New advances in diagnosis and treatment of allergic diseases

Researchers are presenting more than 450 abstracts on investigational findings in the diagnosis and treatment of allergic diseases at the ACAAI Annual Meeting in Seattle, Nov. 6-11. Following are highlights of some key studies in allergy-immunology.

"Prevalence of Oral Breathing and Associated Factors in Patients with Respiratory Allergy." (Abstract #36: Nov. 10 at 1:45 p.m.) - Marisol Traviño-Salinas, M.D., Monterrey, Mexico, et al - Authors report allergic rhinitis and asthma have been associated with craniofacial abnormalities due to their high association with oral breathing. After conducting a complete history and physician examination of 107 patients between 6 and 15 years of age with allergic rhinitis and asthma, they had the parents answer a questionnaire inquiring about snoring, day-time sleepiness and academic performance of their child. Investigators found the prevalence of oral-breathing in patients with respiratory allergies was 29 percent. The children's increased tendency to snore at night causes them to have day time sleepiness, which impacts their academic performance and quality of life.

"Prehospital Administration of Epinephrine for Anaphylaxis." (Abstract #42: Nov. 10 at 1:15 p.m.) - Robert J. Jyde, M.D., Rochester, Minn., et al - Although there is no universal consensus on the diagnostic criteria for anaphylaxis, authors note that epinephrine is the treatment of choice. Objectives of this investigation are to study the frequency of epinephrine administration for anaphylaxis in patients entering the Emergency Medical Services (EMS) system and to determine the outcomes of patients who received pre-hospital epinephrine. Of the 53 patients with anaphylaxis, 8 percent received epinephrine prior to EMS arrival, and paramedics administered epinephrine to 26 percent. Investigators conclude that epinephrine may be underutilized in the pre-hospital management of anaphylaxis.

"Incidence & Temporal Trends of Primary Immunodeficiency in Olmsted County, Minnesota, USA: A Population Based Cohort Study." (Abstract #50: Nov. 10 at 1:15 p.m.) - Avini Y. Joshi, M.D., Rochester, Minn., et al - Described as the first ever population-based study on the incidence of primary immunodeficiencies (PID), this study found that the diagnosis of PID increased over the past three decades. The rate of PID from 2001-2006 (10.3 per 100,000 person-years) was nearly 5 times higher than from 1976-1980 (2.4 per 100,000 person-years) and nearly twice as high from 1996-2000 (5.5 per 100,000 person-years). Authors recommend that frequent, severe, or unusual infections should prompt a thorough immunodeficiency evaluation, because early recognition may avoid considerable morbidity.

"Markers of Immune Tolerance in Successfully Treated Eosinophilic Esophagitis." (Abstract #56: Nov. 10 at 2:45 p.m.- Clemmens von Pirquet Award) - Neha Reshamwala, M.D., Palo Alto, Calif., et al - Although pathophysiological basis of eosinophilic esophagitis (EE) - an allergic inflammatory condition of the esophagus in children and adults - is not well understood, the intake of certain foods may play a role report investigators. Treatment strategies include removal of the offending food, proton pump inhibitors, swallowed steroids, antihistamines, and, in investigational reports, the anit-IL5 monoclonal antibody mepolizumab. In this study, molecular markers associated with immune tolerance, such as Foxp3+CD4+CD25HICD1271o (natural Treg), TGF-beta and IL-10, are found to be correlated with EE disease in remission. Authors note that these markers could be helpful in the management and assessment of treatment progress in EE.

"Does Pregnancy Alter Total or Allergen-Specific IgE?" (Abstract #P44: Nov. 8 at Noon) - Lee Michael Perry, M.D., Augusta, Ga., et al - Described as the first study of the possible effects of pregnancy on allergen-specific IgE, investigators demonstrate that maternal total IgE levels are increased at one and twelve months after childbirth, but in contrast, allergen-specific IgE levels decreased at one month. Blood samples were obtained from 470 female patients during the third trimester or pregnancy and at one month after delivery, and 103 of these patients were studied one year after delivery. The samples were analyzed for total IgE and for specific IgE to eight allergens: dust mite, cat, dog, cockroach, ragweed, timothy grass, egg and Alternaria alternate. Despite these decreases in allergen-specific IgE to the eight common allergens tested, there was only a small percentage of subjects who changed sensitization status to individual allergens.

"Correlation of Atopy in Pediatric Patients with Otitis Media with Effusion." (Abstract #P52: Nov. 8 at Noon) - Maria V. Balotro, M.D., Manila, Philippines, et al - Allergy may contribute to the development of otitis media with effusion (OME), but investigators note it has not been conclusively ascertained. In a case control study of 120 pediatric patients with OME (60 atopics, 60 non-atopics) between age 3 to 12 years, they found a positive correlation between atopy and OME, with a 3-fold increase in atopics compared to those who were non-atopic. Atopic subjects with a greater mean wheal diameter had a higher likelihood of developing OME.

"The Utility of Google Trends to Structure Patient Related Education Initiatives." (Abstract #P296: Nov. 9 at Noon) - Vesselin Dimov, M.D., Omaha, Neb., et al - As the Internet is gradually becoming the first source for health information for many patients, authors suggest it would be helpful to coincide the education on a particular topic with the time when many patients search for that information. To determine the seasonal trends of allergy-related searches on the Internet search engine in the U.S., investigators used the search tool Google Trends. For the years 2004-2008, they found searches for "allergy" peaked in the spring and fall; searches for "bee sting" were most frequent during the summer months; and "asthma" searches showed a double-peak distribution with the highest frequency in spring and winter months, which was most likely explained by exacerbations triggered by high pollen count and upper respiratory tract infections, respectively. Knowledge of such variability in search patterns present the opportunity to tailor online and offline educational programs to what patients want to know during a particular time of year.

"Antitussive Effect of Benzonatate-Guaifenesin Combination Therapy in Acute Viral Cough." (Abstract #P317: Nov. 9 at Noon) - Peter Dicpinigaitis, M.D., Bronx, N.Y., et al - Cough is the most common complaint for which patients in the United States seek medical attention according to investigators, and acute cough due to viral upper respiratory tract infection (URI) is the most common form of cough. Few agents have been shown in proper clinical trials to be effective in acute cough due to URI they note. Evaluating the effect of benzonatate 200 mg, guaifenesin 600 mg, their combination, and placebo on capsaic-induced cough in 30 adult nonsmokers with acute URI, they conclude that benzonatate plus guaifenesin may be an effective therapy for acute cough due to the common cold (URI).

About the American College of Allergy, Asthma and Immunology
The ACAAI is a professional medical organization headquartered in Arlington Heights, Ill., that promotes excellence in the practice of the subspecialty of allergy and immunology. The College, comprising more than 5,000 allergists-immunologists and related health care professionals, fosters a culture of collaboration and congeniality in which its members work together and with others toward the common goals of patient care, education, advocacy and research.


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