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World Allergy Organization Journal: the Editors Look Back at 2016
World Allergy Organization Journal volume 10, Article number: 9 (2017)
As the Editors-in-Chief of the official journal of the World Allergy Organization, we look back at the year 2016 with satisfaction (Fig. 1). The most important themes in allergy were addressed in great part by highly accessed articles. These themes encompass important areas from the new definition of the basics in allergy, from rare clinical cases [1–3] to novel hot topics such as allergy to vaccines . Let us walk together through the past year of the World Allergy Organization Journal (WAO Journal).
Efforts to harmonize the definitions of clinical allergy
With global themes it is important to harmonize language and definitions so that allergic disease classifications can be made universally around the world and communicated without doubt . A similarly important tool is clinical diagnostics, with the skin prick test being an important global diagnostic instrument. In an international survey on skin patch testing a lack of homogeneity was found in an international collaborative, notably with a strong contribution by the Junior Members Group of the World Allergy Organization (WAO) . Allergy is the only discipline with an intrinsically high risk of diagnostic testing as well as of therapeutic intervention by allergen immunotherapy in hypersensitive patients. An international group of experts from different continents evaluated the associated risks and proposed optimal safety measures of a high practical value for allergists and other doctors caring for allergic patients . While allergen immunotherapy is well accepted in allergic rhinitis and asthma, its applicability in atopic patients with eczema is still discussed, and this topic was taken up in two opposing articles within the Debates in Allergy Medicine series [8, 9]. The high access numbers for those articles strongly illustrate the interest in this topic among the readership.
Respiratory allergies deserve global attention
Interestingly, also in respiratory disease the severity of symptoms prompts patients to seek medical advice. This was shown in a Bulgarian study on allergic rhinitis, based on the ARIA guidelines, where more pediatric and adult patients with severe nasal congestion visited physicians . Asthma was addressed in several mega-analyses this year, highlighting novel aspects. An international “manifesto” supported by Interasma, WAO, ARIA and GA2LEN pointed out that the involvement of the small airways should be specifically assessed in asthmatics and COPD, prompting personalized medicine approaches . A European and Canadian mega-survey of 75,335 households revealed that 81% of asthmatics perceived their asthma as well controlled, while still 50% reported acute treatment, implying a discrepancy between perception and actual asthma control . By comparison, in another study approximately one-third of children experienced severe asthma attacks once a year . In the latter study, 734,114 children were analysed, revealing that asthma-related hospitalizations occurred more at younger ages. These numbers underline the ongoing need to improve asthma control by targeted approaches. In this context, an update on inhaled corticosteroids for children with asthma as well as a review on the use of Tiotropium were most appropriate [14, 15], along with a discussion on potential cellular biomarkers which could improve patient stratification [16, 17]. It is important to note that mechanistic basic research also contributed to improved understanding on lung diseases, as discussed in the report on an increased number of T regulatory cells in COPD . Besides environmental concerns, indoor pollution should also be a target for action in the future, and allergen contamination may include monitoring of molecular allergens .
Food allergy – addressing a rising concern
Food allergies are of increasing importance. Among them, milk allergy is a specific concern in children. Besides IgE-mediated, the importance of non-IgE mediated cow’s milk allergy has gained tremendous attention and the urgent need for evidence-based criteria on it was articulated in a call for an update on the DRACMA guidelines . Importantly, current substitution strategies were discussed in this constantly changing field, accompanied by thoughts on food processing methods. The role of baked egg and milk on tolerance development in children  also was discussed, as well as the chance to predict the course of egg allergy by provocation tests with heated egg . This topic yielded a hot debate in the Debates in Allergy Medicine series [23, 24]. In the middle of the complex clinics of food-associated conditions, the phenotypic diversity of eosinophilic esophagitis (EoE) was addressed with less consequent association to food adverse reactions, but classified as a Th2 disease . The authors emphasized that animal models will be needed to study and understand the different phenotypes in EoE.
Can we prevent allergies in the future?
Considering their global increase, prevention of allergies remains the “Holy Grail” in our field as well as a hope for the future. Within the series of Guidelines on Allergic Disease Prevention (GLAD-P), two uttermost current topics were addressed in 2016, rendering the following current recommendations: (1) Currently no evidence could be found for Vitamin D supplementation to be effective against allergies in children, neither in pregnant, nor in breastfeeding, women ; (2) Prebiotics supplementation should be used in non-exclusively breastfed infants, while – at this time – no recommendation was given for pregnancy or for breastfeeding mothers ; (3) a Letter to the Editor claimed the current usage of probiotics was too optimistic, considering the “lack of clear evidence of efficacy of probiotic supplementation in the primary prevention of allergies” . These official statements are important as prebiotics and probiotics increasingly enter the market, due to the suspected potential benefits for children and in atopic eczema . In fact, an Italian consensus document states that for many trendy measures only little if all evidence can be found, such as the use of partially or extensively hydrolyzed formulas, or for a series of dietary supplementations including polyunsaturated fatty acids, vitamins or minerals . A high level of hygiene may be especially detrimental for allergies. On the other hand, poor hygiene in children in a tropical region, assessed by parasite infestations and birth order, rendered either a hypo-responsive or Th2 phenotype, subsequently causing distinct effects on immunologically mediated diseases . This pointed out that there are “particularities of allergy in the tropics” as compared to temperate climate zones, where imminent mite, helminthic and insect sting exposures significantly affect the outcome and management of allergies .
Overall, the work published in 2016 in the WAO Journal reconfirmed that the constant global exchange and collaboration of allergy experts across international borders leads to novel recommendations and guidelines and contributes to an overall harmonization. We consider this important in the increasingly fast pace of change in medicine where evidence-based results have to be weighed out against market strategies for the best care of our patients.
We are looking forward to receiving exciting contributions again in 2017!
Erika Jensen-Jarolim, MD and Alessandro Fiocchi, MD
Vienna, Austria, and Vatican City, Italy
Aleem S, Kumar B, Fasano MB, Takacs E, Azar AE. Successful use of cyclosporine as treatment for eosinophilic cystitis: a case report. World Allergy Organ J. 2016;9:22.
Brauns B, Schon MP, Wulf G, Mempel M. A lurking threat: transfer of peanut allergy through peripheral blood stem cell transplantation. World Allergy Organ J. 2016;9:3.
Jensen-Jarolim E, Roth-Walter F, Leitner E, Buchleitner S, Vogelsang H, Kinaciyan T. Prime and boost aerosol exposure via fog machine or shisha smoke followed by cinnamon hypersensitivity and anaphylaxis to spiced food. World Allergy Organ J. 2016;9:4.
Dreskin SC, Halsey NA, Kelso JM, et al. International Consensus (ICON): allergic reactions to vaccines. World Allergy Organ J. 2016;9:32.
Tanno LK, Calderon MA, Smith HE, et al. Dissemination of definitions and concepts of allergic and hypersensitivity conditions. World Allergy Organ J. 2016;9:24.
Tanno LK, Darlenski R, Sanchez-Garcia S, et al. International survey on skin patch test procedures, attitudes and interpretation. World Allergy Organ J. 2016;9:8.
Kowalski ML, Ansotegui I, Aberer W, et al. Risk and safety requirements for diagnostic and therapeutic procedures in allergology: World Allergy Organization Statement. World Allergy Organ J. 2016;9:33.
Ginsberg DN, Eichenfield LF. Debates in allergy medicine: Specific immunotherapy in children with atopic dermatitis, the “con” view. World Allergy Organ J. 2016;9:16.
Slavyanakaya TA, Derkach VV, Sepiashvili RI. Debates in allergy medicine: specific immunotherapy efficiency in children with atopic dermatitis. World Allergy Organ J. 2016;9:15.
Mustakov TB, Popov TA, Kralimarkova TZ, Staevska MT, Dimitrov VD. Clinical characteristics of patients seeking medical advice for nasal symptoms in Bulgaria with special focus on children. World Allergy Organ J. 2016;9:11.
Braido F, Scichilone N, Lavorini F, et al. Manifesto on small airway involvement and management in asthma and chronic obstructive pulmonary disease: an Interasma (Global Asthma Association - GAA) and World Allergy Organization (WAO) document endorsed by Allergic Rhinitis and its Impact on Asthma (ARIA) and Global Allergy and Asthma European Network (GA2LEN). World Allergy Organ J. 2016;9:37.
Sastre J, Fabbri LM, Price D, et al. Insights, attitudes, and perceptions about asthma and its treatment: a multinational survey of patients from Europe and Canada. World Allergy Organ J. 2016;9:13.
Suruki RY, Boudiaf N, Ortega HG. Retrospective cohort analysis of healthcare claims in the United States characterising asthma exacerbations in paediatric patients. World Allergy Organ J. 2016;9:18.
Hossny E, Rosario N, Lee BW, et al. The use of inhaled corticosteroids in pediatric asthma: update. World Allergy Organ J. 2016;9:26.
Halpin DM. Tiotropium in asthma: what is the evidence and how does it fit in? World Allergy Organ J. 2016;9:29.
Carr TF, Berdnikovs S, Simon HU, Bochner BS, Rosenwasser LJ. Eosinophilic bioactivities in severe asthma. World Allergy Organ J. 2016;9:21.
Metcalfe DD, Pawankar R, Ackerman SJ, et al. Biomarkers of the involvement of mast cells, basophils and eosinophils in asthma and allergic diseases. World Allergy Organ J. 2016;9:7.
Chiappori A, Folli C, Balbi F, et al. CD4(+)CD25(high)CD127(−) regulatory T-cells in COPD: smoke and drugs effect. World Allergy Organ J. 2016;9:5.
Nishikawa K, Fujimura T, Ota Y, et al. Exposure to positively- and negatively-charged plasma cluster ions impairs IgE-binding capacity of indoor cat and fungal allergens. World Allergy Organ J. 2016;9:27.
Fiocchi A, Dahdah L, Dupont C, Campoy C, Fierro V, Nieto A. Cow’s milk allergy: towards an update of DRACMA guidelines. World Allergy Organ J. 2016;9:35.
Dang TD, Peters RL, Allen KJ. Debates in allergy medicine: baked egg and milk do not accelerate tolerance to egg and milk. World Allergy Organ J. 2016;9:2.
Okada Y, Yanagida N, Sato S, Ebisawa M. Heated egg yolk challenge predicts the natural course of hen’s egg allergy: a retrospective study. World Allergy Organ J. 2016;9:31.
Leonard SA. Debates in allergy medicine: baked milk and egg ingestion accelerates resolution of milk and egg allergy. World Allergy Organ J. 2016;9:1.
Yanagida N, Minoura T, Kitaoka S. Allergic reactions to milk appear sooner than reactions to hen’s eggs: a retrospective study. World Allergy Organ J. 2016;9:12.
Mudde AC, Lexmond WS, Blumberg RS, Nurko S, Fiebiger E. Eosinophilic esophagitis: published evidences for disease subtypes, indications for patient subpopulations, and how to translate patient observations to murine experimental models. World Allergy Organ J. 2016;9:23.
Yepes-Nunez JJ, Fiocchi A, Pawankar R, et al. World Allergy Organization-McMaster University Guidelines for Allergic Disease Prevention (GLAD-P): Vitamin D. World Allergy Organ J. 2016;9:17.
Cuello-Garcia CA, Fiocchi A, Pawankar R, et al. World Allergy Organization-McMaster University Guidelines for Allergic Disease Prevention (GLAD-P): prebiotics. World Allergy Organ J. 2016;9:10.
Ricci G, Cipriani F, Cuello-Garcia CA, et al. A clinical reading on “World Allergy Organization-McMaster University Guidelines for Allergic Disease Prevention (GLAD-P): Probiotics”. World Allergy Organ J. 2016;9:9.
Sweileh WM, Shraim NY, Al-Jabi SW, et al. Assessing worldwide research activity on probiotics in pediatrics using Scopus database: 1994–2014. World Allergy Organ J. 2016;9:25.
di Mauro G, Bernardini R, Barberi S, et al. Prevention of food and airway allergy: consensus of the Italian Society of Preventive and Social Paediatrics, the Italian Society of Paediatric Allergy and Immunology, and Italian Society of Pediatrics. World Allergy Organ J. 2016;9:28.
Figueiredo CA, Amorim LD, Vaca M, et al. Effects of poor hygiene on cytokine phenotypes in children in the tropics. World Allergy Organ J. 2016;9:34.
Caraballo L, Zakzuk J, Lee BW, et al. Particularities of allergy in the Tropics. World Allergy Organ J. 2016;9:20.
The authors would like to thank the members of the WAO Journal Editorial Board, and Sofia Dorsano, Managing Editor, for their support and contributions in the development of the journal.
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EJJ initiated and developed the manuscript in collaboration with AF. Both authors read and approved the final manuscript.
The authors declare that they have no competing interests.
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Jensen-Jarolim, E., Fiocchi, A. World Allergy Organization Journal: the Editors Look Back at 2016. World Allergy Organ J 10, 9 (2017). https://doi.org/10.1186/s40413-017-0140-9
- Debates in Allergy Medicine
- WAO Journal
- World Allergy Organization Journal