Highlights of the last 10 years in immunology

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The journal Nature Reviews Immunology reached its 10th anniversary and the authors of one of the top-cited articles from each year took a trip down memory lane. See the results below.


The curved leucine-rich repeat region of toll-like receptors, represented here by TLR3. Image source: Wikipedia.

Some of the advances in immunology over the past 10 years include improved understanding of:

- Toll-like receptor signalling
- immune regulation mediated by regulatory T cells
- indoleamine 2,3-dioxygenase
- myeloid-derived suppressor cells
- interleukin-10
- heterogeneity of macrophages, dendritic cells and T helper cells

We all look forward to what the next 10 years of immunology research may bring.

References:

Highlights of 10 years of immunology in Nature Reviews Immunology. Nature Reviews Immunology 11, 693-702 (October 2011) | doi:10.1038/nri3063

What are the major risk factors for pediatric food anaphylaxis? Asthma and chronic GI symptoms

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This prospective study included 160 children with anaphylaxis seen at 29 outpatient allergy clinics throughout Italy. Food sensitization was evaluated by skin-prick test (SPT).


Mind map diagram of anaphylaxis (click to enlarge the image).

A clinical history of asthma increased the risk of wheezing during food-induced anaphylaxis (odds ratio (OR) 2.2) and respiratory arrest (OR 6.9).

A clinical history of chronic/relapsing gastrointestinal symptoms increased the risk of vomiting (OR 2.1), hypotension (OR 7.9), and bradycardia/cardiac arrest (OR 9.2).

Peanut and egg were the most frequent causes of severe anaphylaxis.

A history of asthma and chronic GI symptoms (probably linked to food allergy) may predict the development of respiratory and GI symptoms and the severity of anaphylaxis.

A generic version of the Anaphylaxis Action Plan is available from the AAAAI website.

References:

Risk factors for severe pediatric food anaphylaxis in Italy. Calvani M, Cardinale F, Martelli A, Muraro A, Pucci N, Savino F, Zappalà D, Panetta V; the Italian Society of Pediatric Allergy and Immunology (SIAIP) anaphylaxis’ study group. Pediatr Allergy Immunol. 2011 Sep 19. doi: 10.1111/j.1399-3038.2011.01200.x.
Anaphylaxis Action Plan

Patients with persistent airway obstruction due to refractory asthma have neutrophil-dominant airway inflammation

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Neutrophilic inflammation in refractory asthma may increase the likelihood of non-responsiveness to inhaled corticosteroids (ICS). This Korean study recruited 77 patients with refractory asthma from a cohort of 2,300 asthmatics.

The group with persistent airway obstruction had a longer duration of asthma and a higher frequency of near-fatal asthma despite the higher doses of inhaled corticosteroids. Neutrophilic inflammation was predominant in the group with persistent airway obstruction (PAO). Eosinophilic inflammation was predominant in the non-PAO group.

The study authors concluded that patients with persistent airway obstruction due to refractory asthma have neutrophil-dominant airway inflammation. This may provide the rationale for developing new asthma medications for individualized therapy.

References:

Role of neutrophils in persistent airway obstruction due to refractory asthma. Choi JS, Jang AS, Park JS, Park SW, Paik SH, Park JS, Uh ST, Kim YH, Park CS.Respirology. 2011 Nov 1. doi: 10.1111/j.1440-1843.2011.02097.x.

Image source: Wikipedia, free GNU license.

Montelukast failure index shows risk of failure before treatment is started

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Leukotriene receptor antagonist (LTRA) montelukast is an option for step-down therapy for mild asthmatics controlled on low-dose inhaled corticosteroids (ICS). Some patients fail montelukast step-down therapy, and it would be helpful to predict this risk. The Leukotriene or Corticosteroid or Corticosteroid-Salmeterol Study (LOCCS) trial included 165 participants.

Characteristics independently associated with montelukast treatment failure included:

- age of asthma onset <10 years old (OR = 2.39)
- need for steroid burst in the last year (OR = 2.39)
- pre-bronchodilator forced expiratory volume in 1 s (FEV1) (OR = 1.44 per 10% lower % predicted)

The montelukast failure index was based on these 3 variables (range: −5 to 7 points):

- scores <0 predicted low risk of treatment failure
- scores >5 predicted high risk of treatment failure

Summary

Early asthma onset, worse asthma control in the last year, and lower FEV1 are associated with montelukast treatment failure. A montelukast failure index is proposed to quantify the risk of failure prior to treatment initiation.

References:

Risk Factors for Montelukast Treatment Failure in Step-Down Therapy for Controlled Asthma. Drummond MB, Peters SP, Castro M, Holbrook JT, Irvin CG, Smith LJ, Wise RA, Sugar EA. J Asthma. 2011 Oct 27.

Image source: Montelukast, from Wikipedia, the free encyclopedia, public domain.

Winter skin care - Mayo Clinic video

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The falling temperatures of winter can be stressful for the largest organ of our body - our skin. Mayo Clinic experts offer some timely reminders for staying comfortable and healthy:



There are more videos here: Medical Edge 2012 by Mayo Clinic YouTube Channel

I recommend the following moisturizers:



Atopic Dermatitis Treatment - Illustrated (click to enlarge the image).

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