Editorial
Quality of life issues ranging from the burden of ocular and nasal allergies to the anxiety associated with having to carry self-injectable epinephrine for insect sting allergy The articles within the pages of the current issue of the Proceedings illustrate how allergic disease adds a significant burden of illness, frequently manifesting a negative effect on quality of life. This issue commences with a review of the multiple drug allergy syndrome by Blumenthal et al.1 who define the syndrome and provide an overview of its evaluation and management. They stress the importance of a systematic evaluation to help determine which drugs can be safely used for future infections. In a second review article, Watanabe et al.2 provide an analysis of the world’s literature regarding the role of Mycoplasma pneumonia in the initial onset and exacerbation of asthma. Ocular and nasal allergy symptoms are common in the United States, affecting approximately one-half of the population. Using a nationwide telephone survey, Bielory et al.3 set out to determine the symptom burden of patients diagnosed with ocular and/or nasal allergies, as reported by patients and health-care providers in the United States. Their findings suggest that ocular and nasal allergy symptoms substantially affect patients’ lives and are comparable in their impact. Allergen immunotherapy (AIT) is often used for the treatment of allergic rhinoconjunctivitis. Forms of administration include subcutaneous and sublingual injections. Skoner et al.4 report the results of a telephone survey to determine patient experience and beliefs regarding AIT. Their findings of low rates of experience and knowledge with AIT suggest a need for better educational efforts for patients. Two studies within this issue examine the role of diet in the development, therapy, and/or prevention of allergic rhinitis and asthma. Stelmach et al.5 report on their evaluation of children from the Polish Mother and Child Cohort Study. In this study, the authors’ goal was to assess the associations between the occurrence of atopic dermatitis; food allergy; the incidence of wheeze; inhaled glucocorticosteroid use in children during the 1st year of life; and cord blood concentrations of copper, zinc, vitamins (A and E), and glutathione peroxidase activity. Complementing this work, D’Auria et al.,6 in a comprehensive review, examine the therapeutic and/or preventive value of omega-3 fatty
Allergy and Asthma Proceedings
acids in childhood asthma. The authors describe implications of their findings for future research. Anti-inflammatory and immunomodulatory agents such as inhaled corticosteroids and omalizumab are proven effective therapies for asthma and both have been shown to reduce fractional nitric oxide concentration in exhaled breath, a marker of airway inflammation. Because small airway inflammation contributes importantly to the clinical expression of asthma, it is of interest to know if these agents have a differential effect on nitric oxide production arising from peripheral small airways/alveoli. In this issue, Pasha et al.7 report the results of their study examining the effects of omalizumab on small airway inflammation as measured by fractional exhaled nitric oxide in moderate to severe asthmatic patients. Since treatment of hereditary angioedema (HAE) in the home offers the potential advantages of more rapid treatment, convenience and reduced cost, the care of this disorder is transitioning out of the clinic, emergency department, and hospitals and into the home. Two studies in this issue explore barriers and solutions to the transitioning of this self-administered therapy for HAE. Tuong et al.8 explore the barriers to selfadministered care by surveying HAE home care nurses throughout the United States. The authors suggest that moving to self-treatment or home treatment through nursing instruction will improve patient’s independence and quality of life, lead to earlier therapy, and reduce costs associated with care. Continuing with the theme of home treatment, Farkas et al.9 report on the efficacy and safety profile of conestat alfa, a recombinant C1-inhibitor, when administered in the home. Findeis and Craig10 explore the relationship between stinging insect allergy treatment and patient anxiety and depression. The authors theorize that the potential need to use self-injected epinephrine can create or increase anxiety, which can further compromise a patient’s ability to enjoy the outdoors and participate in activities. Their study attempts to answer the question as to whether venom immunotherapy improves quality of life by reduction of anxiety and depression. The three articles in this issue that are published exclusively online all relate to asthma. The first investigates a
195
common problem among patients with asthma, viz., running out of prescribed inhaled medications. Hasegawa et al.11 report the percentage of asthma-related emergency department visits made by patients who recently ran out of their inhaled short-acting -agonists or inhaled corticosteroids. These authors make an attempt to better characterize this patient population. The two other articles that relate to asthma are studies of inflammation in pediatric asthma patients. The report by Sa´nchez-Zauco et al.12 is directed to study the effects of obesity on the immune response of children with asthma. Their novel approach involves analyzing Tolllike receptors 2 and 9 and Th1/Th2 cytokine profiles in obese asthmatic children in comparison with healthy children. In the third asthma article, Caffarelli et al.13 explore the use of exhaled breath condensate to sample airway lining fluid as a potential noninvasive biomarker of airway inflammation. In patients with asthma, previously published work has shown the pH of exhaled breath condensate to be decreased in relation to airway inflammation. These authors further expand knowledge in this area of research, by measuring exhaled breath condensate pH levels before and after treatment of acute asthma exacerbations. Because of the significant clinical implications and psychological impact of insect sting allergy, Findeis and Craig’s10 article is featured in this issue’s “For the Patient” section. This segment, found in the back of this issue and also available online, consists of a one-page synopsis of a selected article, which is written in a readily comprehensible fashion to help patients better understand the content of the full article and its diagnostic and therapeutic implications. It is printed in a format to allow reproduction on the practitioner’s letterhead for distribution to patients. In summary, the collection of articles found within the pages of this issue provides another insight into important allergic and respiratory disorders afflicting patients whom the allergist–immunologist serves. In keeping with the overall mission of the Proceedings, which is to distribute timely information regarding advancements in the knowledge and practice of allergy, asthma, and immunology to clinicians entrusted with the care of patients, it is our hope that the articles found within this issue achieve this goal and will help foster enhanced patient management through efficient workup and optimal therapy for a great diversity of clinical problems. These clinical problems include allergic and respiratory disorders seen in various patient populations, ranging across the full age spectrum from infancy to the elderly and from various regions around
196
the world. The pathophysiological mechanisms of allergic and respiratory disease are elegantly explored, illustrating critical insight into the etiology of these diseases and giving hope for the future development of therapeutic innovations. On behalf of the editorial board, we hope you will enjoy the diversity of literature offered in this issue of the Proceedings.
Joseph A. Bellanti, M.D. Russell A. Settipane, M.D. REFERENCES 1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
Blumenthal KG, Saff RR, and Banerji A. Evaluation and management of a patient with multiple drug allergies. Allergy Asthma Proc 35:197–203, 2014. Watanabe H, Uruma T, Nakamura H, and Aoshiba K. The role of Mycoplasma pneumoniae infection in the initial onset and exacerbations of asthma. Allergy Asthma Proc 35:204 –210, 2014. Bielory L, Skoner DP, Blaiss MS, et al. Ocular and nasal allergy symptom burden in America: The Allergies, Immunotherapy, and RhinoconjunctivitiS (AIRS) surveys. Allergy Asthma Proc 35:211–218, 2014. Skoner DP, Blaiss MS, Dykewicz MS, et al. The Allergies, Immunotherapy, and RhinoconjunctivitiS (AIRS) survey: Patients’ experience with allergen immunotherapy. Allergy Asthma Proc 35:219 –226, 2014. Stelmach I, Grzelewski T, Bobrowska-Korzeniowska M, et al. The role of zinc, copper, plasma glutathione peroxidase enzyme, and vitamins in the development of allergic diseases in early childhood: The Polish mother and child cohort study. Allergy Asthma Proc 35:227–232, 2014. D’Auria E, Miraglia Del Giudice M, Barberi S, et al. Omega-3 fatty acids and asthma in children. Allergy Asthma Proc 35:233– 240, 2014. Pasha MA, Jourd’heuil D, Jourd’heuil F, et al. The effect of omalizumab on small airway inflammation as measured by exhaled nitric oxide in moderate-to-severe asthmatic patients. Allergy Asthma Proc 35:241–249, 2014. Tuong L-AC, Olivieri K, and Craig TJ. Barriers to self-administered therapy for hereditary angioedema. Allergy Asthma Proc 35:250 –254, 2014. Farkas H, Csuka D, Veszeli N, et al. Home treatment of attacks with conestat alfa in hereditary angioedema due to C1-inhibitor deficiency. Allergy Asthma Proc 35:255–259, 2014. Findeis S, and Craig T. The relationship between insect sting allergy treatment and patient anxiety and depression. Allergy Asthma Proc 35:260 –264, 2014. Hasegawa K, Brenner BE, Clark S, et al. Emergency department visits for acute asthma by adults who ran out of their inhaled medications. Allergy Asthma Proc 35:e42– e50, 2014. Sa´nchez-Zauco N, del Rio-Navarro B, Gallardo-Casas C, et al. High expression of Toll-like receptors 2 and 9 and Th1/Th2 cytokines profile in obese asthmatic children. Allergy Asthma Proc 35:e34 – e41, 2014. Caffarelli C, Povesi Dascola C, Peroni D, et al. Airway acidification in childhood asthma exacerbations. Allergy Asthma Proc 35:e51– e56, 2014. e
May–June 2014, Vol. 35, No. 3
Quality of life issues ranging from the burden of ocular and nasal allergies to the anxiety associated with having to carry self-injectable epinephrine for insect sting allergy The articles within the pages of the current issue of the Proceedings illustrate how allergic disease adds a significant burden of illness, frequently manifesting a negative effect on quality of life. This issue commences with a review of the multiple drug allergy syndrome by Blumenthal et al.1 who define the syndrome and provide an overview of its evaluation and management. They stress the importance of a systematic evaluation to help determine which drugs can be safely used for future infections. In a second review article, Watanabe et al.2 provide an analysis of the world’s literature regarding the role of Mycoplasma pneumonia in the initial onset and exacerbation of asthma. Ocular and nasal allergy symptoms are common in the United States, affecting approximately one-half of the population. Using a nationwide telephone survey, Bielory et al.3 set out to determine the symptom burden of patients diagnosed with ocular and/or nasal allergies, as reported by patients and health-care providers in the United States. Their findings suggest that ocular and nasal allergy symptoms substantially affect patients’ lives and are comparable in their impact. Allergen immunotherapy (AIT) is often used for the treatment of allergic rhinoconjunctivitis. Forms of administration include subcutaneous and sublingual injections. Skoner et al.4 report the results of a telephone survey to determine patient experience and beliefs regarding AIT. Their findings of low rates of experience and knowledge with AIT suggest a need for better educational efforts for patients. Two studies within this issue examine the role of diet in the development, therapy, and/or prevention of allergic rhinitis and asthma. Stelmach et al.5 report on their evaluation of children from the Polish Mother and Child Cohort Study. In this study, the authors’ goal was to assess the associations between the occurrence of atopic dermatitis; food allergy; the incidence of wheeze; inhaled glucocorticosteroid use in children during the 1st year of life; and cord blood concentrations of copper, zinc, vitamins (A and E), and glutathione peroxidase activity. Complementing this work, D’Auria et al.,6 in a comprehensive review, examine the therapeutic and/or preventive value of omega-3 fatty
Allergy and Asthma Proceedings
acids in childhood asthma. The authors describe implications of their findings for future research. Anti-inflammatory and immunomodulatory agents such as inhaled corticosteroids and omalizumab are proven effective therapies for asthma and both have been shown to reduce fractional nitric oxide concentration in exhaled breath, a marker of airway inflammation. Because small airway inflammation contributes importantly to the clinical expression of asthma, it is of interest to know if these agents have a differential effect on nitric oxide production arising from peripheral small airways/alveoli. In this issue, Pasha et al.7 report the results of their study examining the effects of omalizumab on small airway inflammation as measured by fractional exhaled nitric oxide in moderate to severe asthmatic patients. Since treatment of hereditary angioedema (HAE) in the home offers the potential advantages of more rapid treatment, convenience and reduced cost, the care of this disorder is transitioning out of the clinic, emergency department, and hospitals and into the home. Two studies in this issue explore barriers and solutions to the transitioning of this self-administered therapy for HAE. Tuong et al.8 explore the barriers to selfadministered care by surveying HAE home care nurses throughout the United States. The authors suggest that moving to self-treatment or home treatment through nursing instruction will improve patient’s independence and quality of life, lead to earlier therapy, and reduce costs associated with care. Continuing with the theme of home treatment, Farkas et al.9 report on the efficacy and safety profile of conestat alfa, a recombinant C1-inhibitor, when administered in the home. Findeis and Craig10 explore the relationship between stinging insect allergy treatment and patient anxiety and depression. The authors theorize that the potential need to use self-injected epinephrine can create or increase anxiety, which can further compromise a patient’s ability to enjoy the outdoors and participate in activities. Their study attempts to answer the question as to whether venom immunotherapy improves quality of life by reduction of anxiety and depression. The three articles in this issue that are published exclusively online all relate to asthma. The first investigates a
195
common problem among patients with asthma, viz., running out of prescribed inhaled medications. Hasegawa et al.11 report the percentage of asthma-related emergency department visits made by patients who recently ran out of their inhaled short-acting -agonists or inhaled corticosteroids. These authors make an attempt to better characterize this patient population. The two other articles that relate to asthma are studies of inflammation in pediatric asthma patients. The report by Sa´nchez-Zauco et al.12 is directed to study the effects of obesity on the immune response of children with asthma. Their novel approach involves analyzing Tolllike receptors 2 and 9 and Th1/Th2 cytokine profiles in obese asthmatic children in comparison with healthy children. In the third asthma article, Caffarelli et al.13 explore the use of exhaled breath condensate to sample airway lining fluid as a potential noninvasive biomarker of airway inflammation. In patients with asthma, previously published work has shown the pH of exhaled breath condensate to be decreased in relation to airway inflammation. These authors further expand knowledge in this area of research, by measuring exhaled breath condensate pH levels before and after treatment of acute asthma exacerbations. Because of the significant clinical implications and psychological impact of insect sting allergy, Findeis and Craig’s10 article is featured in this issue’s “For the Patient” section. This segment, found in the back of this issue and also available online, consists of a one-page synopsis of a selected article, which is written in a readily comprehensible fashion to help patients better understand the content of the full article and its diagnostic and therapeutic implications. It is printed in a format to allow reproduction on the practitioner’s letterhead for distribution to patients. In summary, the collection of articles found within the pages of this issue provides another insight into important allergic and respiratory disorders afflicting patients whom the allergist–immunologist serves. In keeping with the overall mission of the Proceedings, which is to distribute timely information regarding advancements in the knowledge and practice of allergy, asthma, and immunology to clinicians entrusted with the care of patients, it is our hope that the articles found within this issue achieve this goal and will help foster enhanced patient management through efficient workup and optimal therapy for a great diversity of clinical problems. These clinical problems include allergic and respiratory disorders seen in various patient populations, ranging across the full age spectrum from infancy to the elderly and from various regions around
196
the world. The pathophysiological mechanisms of allergic and respiratory disease are elegantly explored, illustrating critical insight into the etiology of these diseases and giving hope for the future development of therapeutic innovations. On behalf of the editorial board, we hope you will enjoy the diversity of literature offered in this issue of the Proceedings.
Joseph A. Bellanti, M.D. Russell A. Settipane, M.D. REFERENCES 1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
Blumenthal KG, Saff RR, and Banerji A. Evaluation and management of a patient with multiple drug allergies. Allergy Asthma Proc 35:197–203, 2014. Watanabe H, Uruma T, Nakamura H, and Aoshiba K. The role of Mycoplasma pneumoniae infection in the initial onset and exacerbations of asthma. Allergy Asthma Proc 35:204 –210, 2014. Bielory L, Skoner DP, Blaiss MS, et al. Ocular and nasal allergy symptom burden in America: The Allergies, Immunotherapy, and RhinoconjunctivitiS (AIRS) surveys. Allergy Asthma Proc 35:211–218, 2014. Skoner DP, Blaiss MS, Dykewicz MS, et al. The Allergies, Immunotherapy, and RhinoconjunctivitiS (AIRS) survey: Patients’ experience with allergen immunotherapy. Allergy Asthma Proc 35:219 –226, 2014. Stelmach I, Grzelewski T, Bobrowska-Korzeniowska M, et al. The role of zinc, copper, plasma glutathione peroxidase enzyme, and vitamins in the development of allergic diseases in early childhood: The Polish mother and child cohort study. Allergy Asthma Proc 35:227–232, 2014. D’Auria E, Miraglia Del Giudice M, Barberi S, et al. Omega-3 fatty acids and asthma in children. Allergy Asthma Proc 35:233– 240, 2014. Pasha MA, Jourd’heuil D, Jourd’heuil F, et al. The effect of omalizumab on small airway inflammation as measured by exhaled nitric oxide in moderate-to-severe asthmatic patients. Allergy Asthma Proc 35:241–249, 2014. Tuong L-AC, Olivieri K, and Craig TJ. Barriers to self-administered therapy for hereditary angioedema. Allergy Asthma Proc 35:250 –254, 2014. Farkas H, Csuka D, Veszeli N, et al. Home treatment of attacks with conestat alfa in hereditary angioedema due to C1-inhibitor deficiency. Allergy Asthma Proc 35:255–259, 2014. Findeis S, and Craig T. The relationship between insect sting allergy treatment and patient anxiety and depression. Allergy Asthma Proc 35:260 –264, 2014. Hasegawa K, Brenner BE, Clark S, et al. Emergency department visits for acute asthma by adults who ran out of their inhaled medications. Allergy Asthma Proc 35:e42– e50, 2014. Sa´nchez-Zauco N, del Rio-Navarro B, Gallardo-Casas C, et al. High expression of Toll-like receptors 2 and 9 and Th1/Th2 cytokines profile in obese asthmatic children. Allergy Asthma Proc 35:e34 – e41, 2014. Caffarelli C, Povesi Dascola C, Peroni D, et al. Airway acidification in childhood asthma exacerbations. Allergy Asthma Proc 35:e51– e56, 2014. e
May–June 2014, Vol. 35, No. 3
