Literature review: Immunotherapy - Twitter summary from 2014 #ACAAI meeting

Dr Hal Nelson discussed new literature on immunotherapy.

Comparison of SLIT and SCIT - Clin Exp Allergy 44:417. Take home message: SCIT shows significant and more profound effect than SLIT by symptoms and humoral biomarkers.

AAAAI/ACAAI Study of SCIT 2008-2012 - JACI in Practice 2014;2:161. From 2008-12, 27-49% of AAAAI/ACAAI members responded to surveys, representing 23.3 million injection visits. In Bef 2002 study, there were 3.4 fatal reactions per year from SCIT, from 2008-2012 there was just 1 fatal reaction from SCIT. That was in an asthmatic with comorbidities. Dr Nelson laments that the survey participation rate has declined in recent years.

Esophageal hypereosinophilia induced by grass SLIT - JACI 133: 1482. A 23-yo male was on previous HDM SLIT but had dysphagia 1 month after starting grass SLIT tablet, biopsy showed 18-24 eos/hpf. Once grass SLIT stopped (and patient continued HDM SLIT), symptoms and biopsy findings normalized. There was another case of EoE with another SLIT for birch/alder/hazelnut - Case Rep GI 7:363.

House Dust Mite (HDM) sublingual tablet from Denmark - Mosbech JACI. Dose unknown (trade secret?) but looked at ICS use and asthma control. Only highest dose of the tablet ("6 DU") significantly reduced dose of ICS but other study parameters did not differ.

Ragweed SLIT for Allergic rhinoconjunctivitis - JACI 133:751. This is a Phase III study using product with a higher dose than ragweed tablets or other forms of SLIT. This liquid ragweed product reduced symptoms/medication scores by 20% and was associated with only 12% incidence of local adverse reactions.

This is a Twitter summary from 2014 #ACAAI meeting. The post is a part of series. See the rest here: http://allergynotes.blogspot.com/search/label/ACAAI

The Twitter summary was made possible by @MatthewBowdish

Several allergists did a great job posting updates from the 2014 meeting of the #ACAAI. I used the website “All My Tweets” to review the tweets. For comparison, here are the tweets from previous #ACAAI meetings (scroll down the page for the past years): http://allergynotes.blogspot.com/search/label/ACAAI


Mechanisms of allergen-specific immunotherapy (click to enlarge the image). The diagram is based on: Mechanisms of allergen-specific immunotherapy. Akdis CA, Akdis M. J Allergy Clin Immunol. 2011 Jan;127(1):18-27.

Literature review: drug allergy, immunotherapy and anaphylaxis - Twitter summary from 2014 #ACAAI meeting

Dr Montanaro discussed updates on drug allergy, immunotherapy and anaphylaxis:

1. Consequences of PCN allergy - Macy JACI 2014. Hospital costs of PCN allergy alone may account for $20M/year in just one large hospital system. -- "It would be reasonable to test all presurgical patients who claim to be allergic to penicillin if these patients will be needing perioperative antibiotic therapy. There are a lot of people out there who report a penicillin allergy and are unnecessarily being prescribed a wider-spectrum antibiotic than they really need. If you can work in a multidisciplinary capacity with your colleagues in surgery and anesthesia to come up with a system in which these patients can come to the allergy department as part of their preop evaluation, collectively we can reduce the use of these broader-spectrum antibiotics. More important, we can let these patients know that they're not allergic, so we really can potentially open up their antibiotic armamentarium" http://buff.ly/1xK7Yjx

2. PEN G testing in children - Picard, Annals 2014. Negative Predictive Value of Pen G skin test and challenge was 95%. This compares favorably with protocols using PPL and MDM. The cost of NOT testing for PCN allergy is high!

3. PPI Allergy - Bose, Annals, 2013. Authors reviewed 39 publications and 119 cases of allergy to five different PPI, omeprazole was the most common. Most frequent PPI reactions were: urticaria [54%], angioedema [38%], hypotension [23%] and SOB [20%]. Tested as follows: SPT 20-40mg/ml, ID 0.04-40mg/ml. Omeprazole cross-reacts with pantoprazole. They found 3 different cross-reactivity patterns with PPIs: omeprazole cross-reacts with all, lansoprazole cross-reacts with rabeprazole but not any others.

4. ACEI/VIT - Stoevesandt Clin Exp All. It's important to check serum tryptase in all patients undergoing workup for venom allergy to rule out indolent mastocytosis. ACEI or beta-blocker prescription was not associated with increased risk of systemic reaction, but the study was not powered to answer b-blocker question.

5. Fire Ant Rush IT - Arseneau, Annals, 2013. RIT is safe/efficacious in most patients, it may improve adherence, premed decreases systemic reactions, but there was higher than normal build-up.

6. A Long Study of Stinging Insect Anaphylaxis - Rudders, Annals 2013. Only 70% of patients with stinging insect allergy fill their epinephrine prescriptions.

7. Anaphylaxis in America - Wood, JACI, 2014. Anaphylaxis is common (1 in 20 adults), 50% never received epi, the majority have life-threatening reactions. Anaphylaxis represents a huge opportunity for clinical improvement.

This is a Twitter summary from 2014 #ACAAI meeting. The post is a part of series. See the rest here: http://allergynotes.blogspot.com/search/label/ACAAI

The Twitter summary was made possible by @MatthewBowdish

Several allergists did a great job posting updates from the 2014 meeting of the #ACAAI. I used the website “All My Tweets” to review the tweets. For comparison, here are the tweets from previous #ACAAI meetings (scroll down the page for the past years): http://allergynotes.blogspot.com/search/label/ACAAI



Drug allergy management in 5 steps (click to enlarge the image).

Literature review: allergic rhinitis - Twitter summary from 2014 #ACAAI meeting

Dr Nicklas reviewed allergic rhinitis:

Allergic rhinitis is a risk factor for traffic safety - Allergy 69:906. Driving performance when symptomatic and untreated was significantly impaired. The impairment was comparable with having a blood alcohol level of 0.03%, the legal limit in the Netherlands where this study was done.

Systematic review of secondhand smoke exposure on sinusitis - Int Forum Allergy Rhinol 4:22. The association between 2nd hand smoke exposure and sinusitis was significantly increased. There was no difference between acute and chronic sinusitis for the association between 2nd hand smoke and sinusitis.

EIB and allergic rhinitis - Clin Exp Allergy 44:858. Rhinitis significantly increased the risk of EIB.

Omalizumab for rhinitis - JACI in practice 2: 232. Obviously quite expensive. It works by symptoms score reduction, but study was not done to assess quality of life.

This is a Twitter summary from 2014 #ACAAI meeting. The post is a part of series. See the rest here: http://allergynotes.blogspot.com/search/label/ACAAI

The Twitter summary was made possible by @MatthewBowdish

Several allergists did a great job posting updates from the 2014 meeting of the #ACAAI. I used the website “All My Tweets” to review the tweets. For comparison, here are the tweets from previous #ACAAI meetings (scroll down the page for the past years): http://allergynotes.blogspot.com/search/label/ACAAI

Literature review: skin allergy - Twitter summary from 2014 #ACAAI meeting

Dr Marc Riedl discussed skin allergy updates:

Dapsone seems to help with chronic urticaria, especially with regards to itch and reduction of hives with minimal AEs (some Hgb decrease).

In a sulfasalazine study in chronic urticaria, 20% of sulfasalazine therapy patients had AEs (mainly hematologic), 2 serious AEs (leukopenia and rhabdomyolysis) but there was some efficacy.

In a study of high dose Vitamin D in chronic urticaria, patients were on Zyrtec, Zantac and Singulair plus high-dose, low dose Vit D and control. There was some improvement seen especially in high dose Vit D treated patients but results were not quite statistically significant.

Epidemiology study on angioedema from J Int Med: 1700 patients with recurrent angioedema, 61% did not have allergy or autoimmune disease. Idiopathic was the most common form of angioedema, not allergic or autoimmune, C1-INH deficiency was the second most common. ACEI induced angioedema was probably underestimated in their study

Dupilumab (anti-IL4Ra monoclonal) for atopic dermatitis - NEJM. Dupilumab caused trend toward normalization of gene expression in treated patients, with no adverse effects.

Dr Marc Riedl also showed the Pediatrics article with a SINGLE case of contact derm due to nickel allergy from iPad. http://t.co/gTMfmBJHvu

Wet wipes can be a source for contact dermatitis due to preservative MCI/MI.

This is a Twitter summary from 2014 #ACAAI meeting. The post is a part of series. See the rest here: http://allergynotes.blogspot.com/search/label/ACAAI

The Twitter summary was made possible by @MatthewBowdish

Several allergists did a great job posting updates from the 2014 meeting of the #ACAAI. I used the website “All My Tweets” to review the tweets. For comparison, here are the tweets from previous #ACAAI meetings (scroll down the page for the past years): http://allergynotes.blogspot.com/search/label/ACAAI

Literature review: clinical immunology - Twitter summary from 2014 #ACAAI meeting

Dr Jack Routes presented an update in clinical immunology.

1. CVID registry - JACI 134: 116. They found early onset was actually common, with 34% before age 10! But diagnostic delay varies in different European countries. CVID patients get lymphomas and they are almost always B cell lymphomas, patients should also get CT chest to screen for bronchiectasis. Non-infectious complication may not be assoc with increased mortality (Dr Routes doubts this). Higher IgG trough levels were associated with less serious infections, early onset CVID was more common than previously recognized.

2. PI(3)K mutations leading to T cell senescence and human immunodeficiency - Science 342; 85. PI3KD disease sort of looks like CVID and/or Hyper-IgM, probably more common than previously identified.

3. Reduced intensity condition and HLA-matched HSCT in patients w/CGD - Lancet 383; 436. May be we need to rethink BMT for CGD, and consider early transplantation instead of prophylactic therapy.

4. Clinical features of candidiasis in patients with IL12b1 deficiency - Clin Infect Dis 58; 204. If there is a recurrent/persistent oropharyngeal candidiasis in a young person, think of IL12Rb1 deficiency. Dr Bowdish: “I had to temporarily stop live-tweeting the Routes to be able to take in the beauty and complexity of STAT1 mutations. Sorry!” The current complexity of immunodeficiency is due to genetic heterogeneity, variable expressivity and allelic heterogeneity.

This is a Twitter summary from 2014 #ACAAI meeting. The post is a part of series. See the rest here: http://allergynotes.blogspot.com/search/label/ACAAI

The Twitter summary was made possible by @MatthewBowdish

Several allergists did a great job posting updates from the 2014 meeting of the #ACAAI. I used the website “All My Tweets” to review the tweets. For comparison, here are the tweets from previous #ACAAI meetings (scroll down the page for the past years): http://allergynotes.blogspot.com/search/label/ACAAI
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