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Azithromycin and molecular biomarkers of exacerbations in uncontrolled asthma
Fricker, Michael et al.Journal of Allergy and Clinical Immunology, Volume 144, Issue 1, 51 - 60.e11

AZ is often used as add-on treatment which reduces asthma exacerbations. The Australian authors compared the potential of several biomarkers including sputum 6-gene expression signature to predict responses to inhaled and oral corticosteroids. Compared with blood eosinophils, this signature demonstrated a significant better performance and was not altered by Az treatment (48 weeks ) suggesting a mechanism independent of inflammatory pathways and appearing as a new  tool  to aid in asthma management.

 

 

Azithromycin prophylaxis in patients with primary antibody deficiencies
Milito, Cinzia et al. Journal of Allergy and Clinical Immunology, Volume 144, Issue 2, 584 - 593.e7

In a double blind randomized trial (44 patients vs 45 Placebo), Az in low dose (250mg, 3 consecutive days a week) decreased the frequency of annual respiratory infections. This is the first research proving the efficacy and safety of the macrolide. In the same time Az reduced the need for other antibiotic courses and the risk of hospitalization and improved quality of life. It did not increase the rate of macrolide-resistance organisms such Haemophilus influenzae or Streptococcus pneumoniae, nor adverse side effects. It deserves consideration in clinical practice.

 

 

Relationship and controversy between adult onset and childhood atopic eczema
Abuabara, Katrina et al. Journal of Allergy and Clinical Immunology, Volume 144, Issue 3, 710 - 719

Atopic eczema onset is described primarily in early childhood, but the frequency and characteristics of adult-onset disease remain controversial. A group of British and Australian researchers   sought to determine the proportion of subjects who report atopic eczema symptoms between birth and midadulthood and conducted a longitudinal study using data from 2 nationally representative community-based birth from birth through age 42 to 50 years. The primary outcome was the age period of self-reported atopic eczema symptom onset.                                                                                                         

Results:
- The annual period prevalence of atopic eczema ranged from 5% to 15% in 2 cohorts of more than 17,000 participants. There was no clear trend in prevalence by age, and among adults reporting active atopic eczema during a given year, only 38% had symptom onset reported in childhood.
- Those with adult-onset disease were more likely to be women, from Scotland or Northern England, of lower childhood socioeconomic group, smokers in adulthood, and less likely to have a history of asthma, filaggrin-null mutations, or allergen-specific IgE.


 



Adjuvant-induced more effective subcutaneous desensitization therapy for honey-bee venom allergy
Heddle, Robert et al. Journal of Allergy and Clinical Immunology, Volume 144, Issue 2, 504 - 513.e16

R heddletThis current subcutaneous Immunotherapy is costly and time consuming. Adding a plan-based adjuvant polysaccharide known as delta inulin or Advax, frequently used in Australia,  is an approach which may enable faster and more effective immunotherapy. In a trial randomized on 27 patients divided-up in 2 groups, Immunotherapy combined with Advax was administered monthly for 30 months, was well tolerated and induced specific IgG 4 around week 14, earlier, higher peaked and better maintained in the group with Advax. In conclusion, Advax adjuvant enhances immunogenicity of Honey-bee venom allergy. Its ability to improve clinical efficacy of venom or other allergens immunotherapy warrants further studies.


 


Treatment of hypertension in patients with asthma
Christiansen, Sandra & Zuraw, Bruce L. N Engl J Med 2019; 381:1046-1057

This is an excellent review, devoted to 2 chronic diseases each with morbidity, mortality and economic effects. Worldwide 300 millions people have asthma and the presence of HTA creates an additional burden and risk factor leading to death. A diagnosis of HTA (more than 140mmHg) is associated with Asthma severity and reduced lung function has been correlated with heightened cardiovascular mortality. On the contrary risk of death from cardiovascular disease is decreased when blood pressure is reduced to levels below 130mm Hg. 
In a long chapter the mechanisms of this bidirectional relationship are related showing a systemic inflammation fundamental to the pathogenesis of both conditions, the degree of which reflecting the conjoint effect of the two entities. The cytokines Th1with INF y and IL17 for HTA, the cytokines Th2 for Asthma in its low phenotype (older age, late onset, severity  higher Body-mass index BMI) revealed by C-reactive protein, and also IL 17,  all factors which contribute towards hypertrophy of vascular smooth muscle on one side and airways smooth muscle with bronchoconstriction and remodeling on the other side.                                                                     
On clinical point of view the association HTA-Asthma has for target, patients of female sex, with economic low income, with obesity and risk of sleep-apnea. The treatment of HTA, in correlation with cardiologist, is mentioned and composed of the large family of hypotensive drugs and must avoid bronchoconstrictor β-blockers.
Pharmacotherapy of Asthma must be associated to salt-free diet, and change of style life.

 

 
Your comments and questions are welcome at the following addresses:
Claude Molina - claude.nelly.molina@orange.fr                                                     
Jacques Gayraud - gayraud65@wanadoo.fr

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Last updated 02 October 2019
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