The Journal Of Allergy And Clinical Immunology – journal both reports, and provides a forum for, asthma and allergy research
Donald Y. M. Leung
ON THE FOREFRONT OF DISCOVERY
This relatively new discipline of allergy/immunology has yielded an ever-expanding understanding of the complex interaction of cells, mediators, genes and molecular mechanisms in the immune response. Today, the specialty brings biomedical science to the bedside with the use of new cellular and molecular research methodologies that dramatically improve patients’ health and quality of life.
The Journal of Allergy and Clinical Immunology (JACI), the premier journal in this field and official publication of the American Academy of Allergy, Asthma and Immunology, provides a forum for the exchange of findings from cutting-edge research conducted in allergic disease. JACI articles detail research in mechanisms of allergic responses as well as clinical applications and strategies to develop new therapies. A continual focus for the JACI is new issues and areas of study that impact allergic disease management and related health care costs. For example, allergy is one of the few medical disciplines that examines the role of the environment in health and disease. This focus is evidenced in numerous Journal articles published within the last year on the influences of pollution, occupational exposures, global technologies, infection and life style on diseases such as asthma, hay fever and atopic dermatitis.
The following section provides summaries of recent provocative JACI articles that have broken new ground for discovery, treatment, and awareness. There is still much to discover and much to understand. But we know that as we continue to question and explore, we come ever closer to achieving our goal of optimal patient care.
RELATIONSHIPS BETWEEN DURATION OF ASTHMA AND ASTHMA SEVERITY AMONG CHILDREN IN THE CHILDHOOD ASTHMA MANAGEMENT PROGRAM (CAMP)
Zeiger RS, Dawson C, Weiss S for the Childhood Asthma Management Program (CAMP) Research Group.
JACI 1999; 103:376-387
There are many factors such as heredity, atopic status and environment that have been identified as influencing the severity of asthma. Until now, there has been little understanding of the extent to which the duration of asthma and its severity are linked. The Childhood Asthma Management Program (CAMP), a long-term study of 1041 children with mild to moderate asthma who were enrolled at age 7-11, has provided important data for studying this relationship. The researchers used statistical methods to look at asthma duration, bronchial responsiveness, and various symptomatic markers to evaluate the association between asthma duration and severity. The results showed that as the condition of asthma continues, it is associated with a decrease in lung function, an increase in asthma symptoms, and an increase in as-needed albuterol use. From this data, it is concluded that early diagnosis and treatment may be necessary to prevent detrimental effects of persistent asthma.
SCHOOL AS A RISK ENVIRONMENT FOR CHILDREN ALLERGIC TO CATS AND A SITE FOR TRANSFER OF CAT ALLERGEN TO HOMES
Almqvist C, Larsson PH, Egmar AC, Hedren M, Malmberg P, Wickman M.
Children who are known to have allergies to furred pets must often avoid direct contact with them to avoid symptoms. In determining strategies for avoidance, it has been suspected that schools might provide an unwanted opportunity for exposure to pet allergens, causing ongoing symptoms of allergic disease in children who have no furred pets. Almqvist and co-workers studied levels of airborne cat allergens in schools and homes of children living with and without cats. Hypothesizing that clothing was a mechanism for transfer for allergen distribution between school and home, they examined dust samples from the schools, clothes and mattresses of children from cat and non-cat homes. They found that there was significant exposure to cat allergens at school because allergens travel on the clothing of children from homes that have cats are spread through the air in the school environment and cling to the clothing of children without cats who then transport it to their home environments.
SELF-REPORTED ALLERGIC REACTIONS TO PEANUTS ON COMMERCIAL AIRLINERS
Sicherer SH, Furlong T J, DeSimone J, Sampson HA.
JACI 1999; 104: 186-189
It is known that individuals allergic to peanuts are at risk for unintended exposure to peanuts in prepared foods, such as those cooked in peanut oil or prepared with utensils or machinery that contain residue of peanut products. It has been debated, however, to what extent those with peanut sensitivities might suffer from exposure to peanuts that are in their near vicinity, specifically in a commercial airliner. Searching for some definitive evidence to this debate, Sicherer et al studied reports of 42 participants in the National Peanut and Tree Nut Allergy Registry who had experienced an allergic reaction on an airplane. Most of the respondents were young children whose parents provided the information about the event. Results showed that reactions resulting from inhalation of peanut dust usually occurred when more that 25 passengers on the plane were being served peanuts. In general, the reactions were not life-threatening, but about three-fourths did receive medications and 6 of those received epinephrine. The authors drew the conclusion that peanut-sensitive individuals should take care when traveling on commercial airliners and prepare in advance to have emergency medication at their disposal.
TRANSFORMING GROWTH FACTS. MOTHERS’ COLOSTRUM AND IMMUNE RESPONSES TO COWS’ MILK PROTEINS IN INFANTS WITH COWS’ MILK ALLERGY
Saarinen KM, Vaarala O, Klemetti P, Savilahti E.
JACI 1999; 104: 1093-1098
The newborn infant has immature defenses in the gut. Human breast milk serves to compensate for many factors of this underdevelopment as well as provide factors that promote growth and regulate immunity. There is still little understanding, however, of the factors involved in the development of an infant’s immune responses. Researchers in Finland found through measuring colostrum samples of 65 mothers of infants with IgE-mediated cow’s milk allergy (CMA) levels of transforming growth factor B1 (TGF-B1) were significantly lower than in 37 mothers of infants with non-IgE-mediated CMA. The study suggests for the first time that the cytokine TGF–B1 in human milk may have both suppression and enhancement functions in the immune reaction.
EMERGENCY DEPARTMENT UTILIZATION OF URBAN AFRICAN-AMERICAN CHILDREN WITH ASTHMA
Rand CS, Butz AM, Kolodner K, Huss K, Eggleston P, Malveaux F.
JACI 2000; 105:83-92
Data shows that low-income African-American children are more likely to be treated in emergency rooms or to be hospitalized than are white children. Several factors may influence the frequency of ER visits for asthma such as asthma severity, poor medical management, or social and environmental conditions. In a study by Rand and co-workers, almost 400 parents of school-age asthmatic children, living in low-income African-American areas in Washington D.C. and Baltimore, MD, were interviewed about each child’s symptoms and treatment. They found that children experienced symptoms during the day and night 25% of each month. Of those studied, 44% had received emergency room care within the last 6 months. Almost 80% of the children had used one or more prescription asthma medication, but only 12% of those used inhaled antiflammatory medication. The findings underscore the heavy burden of childhood asthma morbidity in the inner city. To reduce the frequency of emergency room care for asthma, steps must be taken to address the social, medical and environmental factors that are interwoven in this health care problem.
DONALD Y. M. LEUNG, MD, PHD, FAAAAI Editor-in-Chief of The Journal of Allergy and Clinical Immunology
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