/ Asthma (R/A) sensitized to dog cat and horse were recruited.  

-         Specific IgE to Can f1 was significantly associated with persistent R, Can f2 with A, Can f3 with moderate/severe R, Can f 5 with R.
-         Positive IgE to Fel d2 was associated with R and A.                            
-         Equ  c1 with moderate R,  Equi c3 with persistent R and  severe A.

Sensitization to more  than 2 molecules or to pet albumins was associated with severe respiratory symptoms.                                    
In conclusion, molecular diagnosis in patients with pet allergy may help clinicians to predict clinical symptoms and their severity.

4. Higher omega-3 Fatty-acid levels contribute to the asthma-protective effect of farm milk                                         
T.Brick et al JACI June 20161699-1706                                                    
In a study of 934 children living in rural areas in 5 European countries from birth to age 6 years the authors showed that the risk of asthma was reduced by previous consumption of unprocessed farm milk compared with shop-milk. This effect was explained by higher fat content of farm milk, particularly higher content of omega-3 poly-unsatured fatty acids.

However, consumption of raw milk is no solution because it bears a risk of potentially life-threatening infections. Hence there is a need to identify those components of native cow's milk that carry this asthma-and allergy-protective, as well as anti-infectious, effect. A candidate molecule class with relation to immune functions are the microRNAs (miRNAs), which have been described in both cow's milk and human breast milk (B.Kirchner et al :JACI même n° 1893-95) and interfere with genes implied in allergy and asthma development.

*Your comments and questions are welcome at the following addresses:

Claude Molina
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Jacques Gayraud
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Last updated 27 December 2016