Latest research on 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 on asthma.

"Spirometry in Children with Persistent Asthma and Gastroesophageal Reflux: before and Two Years after Anti-reflux Treatment." (Abstract #1: Nov. 9 at 1:00 p.m.) - Aaron K. Kobernick, M.D., New Orleans, La., et al - Gastroesophageal reflux disease (GERD) has been implicated in provoking asthma, but the outcome of anti-GERD treatment on pulmonary functions in children is not clear. Investigators found after 2 years of anti-GERD treatment in non-atopic asthmatic children with GERD there is a significant improvement in pulmonary functions.

"Living Near Freeways Associated with Poor Asthma Control." (Abstract #2: Nov. 9 at 1:15 p.m.) - Peter N. Huynh, M.D., San Marino, Calif., et al - Living near heavy traffic has been linked to increased asthma severity. Investigators examined whether exposure to heavy traffic is associated with the ability to achieve and maintain asthma control in 756 inner city children enrolled in a pediatric asthma management program. They concluded that, in children with asthma, living near freeways is associated with poor asthma control. Proximity to freeways is more important to long term control in patients with mild asthma than in patients with severe asthma.

"Incidence of Clogging for Proventil, Ventolin and ProAir HFA MDIs when Unwashed." (Abstract #3: Nov. 9 at 1:30 p.m.) - Julian Blair, Ph.D., Waterford, Ireland, et al - All albuterol HFA MDIs are at risk of clogging say investigators, particularly if not used in accordance with their patient instruction leaflets (PILs). This study evaluates the risk for clogging if ProAir, Proventil, and Ventolin are not cleaned through the life of the device. All three products did not clog when used according to their PILs. All three products demonstrated clogging when not washed. Authors recommend patients be advised to wash their albuterol inhalers according to each product's PILs in order to ensure the product performs appropriately.

"Status of Asthma Control in Primary Care in the US: Results from the Asthma Control Characteristics and Prevalence Survey Study (ACCESS)." (Abstract #4, Nov. 9 at 1:45 p.m.) - Richard H. Stanford, M.D., Research Triangle Park, N.C., et al - Investigators evaluated the level of not well controlled asthma (NWCA) within primary care providers (PCP) practices in the U.S. in asthma patients seeking care for non-respiratory conditions. The prevalence of NWCA in 1,289 asthma patients seen in PCP for non-respiratory related reasons was found to be nearly 48 percent, with African-Americans having a higher prevalence compared to Caucasians and Hispanics. Approximately 1 in 4 patients with well controlled asthma experienced an asthma exacerbation in the prior year.

"A Correlative Study of Elevated Serum Leptin Concentrations and Asthma Severity in Adult Patients: A Possible Leptin Resistence?" (Abstract #5: Nov. 9 at 2:00 p.m.) - Ulises N. García-Ramírez, M.D., Mexico City, Mexico, et al - According to investigators, leptin is a hormone protein that's functions include inhibiting hypothalamic control of appetite and pro-inflammatory activity. Since leptin resistance appears to be common in the extremely obese, but is rarely seen in formal weight subjects, authors investigate leptin serum concentrations in subjects with different body mass indices (BMIs) and correlate these with severity of asthma. Their findings suggest a correlation between high serum leptin concentrations in patients with obesity and increased asthma severity in adults. They conclude that this may be related to leptin resistance in the obese patients known to have high BMI values.

"Predictors for Early vs. Late Hospital Readmissions among Inner City Asthmatics." (Abstract #6: Nov. 9 at 2:15 p.m.) - Santosh K. Kaipa, M.D., Bronx, N.Y., et al - Asthma is the most common chronic pediatric illness in the United States, affecting approximately 25 percent of children in an urban population say investigators. It is the second most common cause of hospitalization and frequently leads to patients being readmitted a short time after discharge. The study found that pediatric asthma readmissions can be predicted based on risk factors during the index admissions, such as prematurity and younger age. The study also found the majority (85 percent) of the hospital's charts did not report day time/nighttime symptoms, as recommended by NAEPP guidelines. Only a small percentage of readmissions (15.4 percent) had a consultation by an allergist and were given an asthma action plan.

"Atopic and Clinical Characteristics of Children with Frequent Moderate to Severe Viral Respiratory Illnesses during the First Three Years of Life." (Abstract #8: Nov. 9 at 2:45 p.m.) - Christine Virnig, M.D., Madison, Wis., et al - This study tested the hygiene hypothesis that increased exposure to infections early in life confers protection against the development of allergic diseases. By analyzing the influence of frequent viral respiratory illnesses on various clinical and atopic characteristics, investigators found in the COAST (Childhood Origins of ASThma study) birth cohort, children with frequent moderate to severe illnesses during the first 3 years of life were more likely to have attended daycare and to have been breastfed. Frequent illnesses did not protect against the development of atopic diseases as theorized by the hygiene hypothesis, but rather increased the risk of developing wheezing and asthma they concluded.

"Human Mast Cells Stimulate Bronchial Epithelial Cells to Produce Plasminogen Activator Inhibitor-1 Via TGF-Beta and Activin A." (Abstract #54: Nov. 10 at 2:15 p.m. - Clemmens von Pirquet Award) - Seong H. Cho, M.D., Chicago, Ill., et al - Mast cells are associated with airway remodeling in asthma. According to investigators, mast cells producing plasminogen activator inhibitor (PAI)-1 are associated with fatal asthma. In this study, researchers conclude that mast cells may have an important role in the airway remodeling of asthma, not only as a source of PAI-1, but also by influencing other resident cells such as bronchial epithelial cells to produce PAI-1.

"Prevalence of Influenza Vaccination in Children with Asthma in a Specialty Clinic of a University Affiliated Hospital." (Abstract #P62: Nov. 8 at Noon) - Divya Seth, M.D., Detroit, Mich., et al - Investigators study the prevalence of influenza immunization in children with asthma in 2004 and parental beliefs on reasons to or not to vaccinate children with asthma, concluding influenza immunization is inadequate even in this high risk group. The most common reasons cited for vaccination was recommendation by a physician (43 percent), given as a yearly routine (21 percent), and heard at school (15 percent). The most common reasons cited for not vaccinating included lack of benefit (32 percent), previous vaccine related adverse event such as pain and fever (22 percent), and perceptions such as "we never get ill" (16 percent) or "we rather get influenza illness"(10 percent). Authors recommend physicians educate and discuss the benefits and risks of influenza vaccine at every opportunity for successful immunization.

"Access, Utilization & Perception about Information Technology and Online Health Information among Asthmatic Patients in Community Clinics." (Abstract #P99: Nov. 8 at Noon) - Sonal R. Patel, M.D., Los Angeles, Calif., et al - Investigators analyzed data from face-to-face interviews of 169 patients (60 with asthma and 109 with no disease). Compared to those with no disease, asthmatics significantly reported using e-mails (82 percent vs. 59 percent), contribute to a discussion board (32 percent vs. 15 percent), and search for prescription drugs (75 percent vs. 46 percent). They reported that online information changed their perception about diet, exercise, stress management (76 percent vs. 45 percent) and affected the way they cope with their health condition (63 percent vs. 26 percent). Authors concluded that health promotion intervention using computer/Internet might benefit these populations and may improve patient's ability to make health-related decisions.

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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