New data on diagnosis and treatment of allergic diseases to be presented at the ACAAI meeting

Researchers are unveiling new data on investigational findings in nearly 450 abstracts on the diagnosis and treatment of allergic diseases at the ACAAI Annual Meeting in Miami Beach, Fla., Nov. 5-10. Following are highlights of some key studies:

"Use of Epinephrine for the Treatment of Anaphylaxis by US Emergency Medical Service Personnel in the Pre-Hospital Setting." (Abstract #13: Oral Presentation, Nov. 8 at 2:00 p.m.) - Dana V. Wallace, M.D., Fort Lauderdale, Fla., et al - After determining that the current available and use of epinephrine (Epi) for anaphylaxis by emergency medical services personnel (EMS) in the pre-hospital setting is unknown, the ACAAI Drug and Anaphylaxis Committee surveyed 50 State EMS Medical Directors about the availability and use of Epi for anaphylaxis by EMS in their state. They determined that, although all 50 states have some level of EMS that is allowed to carry either Epi auto-injectors or vials, only 17 states require EMS-Basics to have Epi available, and 15 states do not require any level of EMS to carry Epi for anaphylaxis treatment. The major reasons that EMS do not carry Epi are: 1) lack of training 2) cost of auto-injectors, and 3) legal concerns about inappropriate or incorrect use of Epi. Dr. Wallace is developing programs through ACAAI to assist EMS in their crucial work for the public.

"Long-Term Use of Nasal Saline Irrigation: Harmful or Helpful?" (Abstract #32: Oral Presentation, Nov. 8 at 2:45 p.m.) - Talal M. Nsouli, M.D., Washington, D.C., et al - Despite the common use of nasal saline irrigation (NSI, or Neti Pot) in the treatment of sinus disease, investigators say there has been little statistical evidence to confirm its success. After monitoring 68 patients during a 12-month NSI phase, followed by a 12-month NSI discontinuation (NSID) phase, their statistical analyses revealed a 62.2 percent decrease in the frequency of acute rhinosinusitis during the discontinuation phase. Investigators conclude that, "although NSI has been shown to improve nasal mucociliary clearance, its daily long-term use may result in increased frequency of acute infection by potentially depleting the nose of its immune blanket of mucus. Therefore, the practicing clinician should be aware of this potential unwanted effect of long-term utilization of NSI."

"How to Eat Eggs - Proactive Egg Ingestion in High-risk Patients with Severe Egg Allergy." (Abstract #52: Oral Presentation, Nov. 9 at 1:45 p.m.) - Kazuyo Kuzume, M.D., et al, Ehime, Japan - Investigators performed open challenge testing in 29 high risk patients with severe egg allergy, beginning in a hospital carefully monitored by physicians. Initially, the tests consisted of boiled egg yolk ingested in small amounts that were doubled every 60 minutes, at most three times per day. Once the threshold amount was determined in the hospital, patients took the same dose every day at home for 5 days to 1 month depending on their condition, and then the dose was doubled and food ingestion continued. After they could eat one boiled egg yolk without any reactions for 2 weeks, the challenge test starting with small amounts of whole egg were performed in the same manner. Twenty five patients (86 percent) were able to eat one fourth of cooked whole egg within 10 months, and egg-white specific IgE levels decreased significantly after tolerance induction. Authors conclude this was an effective treatment for high-risk patients with egg allergy.

"Time to Response with Ecallantide for the Treatment of Acute Attacks of Hereditary Angioedema: Results from the EDEMA Development Program." (Abstract #57: Oral Presentation, Nov. 9 at 1:00 p.m.) - Marc A. Riedl, M.D., Los Angeles, Calif., et al - Authors define hereditary angioedema (HAE) as "a rare, debilitating, and potentially fatal disease characterized by unpredictable, acute attacks of edema of the larynx, abdomen and periphery." Until recently there were very few effective treatments. This analysis of ecallantide, a novel plasma kallikrein inhibitor developed for the treatment of acute HAE attacks is from the EDEMA Development Program's two randomized, double-blind, placebo controlled Phase 3 trials. In a study population of 143 patients, the median time to onset of improvement was 67.0 minutes for ecallantide vs. 105.0 minutes for placebo; 73 percent of ecallantide patients began to improve by 4 hours post-dosing, vs. 58 percent of placebo patients. Investigators conclude that "ecallantide achieved rapid and sustained relief of symptoms associated with an acute attack of HAE."

"What Does a Patient with Anaphylaxis Do before Seeking Medical Attention?" (Abstract P10: Poster Presentation, Nov. 7 at 12:30 - 1:30 p.m., and Nov. 8, Noon - 1:00 p.m.) - Veena Manivannan, M.D., Rochester, Minn., et al - Investigators assess medication use, reason for delay in seeking medical attention, and understanding of anaphylaxis in 58 patients visiting the emergency department. The delay seeking medical attention was mainly because patients thought symptoms would subside. Overall 65.5 percent perceived symptoms to result from a severe allergic reaction and 86.2 percent thought time to seek medical attention was of essence; 67.2 percent went to the nearest medical facility by car, 19.0 percent by ambulance and 13.7 by other means. Of those with a prescription for self-injectable epinephrine, only 30.8 percent used it prior to arrival. Authors say, "despite a reasonable level of awareness, there is still room for educational models to be implemented to expedite first aid and seek expert medical care for anaphylaxis."

"The School Nurse's Perception of Food Allergy - A Statewide Survey." (Abstract P288: Poster Presentation, Nov. 7 at 12:30 - 1:30 p.m., and Nov. 8, Noon - 1:00 p.m.) - John M. Pulcini, M.D., et al, Jackson, Miss. Food allergy emergency plans are recommended by the ACAAI, the American Academy of Pediatrics, the National Association of School Nurses and Mississippi Department of Education. To determine the current food allergy management plans in Mississippi public schools, a 20-question paper survey administered by investigators was completed by 96 school nurses, of which 97 percent had at least one food allergic student at their school. They found 30 percent of schools had all of their food allergic students on a food allergy action plan, whereas 29 percent of schools had only 10 percent or less of their known food allergic students on food allergy action plans. Authors note that "the students were more likely to have food allergy action plans if the school nurse received information on food allergies from parents or a physician, or if the student attended a school in an urban area."