The Year in Allergy Volume 3

334 Pages·2006·1.89 MB·English

by  S. Hasan Arshad

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T H E Y E A R I N
A L L E RG Y
VO L U M E 3
EDITED BY
S HASAN ARSHAD AND STEPHEN T HOLGATE
CLINICAL PUBLISHING
OXFORD
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Contents
Editors and contributors vii
Foreword ix
Preface xi
Part I
Epidemiology and genetics
1. Epidemiology and risk factors 3
Wilfried Karmaus
2. Genetics of asthma and allergy 19
Susan Ewart
Part II
Pathophysiology and diseases
3. Airway inflammation 45
Gordon Dent
4. Atopic dermatitis 71
Hasan Arshad
5. Allergic rhinitis 91
Hasan Abid
6. Systemic allergic reactions 111
Graham Roberts
7. Food allergy 129
Taraneh Dean
8. Drug allergy 147
John Mucklow
9. Immunodeficiency 171
Richard Baretto, Sarah Goddard, Aarnoud Huisson, Mamidipudi T Krishna
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VI CONTENTS
Part III
Treatment modalities for allergic diseases
10. Environment control 193
Hasan Arshad
11. Immunotherapy 213
Anthony Williams, Richard Baretto, Mamidipudi T Krishna
12. Bronchodilators (including PDE-4 inhibitors) 231
Brett Pereira
13. Corticosteroids and asthma 245
Suresh Babu, Jaymin Morjaria
14. Experimental therapies for allergic disorders 269
Jaymin Morjaria, Suresh Babu
15. Other therapies (antihistamines,leukotriene modifiers,
calcineurin inhibitors,anti-lgE) 285
Brett Pereira
Acronyms/abbreviations 305
Index ofpapers reviewed 309
General index 323
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Editors
S Hasan Arshad, DM, FRCP
Senior Lecturer in Respiratory Medicine and Allergy,Schools ofMedicine and
Life Sciences,Keele University,Keele,Staffordshire,UK
Stephen T Holgate, DSC, FRCP
Medical Research Council Clinical Professor ofImmunopharmacology,School of
Medicine,University ofSouthampton,Southampton,UK
Contributors
S Hasan Abid, FCPS
Associate Professor,Department ofOtolaryngology,Dow University ofMedical
Sciences,Karachi,Pakistan
S Hasan Arshad, DM, FRCP
Senior Lecturer in Respiratory Medicine and Allergy,Schools ofMedicine and
Life Sciences,Keele University,Keele,Staffordshire,UK
K Suresh Babu, DM
Research Fellow,Southampton General Hospital,Southampton,UK
Richard L Baretto, PHD, MRCP, MRCPATH
Consultant Immunologist,Department ofImmunology,Leicester Royal
Infirmary,Leicester,UK
Taraneh Dean, PHD
Reader in Epidemiology,School ofHealth Sciences and Social Work,University of
Portsmouth,Portsmouth,UK
Gordon Dent, PHD
Lecturer in Pharmacology,Institute ofScience and Technology in Medicine,Keele
University,Keele,Staffordshire,UK
Susan Ewart, PHD
Associate Professor ofGenetics,Michigan State University,East Lansing,
Michigan,USA
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VIII CONTRIBUTORS
Sarah Goddard, PHD, MRCP, DIP RCPATH
Specialist Registrar,Department ofImmunology,Birmingham Heartlands
Hospital,Birmingham,UK
Aarnoud Huissoon, PHD, MRCP(I), MRCPATH
Consultant Immunologist and Honorary Senior Clinical Lecturer,Department of
Immunology,Birmingham Heartlands Hospital,Birmingham,UK
Wilfried Karmaus, MD, DR.MED, MPH
Professor ofEpidemiology,University ofSouth Carolina,Columbia,South
Carolina,USA
Mamidipudi Thirumala Krishna, PHD, FRCP, MRCPATH
Consultant Immunologist and Honorary Senior Clinical lecturer,Department of
Immunology,Birmingham Heartlands Hospital,Birmingham,UK
Jaymin Morjaria, MD, MRCP
Research Fellow,Southampton General Hospital,Southampton,UK
John Mucklow, MD, FRCP, FBPHARMACOLS, DIPMEDED
Consultant Physician,Department ofClinical Pharmacology,University Hospital
ofNorth Staffordshire,Stoke-on-Trent,UK
Brett Pereira, MD, MRCP
Consultant Physician,Department ofRespiratory Medicine,Kent and Canterbury
Hospital,Canterbury,Kent,UK
Graham Roberts, DM, MSC, MRCPCH
Clinical Senior Lecturer,Paediatric Allergy and Respiratory Medicine,School of
Medicine,University ofSouthampton,Southampton,UK
Anthony P Williams, PHD, MRCP, MRCPATH
Wellcome Trust Clinician Scientist and Honorary Consultant Immunologist,
University ofSouthampton and Department ofImmunology,Southampton
General Hospital,Southampton,UK
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Foreword
N FRANKLINADKINSONJR, MD
Professor of Medicine and Allergy
Immunology Training Program Director
Johns Hopkins Asthma and Allergy Center
Baltimore, Maryland, USA
In this ‘information age’ofmedicine,researchers and practitioners have easy access
electronically to an ever-increasing portfolio of original research and practice
guidelines.Finding recent literature pertinent to almost any medical problem is a
skill now taught to most medical students,and definitively in post-doctoral med-
ical education.Finding time to read and digest all we can locate and retrieve with
ease is a bigger challenge,but not the biggest one.
After finding and reading a new paper,especially one involving original research,
the important facility is the ability to place it in proper context with what has come
before.To some degree,authors address this chore in the ‘introduction’and ‘discus-
sion’section of their papers.But with increasing frequency,authors are not fully
aware of the significance (or lack thereof) of their work, the determination of
which may require consideration of post-publications dialogues, editorials and
public reactions,and integration with what others know is ‘in press’or underway.
So the optimal time for trying to assess the merits and heuristic value of pub-
lished works may be in the year following its publication,preferably by knowledge-
able and unbiased observers who are monitoring the ‘bigger picture.’Enter now the
third volume of The Year in Allergy which accomplishes this task admirably for
those whose eyes need to be focused on the origins,pathophysiology and treatment
ofallergic diseases.The authors,backed by skilful editorial oversight,have success-
fully reviewed some of the most important papers dealing with allergy published
over the past eighteen months,and put them into proper perspective scientifically
and in most cases clinically as well. Key figures and tables highlight the most
important quantitative findings.The Commentsections identify the significance of
the work and its relationship to previous similar observations,and in some cases to
theories under examination.And then each abstracting section author has written
a conclusion which attempts to assess what ‘progress’has been noted in the topic
area in the recent past,and what obstacles are now impeding needed insights or
data collection.
All in all,this is a wonderfully stimulating way to review recent reports in each
ofthe major areas ofallergic disorders and to get some sense ofhow the field may
have been moved forward in the past year.What I have also found is that these
cogent commentaries have primed me appropriately to read new papers coming
along with a better sense of importance and potential contribution to the field.I
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X FOREWORD
congratulate the Editors on achieving their educational objective, and commend
this book to trainees and experts alike, and to both investigators and clinicians.
Increasingly,I see efforts like this volume as one of the most fruitful formats for
ongoing medical education.
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Preface
STEPHENT HOLGATE, DSC, FRCP
Medical Research Council Clinical Professor of Immunopharmacology
School of Medicine
University of Southampton
Southampton
UK
The Year in Allergyseries is proving to be a very popular source of recent research
findings in allergy.This is the third volume in the series and draws on a research lit-
erature over the last 2 years.We have divided the book into 3 main sections with
individual subjects within each section dealt with separately.While the concept of
allergy has been well accepted since the days ofCharles Blackley who first described
hay fever or hay asthma (catarrhus aestevus) in 1880,and Karl Prausnitz and his
assistant Heinz Kustner who are remembered for the first demonstration in
humans ofreagin (later to be identified as IgE) in 1921,progress since has been rel-
atively slow in determining the role ofatopy in disease pathogenesis.Over the last
decade, however, there has been an explosion of interest in immunology and
immunopharmacology underlying the allergic process through engagement of
both B and T lymphocytes and antigen-presenting cells and their subsets involved
in subverting the immune response towards an allergic state.The identification of
individual chemical substances that contribute to the pathophysiological events of
an allergic response has also provided fertile ground for new discovery including
the development of novel H -antihistamines and cysteinyl leukotriene receptor
1
antagonists.
The clear recognition that all allergic disease and the general state of atopy is
progressively increasing in its incidence worldwide in relation to the adoption ofa
Western-type lifestyle has raised allergy as a public health problem.A better under-
standing ofthe cell and molecular basis ofallergic mechanisms linked to carefully
conducted environmental epidemiology has led to a range ofnew ideas that might
explain these rising trends.In this edition ofThe Year in Allergythere are some new
publications that provide a basis for why these diseases are becoming more preva-
lent and what the underlying environmental factors might be. Allergic diseases,
including rhinitis, asthma, food and insect allergy, and atopic dermatitis, are all
complex disorders with both environmental and genetic factors playing important
roles.The development ofmodern genetic epidemiology and new ways ofexplor-
ing human genetics and epigenetics (gene–gene and gene–environment interac-
tions) in complex disease is leading to the discovery of novel molecules,hitherto
never thought to be involved in disease mechanisms, let alone allergic disease.
Several examples of these are given in this volume including consideration of
gene–environmental interactions.