Literature review: the best new articles in the specialty of allergy, asthma, and immunology, 2004-2005.

A series of eight articles from the published literature for the period 2004-2005 was selected for review in this article. Small-airway obstruction in chronic obstructive pulmonary disease (COPD) and its management were the subjects of the first two articles reviewed in this commentary. Progression of COPD from the Global Initiative for Chronic Obstructive Lung Disease stages 0-4 was found to be most strongly associated with thickening of the airway wall and each of its compartments by a repair or remodeling process. Management of COPD, including the addition of pulmonary rehabilitation to treatment regimens, may reduce symptoms and improve exercise performance. The addition of theophylline or an inhaled corticosteroid (or both) to optimal inhaled bronchodilator therapy together with aggressive treatment of hypoxemia were suggested to provide additional benefits and lung-volume-reduction surgery and transplantation were recommended as other treatment options for a subgroup of patients with very severe disease. The next three articles addressed the impact of outdoor and indoor air pollution and the effects of childhood asthma as antecedents of asthma in the adult in later life. Current levels of air pollution are known to have chronic, adverse effects on lung development in children from age 10 to 18 years, leading to clinically significant deficits in attained forced expiratory volume in one second as children reach adulthood. Among inner-city children with atopic asthma, an individualized, home-based, comprehensive environmental intervention resulted in reduced asthma-associated morbidity and supported that a multifaceted, home-based, environmental intervention approach may be beneficial. The prognosis of childhood allergic asthma in adulthood was found to be determined largely early in life and the degree of atopy appeared to be a critical determinant of asthma persistence. The next article reviewed the controversial area of the treatment of chronic rhinosinusitis caused by fungi. Intranasal Amphotericin B was shown to reduce inflammatory mucosal thickening on both CT scan and nasal endoscopy and decreased the levels of intranasal markers for eosinophilic inflammation in patients with chronic rhinosinusitis. The last two articles reviewed two papers dealing with the role that gastrointestinal immune responses play in maintaining protective immunity in health and a critical role in the pathogenesis of a wide variety of clinical disorders associated with food allergy as well as the suspected pivotal role of oral tolerance to dietary proteins for the prevention of food allergy. The mode of antigen uptake in the gut and different regulatory immune cells appear to play critical roles in maintenance of oral tolerance as shown in many animal model systems.