Asthma, urticaria and less rare than expected FPIES.

Abstract

Recently in the Journal of Allergy and Clinical Immunology, Szefler et al1 have assessed whether once-daily inhaled tiotropium might improve asthma control in young school-aged children with severe symptomatic asthma. In a randomized, double-blind, placebo-controlled trial of 401 participants, the higher 5 mg dose increased peak FEV1 by 139 mL. While the result is interesting, it is not an outcome measure that a patient would recognize. Unfortunately, as a 12-week trial, it was probably not long enough to provide data on relevant patient-orientated outcome measures such as exacerbations or quality of life. Also in Journal of Allergy and Clinical Immunology, Mehr et al2 have provided some population data for the prevalence of food protein-induced enterocolitis syndrome (FPIES). Using an Australia-wide survey via the Australian Paediatric Surveillance Unit, where paediatrics notify cases on a monthly basis, 230 infants with FPIES were identified. This gave an incidence of FPIES in Australian infants aged less than 24 months of 15.4/100 000/year. Commoner than expected. Barton et al3 have looked for possible associations between epigenetic changes around key genes at birth and the development of allergic disease. In the Southampton Women's Survey, they found that higher methylation of GATA3 CpGs -2211/-2209 at birth was associated with less likelihood of asthma at age 3 and 6 (Figure 1). In a cell line, such methylation seems to block transcription factor binding to the GATA3 promoter providing a potential mechanism. They describe other epigenetic associations with eczema. So we need to look at epigenetics to understand the development of childhood asthma and eczema.4 Asady et al5 have looked at a group of 200 adult patients with cholinergic urticaria to try to understand how its feature varies in different groups in this issue. The disease is characterized weal that is often precipitated by physical exercise.6 The group have identified two distinct types of cholinergic urticarial characterized by age of onset (Figure 2). Early-onset patients were more likely to have atopic dermatitis and had high total IgE levels. Late-onset patients were more likely to be female and were more likely to have co-existing other forms of urticarial and psychiatric co-morbidities. They suggest that they may be distinct pathophysiologies.