I love Case Reports.  And I love the Annals of Allergy.  Conclusion?  I love to read Case Reports in the Annals.  What don't I love?  Any change in the status of Case Reports that might threaten to diminish their importance.  The Editorial in this month's issue of the Annals, entitled "Annals Evolution--The Next Phase" states that "The Annals will no longer accept unsolicited case reports" Instead there will be a new "Letters" feature to replace this. OOOHHHH BOY.  So what's the Angry Allergist to  do?

Well, like the song says, "I gotta be me", so I'm offering a Case Report...on...you guessed it...The Case Report.   Why am I publishing this case report here and not in the Annals?  If you don't know the answer, you haven't been paying attention:  like I mentioned earlier, the Annals is no longer accepting unsolicited case reports...so here goes: 

Iatrogenic Atrophy of the Case Report:  A Case Report and Review of the Literature

Introduction 

Case reports are undoubtedly helpful in the progression and advance of medical knowledge.  They have been a time-honored medical communication for many years.  We describe a case of iatrogenic atrophy of the Case Report, relegated to "Letters to the Editor" status, from its former status with more formal article format in this prestigious major allergy journal.

Case Report:

C.R. presented to the Annals of Allergy with a longstanding history of good health.  A vigorous contributor to medical knowledge and academic medical advancement, C.R. was unexpectedly downgraded to "Letters to the Editor" status in The Annals of Allergy, from its former status amongst its peer articles in the Annals.  C.R.'s past history had been excellent--it had regularly visited the Annals for years, and frequently praised for its work.  However, In an article entitled "Annals Evolution--The Next Phase", it was unexpectedly stated that "The Annals Editorial Office will no longer accept unsolicited case reports".   Iatrogenic atrophy of The Case Report is expected to soon follow. 

Literature Review:

Vandenbroucke, in an article entitled "The Importance of Case Reports as Compared to Evidence-Based Medicine and Molecular Explanation" asks the rhetorical question, "Does the case report still have a place in modern medical science?"  He then states "The answer is an emphatic yes."  Clinical case reports form the basis for detecting new ideas--new disease entities, new etiological clues, new side effects, and new treatments.  In an article entitled "In Defense of Case Reports and Case Series" he writes that "Case reports and series have a high sensitivity for detecting novelty and therefore remain one of the cornerstones of medical progress..For example, Morris, in an article entitled "The Importance of Case Reports", relates the Case Report appearing in the summer of 1981 in The American Journal of Dermatopathology.  Gottlieb, et. al. wrote a very small, unassuming case report entitled "A preliminary communication on extensively disseminated Kaposi's sarcoma in young homosexual men".  In the article, the authors raised an interesting question--something characteristic of any good case report: 

"This sudden, very high incidence of the condition in male homosexuals suggests an epidemic and raises the possibility of an infectious cause." 

Arguably, this was one of the first (if not THE first) article describing what we would now call AIDS.  

In addition to giving us a forum for new ideas which would suggest new medical hypotheses and stimulate further medical research, the Case Report forms a time-honored tradition in medical education--the Clinical Pathological conferences where difficult or rare cases are discussed/described for the benefit of all.  They are necessary for medical education.  They are an excellent means of describing important adverse drug effects, and even offer a way for neophyte, young authors to find their way into the medical literature.   

 But enough with the generalizations.  Why are case reports particularly crucial in the allergy literature?  Easy.  Because in our own specialty, we are often dealing with highly sensitive individuals with multiple unique sensitivities.  No two people are exactly alike.  Yet we are deluged with randomized, controlled studies investigating ONE variable in otherwise homogeneous patient populations--let's say grass pollen allergy--and see how a particular SINGLE modality (antihistamine, SLIT, etc.) helps.  The typical allergy patient (if there is such a thing) is usually "messy"--they have multiple sensitivities involving multiple target organs.  An ideal situation for case reports--and not so ideal for randomized trials.  And an ideal situation for keeping the Case Report in a prominent position--and not in the backwaters of "Letters To The Editor" at the tail end of the Annals.