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American Academy of Allergy, Asthma, & Immunology (AAAAI): Annual Meeting
In chronic sinusitis, Pneumovax screen may fuel IVIG overuse
SAN DIEGO – Using chronic sinusitis patients’ response to Pneumovax to screen them for specific antibody deficiency may lead to overtreatment with intravenous immunoglobulin, a study showed.
In addition to its traditional use to prevent pneumonia and other infections, Pneumovax (pneumococcal vaccine polyvalent) has found a new role recently: as a screening tool in chronic rhinosinusitis (CRS) patients for specific antibody deficiency (SAD), a type of immune deficiency. If patients have a poor antibody response to the Pneumovax shot, they are thought to have SAD and are placed on intravenous immunoglobulin (IVIG) – sometimes without much regard for their clinical history. The practice has been fueled by the growing suspicion that chronic rhinosinusitis might be driven by a faulty immune system.
However, the severity of SAD does not correlate neatly with the response to Pneumovax, Northwestern University investigators found in a study of 595 adult CRS patients. So, treating patients with IVIG based primarily on how they respond to the vaccine might be overkill. To prevent overuse of IVIG, it’s probably best to limit Pneumovax screening to patients with clinically worse disease, according to lead investigator Dr. Anjeni Keswani, formerly of Northwestern University in Chicago but now an allergist/immunologist at Duke University in Durham, N.C.
Overall, the proper role of Pneumovax screening still needs to be worked out. At least for now, SAD "just can’t be a laboratory diagnosis. It should include clinical history before you make a decision on IVIG therapy," Dr. Keswani said.
In the Lund-MacKay staging system for CRS, higher scores mean worse disease. The 95 patients in the study who had mild SAD (defined as 7-9 protective Streptococcus pneumoniae antibody titers after vaccination, out of 14 serotypes measured) and the 120 patients with moderate SAD (3-6 protective titers after vaccination) had significantly higher Lund-MacKay scores than the 24 patients with severe SAD. Severe SAD was defined as 2 or fewer protective titers following the vaccine.
Mild and moderate SAD patients also had significantly higher rates of asthma and higher, although not significantly higher, rates of allergic rhinitis and nasal polyps, Dr. Keswani said at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.
Meanwhile, patients with more severe SAD were significantly more likely than mild SAD patients to have pneumonia histories and, when present, more severe asthma. And they used significantly more antibiotics in the 2 years following vaccination.
Asthma severity, antibiotic use, and pneumonia history in mild SAD patients were, in fact, similar to rates in CRS patients without immune deficiency. That raises the possibility that what’s now considered mild SAD might not even be an immunodeficiency, hence the notion of limiting Pneumovax screening to patients who are worse off.
As it all gets sorted out, "we don’t want patients diagnosed with SAD to automatically be placed on immunoglobulin replacement," Dr. Keswani said. "I don’t think that’s useful for the majority of patients. There is a proportion who mount a good response to infection; they may have an impaired response to the vaccine, but we can manage them with antibiotic prophylaxis and early assessment.
"We are trying to come up with guidelines to better help determine who should be screened," she added. "If they don’t have evidence of infection, I don’t think we can actually call them SAD."
Dr. Keswani said she had no relevant disclosures, and there was no outside funding involved in the project.
SAN DIEGO – Using chronic sinusitis patients’ response to Pneumovax to screen them for specific antibody deficiency may lead to overtreatment with intravenous immunoglobulin, a study showed.
In addition to its traditional use to prevent pneumonia and other infections, Pneumovax (pneumococcal vaccine polyvalent) has found a new role recently: as a screening tool in chronic rhinosinusitis (CRS) patients for specific antibody deficiency (SAD), a type of immune deficiency. If patients have a poor antibody response to the Pneumovax shot, they are thought to have SAD and are placed on intravenous immunoglobulin (IVIG) – sometimes without much regard for their clinical history. The practice has been fueled by the growing suspicion that chronic rhinosinusitis might be driven by a faulty immune system.
However, the severity of SAD does not correlate neatly with the response to Pneumovax, Northwestern University investigators found in a study of 595 adult CRS patients. So, treating patients with IVIG based primarily on how they respond to the vaccine might be overkill. To prevent overuse of IVIG, it’s probably best to limit Pneumovax screening to patients with clinically worse disease, according to lead investigator Dr. Anjeni Keswani, formerly of Northwestern University in Chicago but now an allergist/immunologist at Duke University in Durham, N.C.
Overall, the proper role of Pneumovax screening still needs to be worked out. At least for now, SAD "just can’t be a laboratory diagnosis. It should include clinical history before you make a decision on IVIG therapy," Dr. Keswani said.
In the Lund-MacKay staging system for CRS, higher scores mean worse disease. The 95 patients in the study who had mild SAD (defined as 7-9 protective Streptococcus pneumoniae antibody titers after vaccination, out of 14 serotypes measured) and the 120 patients with moderate SAD (3-6 protective titers after vaccination) had significantly higher Lund-MacKay scores than the 24 patients with severe SAD. Severe SAD was defined as 2 or fewer protective titers following the vaccine.
Mild and moderate SAD patients also had significantly higher rates of asthma and higher, although not significantly higher, rates of allergic rhinitis and nasal polyps, Dr. Keswani said at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.
Meanwhile, patients with more severe SAD were significantly more likely than mild SAD patients to have pneumonia histories and, when present, more severe asthma. And they used significantly more antibiotics in the 2 years following vaccination.
Asthma severity, antibiotic use, and pneumonia history in mild SAD patients were, in fact, similar to rates in CRS patients without immune deficiency. That raises the possibility that what’s now considered mild SAD might not even be an immunodeficiency, hence the notion of limiting Pneumovax screening to patients who are worse off.
As it all gets sorted out, "we don’t want patients diagnosed with SAD to automatically be placed on immunoglobulin replacement," Dr. Keswani said. "I don’t think that’s useful for the majority of patients. There is a proportion who mount a good response to infection; they may have an impaired response to the vaccine, but we can manage them with antibiotic prophylaxis and early assessment.
"We are trying to come up with guidelines to better help determine who should be screened," she added. "If they don’t have evidence of infection, I don’t think we can actually call them SAD."
Dr. Keswani said she had no relevant disclosures, and there was no outside funding involved in the project.
SAN DIEGO – Using chronic sinusitis patients’ response to Pneumovax to screen them for specific antibody deficiency may lead to overtreatment with intravenous immunoglobulin, a study showed.
In addition to its traditional use to prevent pneumonia and other infections, Pneumovax (pneumococcal vaccine polyvalent) has found a new role recently: as a screening tool in chronic rhinosinusitis (CRS) patients for specific antibody deficiency (SAD), a type of immune deficiency. If patients have a poor antibody response to the Pneumovax shot, they are thought to have SAD and are placed on intravenous immunoglobulin (IVIG) – sometimes without much regard for their clinical history. The practice has been fueled by the growing suspicion that chronic rhinosinusitis might be driven by a faulty immune system.
However, the severity of SAD does not correlate neatly with the response to Pneumovax, Northwestern University investigators found in a study of 595 adult CRS patients. So, treating patients with IVIG based primarily on how they respond to the vaccine might be overkill. To prevent overuse of IVIG, it’s probably best to limit Pneumovax screening to patients with clinically worse disease, according to lead investigator Dr. Anjeni Keswani, formerly of Northwestern University in Chicago but now an allergist/immunologist at Duke University in Durham, N.C.
Overall, the proper role of Pneumovax screening still needs to be worked out. At least for now, SAD "just can’t be a laboratory diagnosis. It should include clinical history before you make a decision on IVIG therapy," Dr. Keswani said.
In the Lund-MacKay staging system for CRS, higher scores mean worse disease. The 95 patients in the study who had mild SAD (defined as 7-9 protective Streptococcus pneumoniae antibody titers after vaccination, out of 14 serotypes measured) and the 120 patients with moderate SAD (3-6 protective titers after vaccination) had significantly higher Lund-MacKay scores than the 24 patients with severe SAD. Severe SAD was defined as 2 or fewer protective titers following the vaccine.
Mild and moderate SAD patients also had significantly higher rates of asthma and higher, although not significantly higher, rates of allergic rhinitis and nasal polyps, Dr. Keswani said at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.
Meanwhile, patients with more severe SAD were significantly more likely than mild SAD patients to have pneumonia histories and, when present, more severe asthma. And they used significantly more antibiotics in the 2 years following vaccination.
Asthma severity, antibiotic use, and pneumonia history in mild SAD patients were, in fact, similar to rates in CRS patients without immune deficiency. That raises the possibility that what’s now considered mild SAD might not even be an immunodeficiency, hence the notion of limiting Pneumovax screening to patients who are worse off.
As it all gets sorted out, "we don’t want patients diagnosed with SAD to automatically be placed on immunoglobulin replacement," Dr. Keswani said. "I don’t think that’s useful for the majority of patients. There is a proportion who mount a good response to infection; they may have an impaired response to the vaccine, but we can manage them with antibiotic prophylaxis and early assessment.
"We are trying to come up with guidelines to better help determine who should be screened," she added. "If they don’t have evidence of infection, I don’t think we can actually call them SAD."
Dr. Keswani said she had no relevant disclosures, and there was no outside funding involved in the project.
AT THE 2014 AAAAI ANNUAL MEETING
Major finding: In patients with chronic rhinosinusitis, the severity of specific antibody deficiency did not correlate neatly with patients’ response to Pneumovax vaccination.
Data Source: Retrospective, electronic medical record review of 595 patients.
Disclosures: Dr. Anjeni Keswani said she had no disclosures, and the study received no outside funding.
Peanut Reactivity After Immunotherapy
SAN DIEGO – Waiting 3 months after successful oral immunotherapy for peanut allergy before exposure to peanuts significantly increased the odds of reactivity returning in a prospective study of 20 children.
All 20 patients became desensitized to peanuts while on daily oral immunotherapy and successfully passed double-blind, placebo-controlled food challenges at the end of immunotherapy. All 16 patients who then avoided peanuts for 1 month passed a second food challenge, but only 1 of 4 patients who avoided peanuts for 3 months after immunotherapy passed a second one.
"If you wait long enough, the desensitization effect may well wear off," Dr. Brian P. Vickery said at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.
He and his associates looked at levels of basophil activation and conducted skin prick tests to peanut to get a better sense of why this was happening. Basophil activation to peanut antigen and anti-IgE stimulation increased significantly between the times of the first and second food challenges in the patients who avoided peanuts for 3 months but not in those who avoided the nuts for only 1 month.
The basophil activation levels had been similar between groups at the end of immunotherapy, suggesting that desensitization succeeded in all patients, but the length of peanut avoidance affected basophil responses, leading to revival of clinical reactivity.
Skin prick test results returned to baseline levels in three of the four patients who avoided peanuts for 3 months after the end of immunotherapy.
The amount of time on oral immunotherapy did not seem to be a key factor in the likelihood of sustained suppression of allergic disease, reported Dr. Vickery of the department of pediatrics at the University of North Carolina at Chapel Hill. Patients who waited 1 month before exposure to peanut had been on approximately 20-50 months of oral immunotherapy, and patients who waited 3 months before exposure had been on approximately 60 months of immunotherapy.
The lead author of the study was Michael D. Kulis Jr., Ph.D., also of the university.
Prolonged avoidance of peanut after peanut oral immunotherapy appears to be detrimental and may reverse the effects of the treatment, Dr. A. Wesley Burks said at a press briefing.
The findings may be applicable to other food allergies, but "we don’t know that because there have not been enough studies that long with other foods," said Dr. Burks, a coinvestigator in the study and chairman of the department of pediatrics at the university. "I wouldn’t anticipate that it would be different."
The average age of children in the study was 6 years.
This exploratory study was not controlled and was limited by its small size. The Peanut Oral Immunotherapy in Children (IMPACT) study is underway and should answer the question of how long the clinical effects of oral immunotherapy last, Dr. Vickery said. The study is being sponsored by the Immune Tolerance Network and the National Institute of Allergy and Infectious Diseases.
Dr. Vickery, Dr. Kulis, and Dr. Burks reported having no financial disclosures. The National Institutes of Health funded the study.
On Twitter @sherryboschert
SAN DIEGO – Waiting 3 months after successful oral immunotherapy for peanut allergy before exposure to peanuts significantly increased the odds of reactivity returning in a prospective study of 20 children.
All 20 patients became desensitized to peanuts while on daily oral immunotherapy and successfully passed double-blind, placebo-controlled food challenges at the end of immunotherapy. All 16 patients who then avoided peanuts for 1 month passed a second food challenge, but only 1 of 4 patients who avoided peanuts for 3 months after immunotherapy passed a second one.
"If you wait long enough, the desensitization effect may well wear off," Dr. Brian P. Vickery said at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.
He and his associates looked at levels of basophil activation and conducted skin prick tests to peanut to get a better sense of why this was happening. Basophil activation to peanut antigen and anti-IgE stimulation increased significantly between the times of the first and second food challenges in the patients who avoided peanuts for 3 months but not in those who avoided the nuts for only 1 month.
The basophil activation levels had been similar between groups at the end of immunotherapy, suggesting that desensitization succeeded in all patients, but the length of peanut avoidance affected basophil responses, leading to revival of clinical reactivity.
Skin prick test results returned to baseline levels in three of the four patients who avoided peanuts for 3 months after the end of immunotherapy.
The amount of time on oral immunotherapy did not seem to be a key factor in the likelihood of sustained suppression of allergic disease, reported Dr. Vickery of the department of pediatrics at the University of North Carolina at Chapel Hill. Patients who waited 1 month before exposure to peanut had been on approximately 20-50 months of oral immunotherapy, and patients who waited 3 months before exposure had been on approximately 60 months of immunotherapy.
The lead author of the study was Michael D. Kulis Jr., Ph.D., also of the university.
Prolonged avoidance of peanut after peanut oral immunotherapy appears to be detrimental and may reverse the effects of the treatment, Dr. A. Wesley Burks said at a press briefing.
The findings may be applicable to other food allergies, but "we don’t know that because there have not been enough studies that long with other foods," said Dr. Burks, a coinvestigator in the study and chairman of the department of pediatrics at the university. "I wouldn’t anticipate that it would be different."
The average age of children in the study was 6 years.
This exploratory study was not controlled and was limited by its small size. The Peanut Oral Immunotherapy in Children (IMPACT) study is underway and should answer the question of how long the clinical effects of oral immunotherapy last, Dr. Vickery said. The study is being sponsored by the Immune Tolerance Network and the National Institute of Allergy and Infectious Diseases.
Dr. Vickery, Dr. Kulis, and Dr. Burks reported having no financial disclosures. The National Institutes of Health funded the study.
On Twitter @sherryboschert
SAN DIEGO – Waiting 3 months after successful oral immunotherapy for peanut allergy before exposure to peanuts significantly increased the odds of reactivity returning in a prospective study of 20 children.
All 20 patients became desensitized to peanuts while on daily oral immunotherapy and successfully passed double-blind, placebo-controlled food challenges at the end of immunotherapy. All 16 patients who then avoided peanuts for 1 month passed a second food challenge, but only 1 of 4 patients who avoided peanuts for 3 months after immunotherapy passed a second one.
"If you wait long enough, the desensitization effect may well wear off," Dr. Brian P. Vickery said at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.
He and his associates looked at levels of basophil activation and conducted skin prick tests to peanut to get a better sense of why this was happening. Basophil activation to peanut antigen and anti-IgE stimulation increased significantly between the times of the first and second food challenges in the patients who avoided peanuts for 3 months but not in those who avoided the nuts for only 1 month.
The basophil activation levels had been similar between groups at the end of immunotherapy, suggesting that desensitization succeeded in all patients, but the length of peanut avoidance affected basophil responses, leading to revival of clinical reactivity.
Skin prick test results returned to baseline levels in three of the four patients who avoided peanuts for 3 months after the end of immunotherapy.
The amount of time on oral immunotherapy did not seem to be a key factor in the likelihood of sustained suppression of allergic disease, reported Dr. Vickery of the department of pediatrics at the University of North Carolina at Chapel Hill. Patients who waited 1 month before exposure to peanut had been on approximately 20-50 months of oral immunotherapy, and patients who waited 3 months before exposure had been on approximately 60 months of immunotherapy.
The lead author of the study was Michael D. Kulis Jr., Ph.D., also of the university.
Prolonged avoidance of peanut after peanut oral immunotherapy appears to be detrimental and may reverse the effects of the treatment, Dr. A. Wesley Burks said at a press briefing.
The findings may be applicable to other food allergies, but "we don’t know that because there have not been enough studies that long with other foods," said Dr. Burks, a coinvestigator in the study and chairman of the department of pediatrics at the university. "I wouldn’t anticipate that it would be different."
The average age of children in the study was 6 years.
This exploratory study was not controlled and was limited by its small size. The Peanut Oral Immunotherapy in Children (IMPACT) study is underway and should answer the question of how long the clinical effects of oral immunotherapy last, Dr. Vickery said. The study is being sponsored by the Immune Tolerance Network and the National Institute of Allergy and Infectious Diseases.
Dr. Vickery, Dr. Kulis, and Dr. Burks reported having no financial disclosures. The National Institutes of Health funded the study.
On Twitter @sherryboschert
AT 2014 AAAAI ANNUAL MEETING
Peanut reactivity returned if exposure delayed after immunotherapy
SAN DIEGO – Waiting 3 months after successful oral immunotherapy for peanut allergy before exposure to peanuts significantly increased the odds of reactivity returning in a prospective study of 20 children.
All 20 patients became desensitized to peanuts while on daily oral immunotherapy and successfully passed double-blind, placebo-controlled food challenges at the end of immunotherapy. All 16 patients who then avoided peanuts for 1 month passed a second food challenge, but only 1 of 4 patients who avoided peanuts for 3 months after immunotherapy passed a second one.
"If you wait long enough, the desensitization effect may well wear off," Dr. Brian P. Vickery said at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.
He and his associates looked at levels of basophil activation and conducted skin prick tests to peanut to get a better sense of why this was happening. Basophil activation to peanut antigen and anti-IgE stimulation increased significantly between the times of the first and second food challenges in the patients who avoided peanuts for 3 months but not in those who avoided the nuts for only 1 month.
The basophil activation levels had been similar between groups at the end of immunotherapy, suggesting that desensitization succeeded in all patients, but the length of peanut avoidance affected basophil responses, leading to revival of clinical reactivity.
Skin prick test results returned to baseline levels in three of the four patients who avoided peanuts for 3 months after the end of immunotherapy.
The amount of time on oral immunotherapy did not seem to be a key factor in the likelihood of sustained suppression of allergic disease, reported Dr. Vickery of the department of pediatrics at the University of North Carolina at Chapel Hill. Patients who waited 1 month before exposure to peanut had been on approximately 20-50 months of oral immunotherapy, and patients who waited 3 months before exposure had been on approximately 60 months of immunotherapy.
The lead author of the study was Michael D. Kulis Jr., Ph.D., also of the university.
Prolonged avoidance of peanut after peanut oral immunotherapy appears to be detrimental and may reverse the effects of the treatment, Dr. A. Wesley Burks said at a press briefing.
The findings may be applicable to other food allergies, but "we don’t know that because there have not been enough studies that long with other foods," said Dr. Burks, a coinvestigator in the study and chairman of the department of pediatrics at the university. "I wouldn’t anticipate that it would be different."
The average age of children in the study was 6 years.
This exploratory study was not controlled and was limited by its small size. The Peanut Oral Immunotherapy in Children (IMPACT) study is underway and should answer the question of how long the clinical effects of oral immunotherapy last, Dr. Vickery said. The study is being sponsored by the Immune Tolerance Network and the National Institute of Allergy and Infectious Diseases.
Dr. Vickery, Dr. Kulis, and Dr. Burks reported having no financial disclosures. The National Institutes of Health funded the study.
On Twitter @sherryboschert
SAN DIEGO – Waiting 3 months after successful oral immunotherapy for peanut allergy before exposure to peanuts significantly increased the odds of reactivity returning in a prospective study of 20 children.
All 20 patients became desensitized to peanuts while on daily oral immunotherapy and successfully passed double-blind, placebo-controlled food challenges at the end of immunotherapy. All 16 patients who then avoided peanuts for 1 month passed a second food challenge, but only 1 of 4 patients who avoided peanuts for 3 months after immunotherapy passed a second one.
"If you wait long enough, the desensitization effect may well wear off," Dr. Brian P. Vickery said at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.
He and his associates looked at levels of basophil activation and conducted skin prick tests to peanut to get a better sense of why this was happening. Basophil activation to peanut antigen and anti-IgE stimulation increased significantly between the times of the first and second food challenges in the patients who avoided peanuts for 3 months but not in those who avoided the nuts for only 1 month.
The basophil activation levels had been similar between groups at the end of immunotherapy, suggesting that desensitization succeeded in all patients, but the length of peanut avoidance affected basophil responses, leading to revival of clinical reactivity.
Skin prick test results returned to baseline levels in three of the four patients who avoided peanuts for 3 months after the end of immunotherapy.
The amount of time on oral immunotherapy did not seem to be a key factor in the likelihood of sustained suppression of allergic disease, reported Dr. Vickery of the department of pediatrics at the University of North Carolina at Chapel Hill. Patients who waited 1 month before exposure to peanut had been on approximately 20-50 months of oral immunotherapy, and patients who waited 3 months before exposure had been on approximately 60 months of immunotherapy.
The lead author of the study was Michael D. Kulis Jr., Ph.D., also of the university.
Prolonged avoidance of peanut after peanut oral immunotherapy appears to be detrimental and may reverse the effects of the treatment, Dr. A. Wesley Burks said at a press briefing.
The findings may be applicable to other food allergies, but "we don’t know that because there have not been enough studies that long with other foods," said Dr. Burks, a coinvestigator in the study and chairman of the department of pediatrics at the university. "I wouldn’t anticipate that it would be different."
The average age of children in the study was 6 years.
This exploratory study was not controlled and was limited by its small size. The Peanut Oral Immunotherapy in Children (IMPACT) study is underway and should answer the question of how long the clinical effects of oral immunotherapy last, Dr. Vickery said. The study is being sponsored by the Immune Tolerance Network and the National Institute of Allergy and Infectious Diseases.
Dr. Vickery, Dr. Kulis, and Dr. Burks reported having no financial disclosures. The National Institutes of Health funded the study.
On Twitter @sherryboschert
SAN DIEGO – Waiting 3 months after successful oral immunotherapy for peanut allergy before exposure to peanuts significantly increased the odds of reactivity returning in a prospective study of 20 children.
All 20 patients became desensitized to peanuts while on daily oral immunotherapy and successfully passed double-blind, placebo-controlled food challenges at the end of immunotherapy. All 16 patients who then avoided peanuts for 1 month passed a second food challenge, but only 1 of 4 patients who avoided peanuts for 3 months after immunotherapy passed a second one.
"If you wait long enough, the desensitization effect may well wear off," Dr. Brian P. Vickery said at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.
He and his associates looked at levels of basophil activation and conducted skin prick tests to peanut to get a better sense of why this was happening. Basophil activation to peanut antigen and anti-IgE stimulation increased significantly between the times of the first and second food challenges in the patients who avoided peanuts for 3 months but not in those who avoided the nuts for only 1 month.
The basophil activation levels had been similar between groups at the end of immunotherapy, suggesting that desensitization succeeded in all patients, but the length of peanut avoidance affected basophil responses, leading to revival of clinical reactivity.
Skin prick test results returned to baseline levels in three of the four patients who avoided peanuts for 3 months after the end of immunotherapy.
The amount of time on oral immunotherapy did not seem to be a key factor in the likelihood of sustained suppression of allergic disease, reported Dr. Vickery of the department of pediatrics at the University of North Carolina at Chapel Hill. Patients who waited 1 month before exposure to peanut had been on approximately 20-50 months of oral immunotherapy, and patients who waited 3 months before exposure had been on approximately 60 months of immunotherapy.
The lead author of the study was Michael D. Kulis Jr., Ph.D., also of the university.
Prolonged avoidance of peanut after peanut oral immunotherapy appears to be detrimental and may reverse the effects of the treatment, Dr. A. Wesley Burks said at a press briefing.
The findings may be applicable to other food allergies, but "we don’t know that because there have not been enough studies that long with other foods," said Dr. Burks, a coinvestigator in the study and chairman of the department of pediatrics at the university. "I wouldn’t anticipate that it would be different."
The average age of children in the study was 6 years.
This exploratory study was not controlled and was limited by its small size. The Peanut Oral Immunotherapy in Children (IMPACT) study is underway and should answer the question of how long the clinical effects of oral immunotherapy last, Dr. Vickery said. The study is being sponsored by the Immune Tolerance Network and the National Institute of Allergy and Infectious Diseases.
Dr. Vickery, Dr. Kulis, and Dr. Burks reported having no financial disclosures. The National Institutes of Health funded the study.
On Twitter @sherryboschert
AT 2014 AAAAI ANNUAL MEETING
Major finding: Reactivity to peanuts returned in none of the 16 patients who avoided peanuts for 1 month after oral immunotherapy and in three of four patients who avoided peanuts for 3 months.
Data source: A prospective study of 20 children who underwent food challenges after oral immunotherapy treatment for peanut allergy.
Disclosures: Dr. Vickery, Dr. Kulis, and Dr. Burks reported having no financial disclosures.
Food allergy overdiagnosed with IgE tests
SAN DIEGO – Unwarranted food allergy testing in 67% of 274 patients who underwent testing identified a new food allergen in only 4 patients, in a retrospective study.
The review of charts on patients referred to a tertiary food allergy center from September 2011 to December 2012 found 274 children with results from a standard panel of food-specific IgE tests obtained prior to referral. Only 33% of cases warranted evaluation for food allergy according to criteria set by the National Institute of Allergy and Infectious Diseases, according to Dr. Maryam Saifi and her associates.
In the 90 patients who underwent food allergy testing appropriately, testing identified a previously unknown allergen in 38 patients (42%) and found no new allergen in 52 (58%). When food allergy testing was not warranted, however, testing identified a previously unknown allergen in only 4 of 184 patients (5%) and no new allergen in 180 patients (95%), Dr. Saifi reported in a poster presentation at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.
The most common reason for conducting food-specific IgE panel testing in patients who did not meet criteria for testing was allergic rhinitis, followed by mild atopic dermatitis, urticaria, GI complaints, rash (not otherwise specified), angioedema without urticaria, and cough.
Test results and recommendations from primary care providers led 126 of the 274 patients to alter their diets (46%), yet only 54 food-avoiding patients had a history warranting evaluation for food allergy (20% of the whole cohort), reported Dr. Saifi, a pediatrician at the University of Texas Southwestern Medical Center, Dallas.
Diet-altering patients were avoiding foods such as milk, eggs, peanuts, tree nuts, soy, wheat, fish, shellfish, sesame seed, corn, chocolate, or beef. After being seen at the referral clinic for a history, repeat testing, and observed challenges when necessary, patients were able to reintroduce an average of two foods per person, most commonly among milk, eggs, peanuts, soy, and wheat. All patients who had been avoiding corn and chocolate were able to reintroduce those foods.
Serum allergy testing should be used judiciously and only when indicated by history and physical exam, Dr. Saifi concluded. IgE panels for food allergy seem to have little utility as screening tests and often lead to misdiagnosis of food allergy, resulting in inappropriate food avoidance that could cause nutritional deficiencies, increased anxiety, and lower quality of life, she said.
The study excluded patients diagnosed with eosinophilic esophagitis and patients whose records lacked results from food-specific IgE tests prior to referral.
The investigators’ financial disclosures were not available.
On Twitter @sherryboschert
SAN DIEGO – Unwarranted food allergy testing in 67% of 274 patients who underwent testing identified a new food allergen in only 4 patients, in a retrospective study.
The review of charts on patients referred to a tertiary food allergy center from September 2011 to December 2012 found 274 children with results from a standard panel of food-specific IgE tests obtained prior to referral. Only 33% of cases warranted evaluation for food allergy according to criteria set by the National Institute of Allergy and Infectious Diseases, according to Dr. Maryam Saifi and her associates.
In the 90 patients who underwent food allergy testing appropriately, testing identified a previously unknown allergen in 38 patients (42%) and found no new allergen in 52 (58%). When food allergy testing was not warranted, however, testing identified a previously unknown allergen in only 4 of 184 patients (5%) and no new allergen in 180 patients (95%), Dr. Saifi reported in a poster presentation at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.
The most common reason for conducting food-specific IgE panel testing in patients who did not meet criteria for testing was allergic rhinitis, followed by mild atopic dermatitis, urticaria, GI complaints, rash (not otherwise specified), angioedema without urticaria, and cough.
Test results and recommendations from primary care providers led 126 of the 274 patients to alter their diets (46%), yet only 54 food-avoiding patients had a history warranting evaluation for food allergy (20% of the whole cohort), reported Dr. Saifi, a pediatrician at the University of Texas Southwestern Medical Center, Dallas.
Diet-altering patients were avoiding foods such as milk, eggs, peanuts, tree nuts, soy, wheat, fish, shellfish, sesame seed, corn, chocolate, or beef. After being seen at the referral clinic for a history, repeat testing, and observed challenges when necessary, patients were able to reintroduce an average of two foods per person, most commonly among milk, eggs, peanuts, soy, and wheat. All patients who had been avoiding corn and chocolate were able to reintroduce those foods.
Serum allergy testing should be used judiciously and only when indicated by history and physical exam, Dr. Saifi concluded. IgE panels for food allergy seem to have little utility as screening tests and often lead to misdiagnosis of food allergy, resulting in inappropriate food avoidance that could cause nutritional deficiencies, increased anxiety, and lower quality of life, she said.
The study excluded patients diagnosed with eosinophilic esophagitis and patients whose records lacked results from food-specific IgE tests prior to referral.
The investigators’ financial disclosures were not available.
On Twitter @sherryboschert
SAN DIEGO – Unwarranted food allergy testing in 67% of 274 patients who underwent testing identified a new food allergen in only 4 patients, in a retrospective study.
The review of charts on patients referred to a tertiary food allergy center from September 2011 to December 2012 found 274 children with results from a standard panel of food-specific IgE tests obtained prior to referral. Only 33% of cases warranted evaluation for food allergy according to criteria set by the National Institute of Allergy and Infectious Diseases, according to Dr. Maryam Saifi and her associates.
In the 90 patients who underwent food allergy testing appropriately, testing identified a previously unknown allergen in 38 patients (42%) and found no new allergen in 52 (58%). When food allergy testing was not warranted, however, testing identified a previously unknown allergen in only 4 of 184 patients (5%) and no new allergen in 180 patients (95%), Dr. Saifi reported in a poster presentation at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.
The most common reason for conducting food-specific IgE panel testing in patients who did not meet criteria for testing was allergic rhinitis, followed by mild atopic dermatitis, urticaria, GI complaints, rash (not otherwise specified), angioedema without urticaria, and cough.
Test results and recommendations from primary care providers led 126 of the 274 patients to alter their diets (46%), yet only 54 food-avoiding patients had a history warranting evaluation for food allergy (20% of the whole cohort), reported Dr. Saifi, a pediatrician at the University of Texas Southwestern Medical Center, Dallas.
Diet-altering patients were avoiding foods such as milk, eggs, peanuts, tree nuts, soy, wheat, fish, shellfish, sesame seed, corn, chocolate, or beef. After being seen at the referral clinic for a history, repeat testing, and observed challenges when necessary, patients were able to reintroduce an average of two foods per person, most commonly among milk, eggs, peanuts, soy, and wheat. All patients who had been avoiding corn and chocolate were able to reintroduce those foods.
Serum allergy testing should be used judiciously and only when indicated by history and physical exam, Dr. Saifi concluded. IgE panels for food allergy seem to have little utility as screening tests and often lead to misdiagnosis of food allergy, resulting in inappropriate food avoidance that could cause nutritional deficiencies, increased anxiety, and lower quality of life, she said.
The study excluded patients diagnosed with eosinophilic esophagitis and patients whose records lacked results from food-specific IgE tests prior to referral.
The investigators’ financial disclosures were not available.
On Twitter @sherryboschert
AT THE 2014 AAAAI ANNUAL MEETING
Major finding: Food allergy testing identified a new allergen in 5% of 184 patients in whom testing was not warranted and in 42% of 90 patients in whom testing was warranted.
Data source: Retrospective study of 274 patients referred to a tertiary allergy center who had results from a panel of food-specific IgE tests before referral.
Disclosures: The investigators’ financial disclosures were not available.
Know the urban myths that compromise allergy care
SAN DIEGO – There’s no such thing as a hypoallergenic dog. Blood tests for sale on the Internet won’t identify a child’s allergies. And parents don’t have to wait until a child is 1, 2 or 3 years of age to introduce dietary milk, eggs, or nuts.
These are some of the facts that physicians need to know in order to counter common myths about allergy, Dr. David R. Stukus said at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.
Patients aren’t the only ones who need enlightening. Too many physicians still believe some of the myths listed below, said Dr. Stukus of the department of pediatrics at Nationwide Children’s Hospital and Ohio State University, Columbus:
• Hypoallergenic pets: "There’s a lot of false advertising" by companies marketing supposedly hypoallergenic pets, some selling cats for $7,000-$28,000 or dogs for $16,000, he said. While some of these animals have been bred to produce fewer major allergens from their saliva, sebaceous glands, or perianal glands, they still produce minor allergens that cause clinical symptoms in sensitized people.
• Blood testing: Allergen-specific serum IgE testing is not a reliable screen for allergy, and often leads to misinterpretation and false-positive results – which in turn lead to diagnostic confusion and unnecessarily eliminating foods from a diet. Patients can purchase kits on the Internet for $49.95 that purport to test blood for 10 food, animal, environmental, and inhalant allergens, the results of which are sent back to patients for them to interpret or to ask their doctors to interpret.
Other blood-test kits selling for $450 on the Internet claim to test for IgG antibodies toward foods and additives, even thought IgG antibodies indicate exposure to products, not allergy, and may be a marker for food tolerance, not intolerance, Dr. Stukus said. A physician in the audience said that some allergists in his community are doing these IgG antibody tests, "so we have to watch ourselves, too," he said.
• No milk, eggs, or nuts for babies: Changes in recommendations over the years have contributed to the myth that highly allergenic food such as milk, eggs, or nuts should be avoided by infants until ages 1, 2, or 3 years. The most current recommendations from the American Academy of Pediatrics say that there’s no evidence to support avoiding highly allergenic foods past 4-6 months of age (Pediatrics 2008;121:183-91).
Some evidence is emerging from recent trials that early introduction of highly allergenic foods may promote tolerance, but "if they have a sibling with a peanut allergy, it makes sense to do IgE testing before peanut introduction," he said.
• Artificial dye: Despite controversy around artificial food coloring since the 1950s and around food additives in the 1970s, there is no scientific evidence to support a link between exposure to artificial dye or coloring and IgE-mediated allergic reactions, and there are no skin test extracts or serum-specific IgE tests to test for artificial dye allergy. On the contrary, many studies have found no associations.
There is some evidence, however, that an additive-free diet may improve symptoms of attention-deficit/hyperactivity disorder in a small subset of children (Clin. Pediatr. 2011;50:279-93) And rare cases of anaphylaxis have been reported in reaction to carmine, a natural red coloring derived from dried insects that is commonly used in cosmetics, but not in reaction to artificial dye.
• Egg in vaccines: Dr. Stukus handled a recent consultation in which "they were refusing to give MMR vaccine to someone with egg allergy. So, there is still a lot of confusion over this," he said.
MMR vaccine is safe for anyone with a history of egg allergy, with no testing or allergy referral required, he said. Influenza vaccine also can be given safely to egg-allergic patients, dozens of trials and guidelines conclude, with some differences in recommendations, he said. The Joint Council of Allergy, Asthma, and Immunology says there’s no need for a waiting period or referral to an allergy specialist, while the Centers for Disease Control and Prevention and the American Academy of Pediatrics recommend 30 minutes of observation for egg-allergic patients who receive influenza vaccine and referral to an allergist if there’s a history of anaphylaxis to egg. Egg-free influenza vaccine is a relatively new alternative.
Vaccine for yellow fever or rabies is contraindicated in patients with allergy to egg, but there are tests and procedures that may allow these vaccinations in a graded manner in some patients. Egg-free alternatives to rabies vaccine also are an alternative. Gelatin in both of these vaccines can cause allergic reactions, so evaluate gelatin-hypersensitive patients before vaccinating.
• Shellfish, iodine, and radiocontrast media: Surveys suggest that a majority of radiologists and cardiologists routinely ask patients about shellfish allergy before administering iodinated contrast media, even though iodine is not an allergen, Dr. Stukus said. This myth seems to have originated from a 1975 study in which patients with any kind of reported allergy were twice as likely to react to contrast media (Am. J. Roentgenol. Radium. Ther. Nucl. Med. 1975;124:145-52). Reports of seafood allergy in 15% of patients were associated with reaction to contrast media, but so were reported egg, milk, or chocolate allergy, each in 15% of patients. "Have any of you ever asked patients if they have a chocolate allergy before irradiating them?" Dr. Stukus asked.
Reactions to radiocontrast media with high osmolality agents are common, however, affecting 5%-12% of patients, with elevated risk in patients with atopy. Premedication regimens for patients with a previous reaction to radiocontrast media can lower the risk to less than 1%.
• Skin testing: The idea that skin testing is unreliable until 2, 3, or 5 years of age is sheer myth, but an ongoing one. "I had one of my colleagues say this to me 2 weeks ago," Dr. Stukus said. Skin testing is reliable at any age and can accurately assess for the presence of specific IgE, he said.
• Penicillin allergy: Adverse reactions to antibiotics are very common, but true allergic reactions are uncommon. Approximately 10% of people in general say they are allergic to penicillin, but fewer than 10% of those will have a positive skin test or symptoms if challenged. "If patients get labeled allergic" to penicillin "on their chart, that follows them forever" and makes them more likely to use less-effective, more-toxic, costlier antibiotic alternatives, Dr. Stukus said. "We can improve their lives by proving they don’t have it and taking this label off their chart."
• Gluten: Eating gluten "is currently being blamed for the ails of humanity," largely driven by companies with products to sell – so be prepared to talk about this with patients with self-diagnosed gluten allergy, Dr. Stukus said. IgE-mediated hypersensitivity reactions can occur toward wheat, rye, or barley, but not to gluten. Celiac disease is an autoimmune condition (not IgE-mediated hypersensitivity) that improves with a gluten-free diet. IgE-mediated hypersensitivity to gluten is very uncommon, but patients more commonly report having "gluten sensitivity" and GI symptoms after eating foods with gluten. That’s a poorly defined condition that’s hard to prove. A double-blind, placebo-controlled challenge is the only available method of diagnosing gluten sensitivity.
• Mold: Mold is everywhere and can cause real disease in susceptible persons, but mycotoxins rarely cause disease unless ingested in large quantities. Most health problems attributed to mold exposure are exaggerated, with no scientific basis or supportive evidence, Dr. Stukus said. But "hysteria" around mold has been a boon to some lawyers and companies that sell air purifiers and other detoxification equipment. Know your approach to identifying mold allergy, and be straightforward with patients, he advised.
Dr. Stukus reported having no financial disclosures.
On Twitter @sherryboschert
SAN DIEGO – There’s no such thing as a hypoallergenic dog. Blood tests for sale on the Internet won’t identify a child’s allergies. And parents don’t have to wait until a child is 1, 2 or 3 years of age to introduce dietary milk, eggs, or nuts.
These are some of the facts that physicians need to know in order to counter common myths about allergy, Dr. David R. Stukus said at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.
Patients aren’t the only ones who need enlightening. Too many physicians still believe some of the myths listed below, said Dr. Stukus of the department of pediatrics at Nationwide Children’s Hospital and Ohio State University, Columbus:
• Hypoallergenic pets: "There’s a lot of false advertising" by companies marketing supposedly hypoallergenic pets, some selling cats for $7,000-$28,000 or dogs for $16,000, he said. While some of these animals have been bred to produce fewer major allergens from their saliva, sebaceous glands, or perianal glands, they still produce minor allergens that cause clinical symptoms in sensitized people.
• Blood testing: Allergen-specific serum IgE testing is not a reliable screen for allergy, and often leads to misinterpretation and false-positive results – which in turn lead to diagnostic confusion and unnecessarily eliminating foods from a diet. Patients can purchase kits on the Internet for $49.95 that purport to test blood for 10 food, animal, environmental, and inhalant allergens, the results of which are sent back to patients for them to interpret or to ask their doctors to interpret.
Other blood-test kits selling for $450 on the Internet claim to test for IgG antibodies toward foods and additives, even thought IgG antibodies indicate exposure to products, not allergy, and may be a marker for food tolerance, not intolerance, Dr. Stukus said. A physician in the audience said that some allergists in his community are doing these IgG antibody tests, "so we have to watch ourselves, too," he said.
• No milk, eggs, or nuts for babies: Changes in recommendations over the years have contributed to the myth that highly allergenic food such as milk, eggs, or nuts should be avoided by infants until ages 1, 2, or 3 years. The most current recommendations from the American Academy of Pediatrics say that there’s no evidence to support avoiding highly allergenic foods past 4-6 months of age (Pediatrics 2008;121:183-91).
Some evidence is emerging from recent trials that early introduction of highly allergenic foods may promote tolerance, but "if they have a sibling with a peanut allergy, it makes sense to do IgE testing before peanut introduction," he said.
• Artificial dye: Despite controversy around artificial food coloring since the 1950s and around food additives in the 1970s, there is no scientific evidence to support a link between exposure to artificial dye or coloring and IgE-mediated allergic reactions, and there are no skin test extracts or serum-specific IgE tests to test for artificial dye allergy. On the contrary, many studies have found no associations.
There is some evidence, however, that an additive-free diet may improve symptoms of attention-deficit/hyperactivity disorder in a small subset of children (Clin. Pediatr. 2011;50:279-93) And rare cases of anaphylaxis have been reported in reaction to carmine, a natural red coloring derived from dried insects that is commonly used in cosmetics, but not in reaction to artificial dye.
• Egg in vaccines: Dr. Stukus handled a recent consultation in which "they were refusing to give MMR vaccine to someone with egg allergy. So, there is still a lot of confusion over this," he said.
MMR vaccine is safe for anyone with a history of egg allergy, with no testing or allergy referral required, he said. Influenza vaccine also can be given safely to egg-allergic patients, dozens of trials and guidelines conclude, with some differences in recommendations, he said. The Joint Council of Allergy, Asthma, and Immunology says there’s no need for a waiting period or referral to an allergy specialist, while the Centers for Disease Control and Prevention and the American Academy of Pediatrics recommend 30 minutes of observation for egg-allergic patients who receive influenza vaccine and referral to an allergist if there’s a history of anaphylaxis to egg. Egg-free influenza vaccine is a relatively new alternative.
Vaccine for yellow fever or rabies is contraindicated in patients with allergy to egg, but there are tests and procedures that may allow these vaccinations in a graded manner in some patients. Egg-free alternatives to rabies vaccine also are an alternative. Gelatin in both of these vaccines can cause allergic reactions, so evaluate gelatin-hypersensitive patients before vaccinating.
• Shellfish, iodine, and radiocontrast media: Surveys suggest that a majority of radiologists and cardiologists routinely ask patients about shellfish allergy before administering iodinated contrast media, even though iodine is not an allergen, Dr. Stukus said. This myth seems to have originated from a 1975 study in which patients with any kind of reported allergy were twice as likely to react to contrast media (Am. J. Roentgenol. Radium. Ther. Nucl. Med. 1975;124:145-52). Reports of seafood allergy in 15% of patients were associated with reaction to contrast media, but so were reported egg, milk, or chocolate allergy, each in 15% of patients. "Have any of you ever asked patients if they have a chocolate allergy before irradiating them?" Dr. Stukus asked.
Reactions to radiocontrast media with high osmolality agents are common, however, affecting 5%-12% of patients, with elevated risk in patients with atopy. Premedication regimens for patients with a previous reaction to radiocontrast media can lower the risk to less than 1%.
• Skin testing: The idea that skin testing is unreliable until 2, 3, or 5 years of age is sheer myth, but an ongoing one. "I had one of my colleagues say this to me 2 weeks ago," Dr. Stukus said. Skin testing is reliable at any age and can accurately assess for the presence of specific IgE, he said.
• Penicillin allergy: Adverse reactions to antibiotics are very common, but true allergic reactions are uncommon. Approximately 10% of people in general say they are allergic to penicillin, but fewer than 10% of those will have a positive skin test or symptoms if challenged. "If patients get labeled allergic" to penicillin "on their chart, that follows them forever" and makes them more likely to use less-effective, more-toxic, costlier antibiotic alternatives, Dr. Stukus said. "We can improve their lives by proving they don’t have it and taking this label off their chart."
• Gluten: Eating gluten "is currently being blamed for the ails of humanity," largely driven by companies with products to sell – so be prepared to talk about this with patients with self-diagnosed gluten allergy, Dr. Stukus said. IgE-mediated hypersensitivity reactions can occur toward wheat, rye, or barley, but not to gluten. Celiac disease is an autoimmune condition (not IgE-mediated hypersensitivity) that improves with a gluten-free diet. IgE-mediated hypersensitivity to gluten is very uncommon, but patients more commonly report having "gluten sensitivity" and GI symptoms after eating foods with gluten. That’s a poorly defined condition that’s hard to prove. A double-blind, placebo-controlled challenge is the only available method of diagnosing gluten sensitivity.
• Mold: Mold is everywhere and can cause real disease in susceptible persons, but mycotoxins rarely cause disease unless ingested in large quantities. Most health problems attributed to mold exposure are exaggerated, with no scientific basis or supportive evidence, Dr. Stukus said. But "hysteria" around mold has been a boon to some lawyers and companies that sell air purifiers and other detoxification equipment. Know your approach to identifying mold allergy, and be straightforward with patients, he advised.
Dr. Stukus reported having no financial disclosures.
On Twitter @sherryboschert
SAN DIEGO – There’s no such thing as a hypoallergenic dog. Blood tests for sale on the Internet won’t identify a child’s allergies. And parents don’t have to wait until a child is 1, 2 or 3 years of age to introduce dietary milk, eggs, or nuts.
These are some of the facts that physicians need to know in order to counter common myths about allergy, Dr. David R. Stukus said at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.
Patients aren’t the only ones who need enlightening. Too many physicians still believe some of the myths listed below, said Dr. Stukus of the department of pediatrics at Nationwide Children’s Hospital and Ohio State University, Columbus:
• Hypoallergenic pets: "There’s a lot of false advertising" by companies marketing supposedly hypoallergenic pets, some selling cats for $7,000-$28,000 or dogs for $16,000, he said. While some of these animals have been bred to produce fewer major allergens from their saliva, sebaceous glands, or perianal glands, they still produce minor allergens that cause clinical symptoms in sensitized people.
• Blood testing: Allergen-specific serum IgE testing is not a reliable screen for allergy, and often leads to misinterpretation and false-positive results – which in turn lead to diagnostic confusion and unnecessarily eliminating foods from a diet. Patients can purchase kits on the Internet for $49.95 that purport to test blood for 10 food, animal, environmental, and inhalant allergens, the results of which are sent back to patients for them to interpret or to ask their doctors to interpret.
Other blood-test kits selling for $450 on the Internet claim to test for IgG antibodies toward foods and additives, even thought IgG antibodies indicate exposure to products, not allergy, and may be a marker for food tolerance, not intolerance, Dr. Stukus said. A physician in the audience said that some allergists in his community are doing these IgG antibody tests, "so we have to watch ourselves, too," he said.
• No milk, eggs, or nuts for babies: Changes in recommendations over the years have contributed to the myth that highly allergenic food such as milk, eggs, or nuts should be avoided by infants until ages 1, 2, or 3 years. The most current recommendations from the American Academy of Pediatrics say that there’s no evidence to support avoiding highly allergenic foods past 4-6 months of age (Pediatrics 2008;121:183-91).
Some evidence is emerging from recent trials that early introduction of highly allergenic foods may promote tolerance, but "if they have a sibling with a peanut allergy, it makes sense to do IgE testing before peanut introduction," he said.
• Artificial dye: Despite controversy around artificial food coloring since the 1950s and around food additives in the 1970s, there is no scientific evidence to support a link between exposure to artificial dye or coloring and IgE-mediated allergic reactions, and there are no skin test extracts or serum-specific IgE tests to test for artificial dye allergy. On the contrary, many studies have found no associations.
There is some evidence, however, that an additive-free diet may improve symptoms of attention-deficit/hyperactivity disorder in a small subset of children (Clin. Pediatr. 2011;50:279-93) And rare cases of anaphylaxis have been reported in reaction to carmine, a natural red coloring derived from dried insects that is commonly used in cosmetics, but not in reaction to artificial dye.
• Egg in vaccines: Dr. Stukus handled a recent consultation in which "they were refusing to give MMR vaccine to someone with egg allergy. So, there is still a lot of confusion over this," he said.
MMR vaccine is safe for anyone with a history of egg allergy, with no testing or allergy referral required, he said. Influenza vaccine also can be given safely to egg-allergic patients, dozens of trials and guidelines conclude, with some differences in recommendations, he said. The Joint Council of Allergy, Asthma, and Immunology says there’s no need for a waiting period or referral to an allergy specialist, while the Centers for Disease Control and Prevention and the American Academy of Pediatrics recommend 30 minutes of observation for egg-allergic patients who receive influenza vaccine and referral to an allergist if there’s a history of anaphylaxis to egg. Egg-free influenza vaccine is a relatively new alternative.
Vaccine for yellow fever or rabies is contraindicated in patients with allergy to egg, but there are tests and procedures that may allow these vaccinations in a graded manner in some patients. Egg-free alternatives to rabies vaccine also are an alternative. Gelatin in both of these vaccines can cause allergic reactions, so evaluate gelatin-hypersensitive patients before vaccinating.
• Shellfish, iodine, and radiocontrast media: Surveys suggest that a majority of radiologists and cardiologists routinely ask patients about shellfish allergy before administering iodinated contrast media, even though iodine is not an allergen, Dr. Stukus said. This myth seems to have originated from a 1975 study in which patients with any kind of reported allergy were twice as likely to react to contrast media (Am. J. Roentgenol. Radium. Ther. Nucl. Med. 1975;124:145-52). Reports of seafood allergy in 15% of patients were associated with reaction to contrast media, but so were reported egg, milk, or chocolate allergy, each in 15% of patients. "Have any of you ever asked patients if they have a chocolate allergy before irradiating them?" Dr. Stukus asked.
Reactions to radiocontrast media with high osmolality agents are common, however, affecting 5%-12% of patients, with elevated risk in patients with atopy. Premedication regimens for patients with a previous reaction to radiocontrast media can lower the risk to less than 1%.
• Skin testing: The idea that skin testing is unreliable until 2, 3, or 5 years of age is sheer myth, but an ongoing one. "I had one of my colleagues say this to me 2 weeks ago," Dr. Stukus said. Skin testing is reliable at any age and can accurately assess for the presence of specific IgE, he said.
• Penicillin allergy: Adverse reactions to antibiotics are very common, but true allergic reactions are uncommon. Approximately 10% of people in general say they are allergic to penicillin, but fewer than 10% of those will have a positive skin test or symptoms if challenged. "If patients get labeled allergic" to penicillin "on their chart, that follows them forever" and makes them more likely to use less-effective, more-toxic, costlier antibiotic alternatives, Dr. Stukus said. "We can improve their lives by proving they don’t have it and taking this label off their chart."
• Gluten: Eating gluten "is currently being blamed for the ails of humanity," largely driven by companies with products to sell – so be prepared to talk about this with patients with self-diagnosed gluten allergy, Dr. Stukus said. IgE-mediated hypersensitivity reactions can occur toward wheat, rye, or barley, but not to gluten. Celiac disease is an autoimmune condition (not IgE-mediated hypersensitivity) that improves with a gluten-free diet. IgE-mediated hypersensitivity to gluten is very uncommon, but patients more commonly report having "gluten sensitivity" and GI symptoms after eating foods with gluten. That’s a poorly defined condition that’s hard to prove. A double-blind, placebo-controlled challenge is the only available method of diagnosing gluten sensitivity.
• Mold: Mold is everywhere and can cause real disease in susceptible persons, but mycotoxins rarely cause disease unless ingested in large quantities. Most health problems attributed to mold exposure are exaggerated, with no scientific basis or supportive evidence, Dr. Stukus said. But "hysteria" around mold has been a boon to some lawyers and companies that sell air purifiers and other detoxification equipment. Know your approach to identifying mold allergy, and be straightforward with patients, he advised.
Dr. Stukus reported having no financial disclosures.
On Twitter @sherryboschert
AT 2014 AAAAI ANNUAL MEETING
Asthma deaths declined modestly during 1999-2010
SAN DIEGO – Between 1999 and 2010, age-adjusted deaths from asthma in the United States declined modestly but significantly, deaths from angioedema increased significantly, and deaths from anaphylaxis remained stable.
Those are key findings from an analysis of Centers for Disease Control and Prevention (CDC) data presented by Dr. Susan J. Kim at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.
Dr. Kim, a first-year allergy fellow at Kaiser Permanente Los Angeles Medical Center, and her associate, Jordan C. Brooks, Ph.D., set out to document the number of deaths in the United States in which asthma or allergy played a role between 1990 and 2010, and to determine if there have been secular trends in the incidence of such deaths. The researchers queried the CDC’s online Multiple Cause of Death compressed mortality file for International Classification of Disease (ICD-10) codes relating to asthma, urticaria, angioedema, and anaphylaxis, and proceeded to calculate age-adjusted death rates for 1999-2004 (early period) and 2005-2010 (late period).
During the overall time period, there were 113,778 deaths from asthma of all types, 908 from angioedema, and 2,448 from anaphylaxis. Dr. Kim reported that the total number of deaths from asthma of all types (including status asthmaticus) dropped from 57,935 in the early period to 55,843 in the late period. This represented a significant decline, from a rate of 3.38 per 100,000 persons to 2.95 per 100,000 persons.
Blacks had a significantly higher rate of mortality from asthma than whites (5.85 per 100,000 persons vs. 2.55 per 100,000 persons). "This racial disparity might be attributed to a discrepancy in access to quality medical care and use of medications," Dr. Kim said.
She went on to note that women had a higher rate of mortality from asthma than men (3.61 per 100,000 vs. 2.56 per 100,000). "This is interesting, because when taking all causes of mortality in the United States – cardiovascular disease, malignancy, et cetera – men have a higher mortality rate," she said. "The cause may be due to estrogen and progesterone’s effects on airway contractility and immune function."
The researchers observed a significant increase in total deaths from angioedema, from 0.0157 per 100,000 persons during the early period to 0.0289 per 100,000 persons during the late period. "Perhaps an explanation is that there is a lack of awareness that life-threatening laryngeal attacks and asphyxiation can occur," Dr. Kim hypothesized.
At the same time, no significant trends in anaphylaxis death occurred between the early and late periods. Overall, the death rate from anaphylaxis was 0.0637 per 100,000, or 0.6 per million people. "This mortality rate remained stable between our two time periods," she said. "Previous estimates have ranged from 0.5 and 5.5 per million people."
Dr. Kim acknowledged certain limitations of the study, including the fact that the CDC database used for the analysis is subject to missing data, variability in coding, and miscoding. "There’s also no way for us to know how race was identified," she said. "It also lacked clinical details, including the sequence of events leading to death, and medication reconciliation."
Dr. Kim had no relevant financial conflicts to disclose.
SAN DIEGO – Between 1999 and 2010, age-adjusted deaths from asthma in the United States declined modestly but significantly, deaths from angioedema increased significantly, and deaths from anaphylaxis remained stable.
Those are key findings from an analysis of Centers for Disease Control and Prevention (CDC) data presented by Dr. Susan J. Kim at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.
Dr. Kim, a first-year allergy fellow at Kaiser Permanente Los Angeles Medical Center, and her associate, Jordan C. Brooks, Ph.D., set out to document the number of deaths in the United States in which asthma or allergy played a role between 1990 and 2010, and to determine if there have been secular trends in the incidence of such deaths. The researchers queried the CDC’s online Multiple Cause of Death compressed mortality file for International Classification of Disease (ICD-10) codes relating to asthma, urticaria, angioedema, and anaphylaxis, and proceeded to calculate age-adjusted death rates for 1999-2004 (early period) and 2005-2010 (late period).
During the overall time period, there were 113,778 deaths from asthma of all types, 908 from angioedema, and 2,448 from anaphylaxis. Dr. Kim reported that the total number of deaths from asthma of all types (including status asthmaticus) dropped from 57,935 in the early period to 55,843 in the late period. This represented a significant decline, from a rate of 3.38 per 100,000 persons to 2.95 per 100,000 persons.
Blacks had a significantly higher rate of mortality from asthma than whites (5.85 per 100,000 persons vs. 2.55 per 100,000 persons). "This racial disparity might be attributed to a discrepancy in access to quality medical care and use of medications," Dr. Kim said.
She went on to note that women had a higher rate of mortality from asthma than men (3.61 per 100,000 vs. 2.56 per 100,000). "This is interesting, because when taking all causes of mortality in the United States – cardiovascular disease, malignancy, et cetera – men have a higher mortality rate," she said. "The cause may be due to estrogen and progesterone’s effects on airway contractility and immune function."
The researchers observed a significant increase in total deaths from angioedema, from 0.0157 per 100,000 persons during the early period to 0.0289 per 100,000 persons during the late period. "Perhaps an explanation is that there is a lack of awareness that life-threatening laryngeal attacks and asphyxiation can occur," Dr. Kim hypothesized.
At the same time, no significant trends in anaphylaxis death occurred between the early and late periods. Overall, the death rate from anaphylaxis was 0.0637 per 100,000, or 0.6 per million people. "This mortality rate remained stable between our two time periods," she said. "Previous estimates have ranged from 0.5 and 5.5 per million people."
Dr. Kim acknowledged certain limitations of the study, including the fact that the CDC database used for the analysis is subject to missing data, variability in coding, and miscoding. "There’s also no way for us to know how race was identified," she said. "It also lacked clinical details, including the sequence of events leading to death, and medication reconciliation."
Dr. Kim had no relevant financial conflicts to disclose.
SAN DIEGO – Between 1999 and 2010, age-adjusted deaths from asthma in the United States declined modestly but significantly, deaths from angioedema increased significantly, and deaths from anaphylaxis remained stable.
Those are key findings from an analysis of Centers for Disease Control and Prevention (CDC) data presented by Dr. Susan J. Kim at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.
Dr. Kim, a first-year allergy fellow at Kaiser Permanente Los Angeles Medical Center, and her associate, Jordan C. Brooks, Ph.D., set out to document the number of deaths in the United States in which asthma or allergy played a role between 1990 and 2010, and to determine if there have been secular trends in the incidence of such deaths. The researchers queried the CDC’s online Multiple Cause of Death compressed mortality file for International Classification of Disease (ICD-10) codes relating to asthma, urticaria, angioedema, and anaphylaxis, and proceeded to calculate age-adjusted death rates for 1999-2004 (early period) and 2005-2010 (late period).
During the overall time period, there were 113,778 deaths from asthma of all types, 908 from angioedema, and 2,448 from anaphylaxis. Dr. Kim reported that the total number of deaths from asthma of all types (including status asthmaticus) dropped from 57,935 in the early period to 55,843 in the late period. This represented a significant decline, from a rate of 3.38 per 100,000 persons to 2.95 per 100,000 persons.
Blacks had a significantly higher rate of mortality from asthma than whites (5.85 per 100,000 persons vs. 2.55 per 100,000 persons). "This racial disparity might be attributed to a discrepancy in access to quality medical care and use of medications," Dr. Kim said.
She went on to note that women had a higher rate of mortality from asthma than men (3.61 per 100,000 vs. 2.56 per 100,000). "This is interesting, because when taking all causes of mortality in the United States – cardiovascular disease, malignancy, et cetera – men have a higher mortality rate," she said. "The cause may be due to estrogen and progesterone’s effects on airway contractility and immune function."
The researchers observed a significant increase in total deaths from angioedema, from 0.0157 per 100,000 persons during the early period to 0.0289 per 100,000 persons during the late period. "Perhaps an explanation is that there is a lack of awareness that life-threatening laryngeal attacks and asphyxiation can occur," Dr. Kim hypothesized.
At the same time, no significant trends in anaphylaxis death occurred between the early and late periods. Overall, the death rate from anaphylaxis was 0.0637 per 100,000, or 0.6 per million people. "This mortality rate remained stable between our two time periods," she said. "Previous estimates have ranged from 0.5 and 5.5 per million people."
Dr. Kim acknowledged certain limitations of the study, including the fact that the CDC database used for the analysis is subject to missing data, variability in coding, and miscoding. "There’s also no way for us to know how race was identified," she said. "It also lacked clinical details, including the sequence of events leading to death, and medication reconciliation."
Dr. Kim had no relevant financial conflicts to disclose.
AT THE 2014 AAAAI ANNUAL MEETING
Major Finding: Between 1999 and 2010, mortality from asthma in the United States declined significantly from a rate of 3.38 per 100,000 persons to 2.95 per 100,000 persons, while total deaths from angioedema increased significantly from 0.0157 per 100,000 persons to 0.0289 per 100,000 persons.
Data Source: An analysis of the CDC’s online Multiple Cause of Death compressed mortality file for ICD-10 codes relating to asthma, urticaria, angioedema, and anaphylaxis.
Disclosures: Dr. Kim had no relevant financial conflicts to disclose.
Asthma more common in eosinophilic esophagitis than previously thought
SAN DIEGO – Asthma and airway hyperresponsiveness may be underrecognized in children with eosinophilic esophagitis, results from a controlled cross-sectional study demonstrated.
While previous studies have estimated the prevalence of asthma in children with eosinophilic esophagitis (EoE), to range from 24-42%, a recent analysis presented during a late-breaker abstract session at annual meeting of the American Academy of Allergy, Asthma, and Immunology found that up to 70% of children with EoE may suffer from asthma.
"Clinicians treating children with eosinophilic esophagitis should consider asking additional history questions related to asthma symptoms and may also want to consider pulmonary function testing or referral to an asthma specialist for evaluation," lead author Dr. Nadia L. Krupp said in an interview prior to the meeting. "This is the first study to formally evaluate lung function and airway hyperresponsiveness in children with EoE. Prior estimations of asthma have solely come from patient/parent report."
Dr. Krupp, director of the Riley Asthma Care Center in the section of pulmonology, allergy, and critical care medicine at Riley Hospital Children, Indianapolis, and her associates conducted a cross-sectional study of 33 children aged 6-18 years with EoE and 37 healthy controls. The researchers performed methacholine challenge (airway hyperresponsiveness defined as provocative concentration of methacholine less than 8mg/mL), and exhaled nitric oxide. They also analyzed peripheral blood for total IgE, eosinophil count, eotaxin, and serum cytokines.
Baseline spirometry did not significantly differ between EoE subjects and healthy controls. However, airway hyperresponsiveness was present in 33% of children with EoE, compared with only 10.8% of healthy controls (P = .04). In addition, 20% of the 15 EoE subjects with asthma had airway hyperresponsiveness, compared with 44% of the 18 EoE subjects without asthma. Overall, 69.7% of EoE subjects had either asthma or airway hyperresponsiveness.
The researchers found that airway hyperresponsiveness correlated strongly with serum IgE (P less than .0001) and exhaled nitric oxide (P = .0002), while epidermal growth factor (EGF) and fibroblastic growth factor–2 (FGF-2) were elevated in subjects with EoE and asthma, compared to healthy controls and those with EoE but no asthma (P less than .05). In addition, subjects with EoE and asthma who were on asthma controller medications had similar levels of EGF and FGF-2 as healthy controls, while Th2 cytokines and eotaxin did not differ significantly among any groups.
Dr. Krupp said she was surprised "by the fact that airway hyperresponsiveness was more prevalent in those subjects without a history of asthma than those with a known diagnosis, and the fact that Th2-related cytokines were not significantly different between healthy controls and EoE subjects."
She acknowledged certain limitations of the study, including its cross-sectional design and "the fact EoE subjects may have had significant variability in the current activity of their esophageal disease at the time of enrollment."
The study was partially funded by Aerocrine. Dr. Krupp said that she had no relevant financial conflicts to disclose.
Eric J. Gartman comments: Given the potential negative health and societal implications of unrecognized asthma/bronchial hyper-reactivty in growing children, proactively evaluating patients with allergy-mediated conditions (like EoE) for asthma seems appropriate - and is supported by this data. Further longitudinal data that may assess the relationship of EoE activity after treatment and changes in the degree of bronchial hyper-responsiveness would be valuable from a scientific and therapeutic standpoint.
Eric J. Gartman comments: Given the potential negative health and societal implications of unrecognized asthma/bronchial hyper-reactivty in growing children, proactively evaluating patients with allergy-mediated conditions (like EoE) for asthma seems appropriate - and is supported by this data. Further longitudinal data that may assess the relationship of EoE activity after treatment and changes in the degree of bronchial hyper-responsiveness would be valuable from a scientific and therapeutic standpoint.
Eric J. Gartman comments: Given the potential negative health and societal implications of unrecognized asthma/bronchial hyper-reactivty in growing children, proactively evaluating patients with allergy-mediated conditions (like EoE) for asthma seems appropriate - and is supported by this data. Further longitudinal data that may assess the relationship of EoE activity after treatment and changes in the degree of bronchial hyper-responsiveness would be valuable from a scientific and therapeutic standpoint.
SAN DIEGO – Asthma and airway hyperresponsiveness may be underrecognized in children with eosinophilic esophagitis, results from a controlled cross-sectional study demonstrated.
While previous studies have estimated the prevalence of asthma in children with eosinophilic esophagitis (EoE), to range from 24-42%, a recent analysis presented during a late-breaker abstract session at annual meeting of the American Academy of Allergy, Asthma, and Immunology found that up to 70% of children with EoE may suffer from asthma.
"Clinicians treating children with eosinophilic esophagitis should consider asking additional history questions related to asthma symptoms and may also want to consider pulmonary function testing or referral to an asthma specialist for evaluation," lead author Dr. Nadia L. Krupp said in an interview prior to the meeting. "This is the first study to formally evaluate lung function and airway hyperresponsiveness in children with EoE. Prior estimations of asthma have solely come from patient/parent report."
Dr. Krupp, director of the Riley Asthma Care Center in the section of pulmonology, allergy, and critical care medicine at Riley Hospital Children, Indianapolis, and her associates conducted a cross-sectional study of 33 children aged 6-18 years with EoE and 37 healthy controls. The researchers performed methacholine challenge (airway hyperresponsiveness defined as provocative concentration of methacholine less than 8mg/mL), and exhaled nitric oxide. They also analyzed peripheral blood for total IgE, eosinophil count, eotaxin, and serum cytokines.
Baseline spirometry did not significantly differ between EoE subjects and healthy controls. However, airway hyperresponsiveness was present in 33% of children with EoE, compared with only 10.8% of healthy controls (P = .04). In addition, 20% of the 15 EoE subjects with asthma had airway hyperresponsiveness, compared with 44% of the 18 EoE subjects without asthma. Overall, 69.7% of EoE subjects had either asthma or airway hyperresponsiveness.
The researchers found that airway hyperresponsiveness correlated strongly with serum IgE (P less than .0001) and exhaled nitric oxide (P = .0002), while epidermal growth factor (EGF) and fibroblastic growth factor–2 (FGF-2) were elevated in subjects with EoE and asthma, compared to healthy controls and those with EoE but no asthma (P less than .05). In addition, subjects with EoE and asthma who were on asthma controller medications had similar levels of EGF and FGF-2 as healthy controls, while Th2 cytokines and eotaxin did not differ significantly among any groups.
Dr. Krupp said she was surprised "by the fact that airway hyperresponsiveness was more prevalent in those subjects without a history of asthma than those with a known diagnosis, and the fact that Th2-related cytokines were not significantly different between healthy controls and EoE subjects."
She acknowledged certain limitations of the study, including its cross-sectional design and "the fact EoE subjects may have had significant variability in the current activity of their esophageal disease at the time of enrollment."
The study was partially funded by Aerocrine. Dr. Krupp said that she had no relevant financial conflicts to disclose.
SAN DIEGO – Asthma and airway hyperresponsiveness may be underrecognized in children with eosinophilic esophagitis, results from a controlled cross-sectional study demonstrated.
While previous studies have estimated the prevalence of asthma in children with eosinophilic esophagitis (EoE), to range from 24-42%, a recent analysis presented during a late-breaker abstract session at annual meeting of the American Academy of Allergy, Asthma, and Immunology found that up to 70% of children with EoE may suffer from asthma.
"Clinicians treating children with eosinophilic esophagitis should consider asking additional history questions related to asthma symptoms and may also want to consider pulmonary function testing or referral to an asthma specialist for evaluation," lead author Dr. Nadia L. Krupp said in an interview prior to the meeting. "This is the first study to formally evaluate lung function and airway hyperresponsiveness in children with EoE. Prior estimations of asthma have solely come from patient/parent report."
Dr. Krupp, director of the Riley Asthma Care Center in the section of pulmonology, allergy, and critical care medicine at Riley Hospital Children, Indianapolis, and her associates conducted a cross-sectional study of 33 children aged 6-18 years with EoE and 37 healthy controls. The researchers performed methacholine challenge (airway hyperresponsiveness defined as provocative concentration of methacholine less than 8mg/mL), and exhaled nitric oxide. They also analyzed peripheral blood for total IgE, eosinophil count, eotaxin, and serum cytokines.
Baseline spirometry did not significantly differ between EoE subjects and healthy controls. However, airway hyperresponsiveness was present in 33% of children with EoE, compared with only 10.8% of healthy controls (P = .04). In addition, 20% of the 15 EoE subjects with asthma had airway hyperresponsiveness, compared with 44% of the 18 EoE subjects without asthma. Overall, 69.7% of EoE subjects had either asthma or airway hyperresponsiveness.
The researchers found that airway hyperresponsiveness correlated strongly with serum IgE (P less than .0001) and exhaled nitric oxide (P = .0002), while epidermal growth factor (EGF) and fibroblastic growth factor–2 (FGF-2) were elevated in subjects with EoE and asthma, compared to healthy controls and those with EoE but no asthma (P less than .05). In addition, subjects with EoE and asthma who were on asthma controller medications had similar levels of EGF and FGF-2 as healthy controls, while Th2 cytokines and eotaxin did not differ significantly among any groups.
Dr. Krupp said she was surprised "by the fact that airway hyperresponsiveness was more prevalent in those subjects without a history of asthma than those with a known diagnosis, and the fact that Th2-related cytokines were not significantly different between healthy controls and EoE subjects."
She acknowledged certain limitations of the study, including its cross-sectional design and "the fact EoE subjects may have had significant variability in the current activity of their esophageal disease at the time of enrollment."
The study was partially funded by Aerocrine. Dr. Krupp said that she had no relevant financial conflicts to disclose.
AT THE 2014 AAAAI ANNUAL MEETING
Major finding: Airway hyperresponsiveness was present in 33% of children with EoE, compared with only 10.8% of healthy controls (P= .04). In addition, 20% of the 15 EoE subjects with asthma had airway hyperresponsiveness, compared with 44% of the 18 EoE subjects without asthma.
Data source: A cross-sectional study of 33 children aged 6-18 years with EoE and 37 healthy controls.
Disclosures: The study was partially funded by Aerocrine. Dr. Krupp said that she had no relevant financial conflicts to disclose.
Texting reminders improved pediatric asthma control
A small study presented at the American Academy of Allergy, Asthma, and Immunology meeting in San Diego adds to a growing body of evidence that texting patients reminders to take their medication may improve asthma control.
Dr. Humaa M. Bhatti’s ongoing study is one of the few so far to look not just at medication adherence but at health outcomes. But, like similar studies before it, the trial’s small size and short duration so far preclude any definitive pronouncements about the effectiveness of using text messages (also known as short message service) via mobile phones to influence patient behavior. A couple of recent reviews of the literature, however, show mostly positive results.
Starting in April 2013, Dr. Bhatti and her associates recruited 37 patients up to 18 years of age with asthma to receive twice-daily texts from a research assistant reminding them to take medication. Texts went to the parents of children and/or directly to the adolescents. Patients or parents also could reply to communicate with the research assistant.
For the 29 patients who received 3-9 months of texting at the time of preliminary analysis of results (8 patients dropped out), records showed that 21 patients had two or more steroid bursts in the 12 months prior to the start of texting (72%), 28 had at least one urgent visit (96%) in that year, and 28 had been hospitalized for asthma at least once (96%).
The number of asthma exacerbations requiring prednisone decreased from a mean of 3.4/patient before the trial to 1.6/patient with texted reminders. Hospitalizations decreased from a mean of 1.6/patient before the trial to 0.8/patient. Urgent or emergency visits decreased from a mean of 3/patient before the trial to 1.4/patient. Those differences were statistically significant, reported Dr. Bhatti, an allergy and immunology fellow at the Children’s Hospital of Michigan, Detroit.
Since the texting started, 16 of the 29 patients (55%) had no steroid bursts, emergency department visits, or hospitalizations. Similar results were seen for 25 patients who were added to the study since November 2013, a preliminary analysis found.
The study soon will open to all patients with asthma at the hospital to see if results remain positive and are sustained over longer periods. With more patients to text, the investigators are considering using an automated text-sending program that would not allow the recipients to reply, and patients may be randomized to receive texts from either the research assistant or the text program to see if there is a difference in outcomes.
A separate systematic review of the literature found five randomized controlled trials and one "pragmatic" randomized controlled trial reporting evidence that daily technology-based reminders improved asthma medication adherence. None of these trials documented improved clinical outcomes or changes in asthma-related quality of life. The reminder systems studied included text messages, automated phone calls, or audiovisual reminder devices. The median follow-up time was 16 weeks (J. Asthma 2014 Feb. 13 [doi: 10.3109/02770903.2014.888572]).
Texting also looked good in another literature review that found 13 controlled clinical trials of interventions using text messages, audiovisual reminders from electronic reminder devices, or pagers for patients on chronic medication. Of the four studies using texting, medication adherence improved in the one study of asthma and in two studies of HIV, but made no difference in one study of women on oral contraceptives (J. Am. Med. Inform. Assoc. 2012 [doi: 10.1136/amiajnl-2011-00748]). The one study on patients with asthma in that review was, again, a small, short study of 26 adults. Adherence to treatment improved after 12 weeks by an absolute rate of 18% in the texting group compared with controls (Respir. Med. 2010;104:166-71).
There are hints elsewhere that texting may not always help. At the 2011 meeting of the American Academy of Allergy, Asthma and Immunology, Dr. Jennifer S. Lee reported that two of seven patients aged 6-17 years improved their asthma control after receiving text message reminders. Texting influenced children but not adolescents, according to news interviews with Dr. Lee, an allergist and ear, nose, and throat specialist in Brooklyn, N.Y.
Dr. Bhatti had no financial disclosures.
A small study presented at the American Academy of Allergy, Asthma, and Immunology meeting in San Diego adds to a growing body of evidence that texting patients reminders to take their medication may improve asthma control.
Dr. Humaa M. Bhatti’s ongoing study is one of the few so far to look not just at medication adherence but at health outcomes. But, like similar studies before it, the trial’s small size and short duration so far preclude any definitive pronouncements about the effectiveness of using text messages (also known as short message service) via mobile phones to influence patient behavior. A couple of recent reviews of the literature, however, show mostly positive results.
Starting in April 2013, Dr. Bhatti and her associates recruited 37 patients up to 18 years of age with asthma to receive twice-daily texts from a research assistant reminding them to take medication. Texts went to the parents of children and/or directly to the adolescents. Patients or parents also could reply to communicate with the research assistant.
For the 29 patients who received 3-9 months of texting at the time of preliminary analysis of results (8 patients dropped out), records showed that 21 patients had two or more steroid bursts in the 12 months prior to the start of texting (72%), 28 had at least one urgent visit (96%) in that year, and 28 had been hospitalized for asthma at least once (96%).
The number of asthma exacerbations requiring prednisone decreased from a mean of 3.4/patient before the trial to 1.6/patient with texted reminders. Hospitalizations decreased from a mean of 1.6/patient before the trial to 0.8/patient. Urgent or emergency visits decreased from a mean of 3/patient before the trial to 1.4/patient. Those differences were statistically significant, reported Dr. Bhatti, an allergy and immunology fellow at the Children’s Hospital of Michigan, Detroit.
Since the texting started, 16 of the 29 patients (55%) had no steroid bursts, emergency department visits, or hospitalizations. Similar results were seen for 25 patients who were added to the study since November 2013, a preliminary analysis found.
The study soon will open to all patients with asthma at the hospital to see if results remain positive and are sustained over longer periods. With more patients to text, the investigators are considering using an automated text-sending program that would not allow the recipients to reply, and patients may be randomized to receive texts from either the research assistant or the text program to see if there is a difference in outcomes.
A separate systematic review of the literature found five randomized controlled trials and one "pragmatic" randomized controlled trial reporting evidence that daily technology-based reminders improved asthma medication adherence. None of these trials documented improved clinical outcomes or changes in asthma-related quality of life. The reminder systems studied included text messages, automated phone calls, or audiovisual reminder devices. The median follow-up time was 16 weeks (J. Asthma 2014 Feb. 13 [doi: 10.3109/02770903.2014.888572]).
Texting also looked good in another literature review that found 13 controlled clinical trials of interventions using text messages, audiovisual reminders from electronic reminder devices, or pagers for patients on chronic medication. Of the four studies using texting, medication adherence improved in the one study of asthma and in two studies of HIV, but made no difference in one study of women on oral contraceptives (J. Am. Med. Inform. Assoc. 2012 [doi: 10.1136/amiajnl-2011-00748]). The one study on patients with asthma in that review was, again, a small, short study of 26 adults. Adherence to treatment improved after 12 weeks by an absolute rate of 18% in the texting group compared with controls (Respir. Med. 2010;104:166-71).
There are hints elsewhere that texting may not always help. At the 2011 meeting of the American Academy of Allergy, Asthma and Immunology, Dr. Jennifer S. Lee reported that two of seven patients aged 6-17 years improved their asthma control after receiving text message reminders. Texting influenced children but not adolescents, according to news interviews with Dr. Lee, an allergist and ear, nose, and throat specialist in Brooklyn, N.Y.
Dr. Bhatti had no financial disclosures.
A small study presented at the American Academy of Allergy, Asthma, and Immunology meeting in San Diego adds to a growing body of evidence that texting patients reminders to take their medication may improve asthma control.
Dr. Humaa M. Bhatti’s ongoing study is one of the few so far to look not just at medication adherence but at health outcomes. But, like similar studies before it, the trial’s small size and short duration so far preclude any definitive pronouncements about the effectiveness of using text messages (also known as short message service) via mobile phones to influence patient behavior. A couple of recent reviews of the literature, however, show mostly positive results.
Starting in April 2013, Dr. Bhatti and her associates recruited 37 patients up to 18 years of age with asthma to receive twice-daily texts from a research assistant reminding them to take medication. Texts went to the parents of children and/or directly to the adolescents. Patients or parents also could reply to communicate with the research assistant.
For the 29 patients who received 3-9 months of texting at the time of preliminary analysis of results (8 patients dropped out), records showed that 21 patients had two or more steroid bursts in the 12 months prior to the start of texting (72%), 28 had at least one urgent visit (96%) in that year, and 28 had been hospitalized for asthma at least once (96%).
The number of asthma exacerbations requiring prednisone decreased from a mean of 3.4/patient before the trial to 1.6/patient with texted reminders. Hospitalizations decreased from a mean of 1.6/patient before the trial to 0.8/patient. Urgent or emergency visits decreased from a mean of 3/patient before the trial to 1.4/patient. Those differences were statistically significant, reported Dr. Bhatti, an allergy and immunology fellow at the Children’s Hospital of Michigan, Detroit.
Since the texting started, 16 of the 29 patients (55%) had no steroid bursts, emergency department visits, or hospitalizations. Similar results were seen for 25 patients who were added to the study since November 2013, a preliminary analysis found.
The study soon will open to all patients with asthma at the hospital to see if results remain positive and are sustained over longer periods. With more patients to text, the investigators are considering using an automated text-sending program that would not allow the recipients to reply, and patients may be randomized to receive texts from either the research assistant or the text program to see if there is a difference in outcomes.
A separate systematic review of the literature found five randomized controlled trials and one "pragmatic" randomized controlled trial reporting evidence that daily technology-based reminders improved asthma medication adherence. None of these trials documented improved clinical outcomes or changes in asthma-related quality of life. The reminder systems studied included text messages, automated phone calls, or audiovisual reminder devices. The median follow-up time was 16 weeks (J. Asthma 2014 Feb. 13 [doi: 10.3109/02770903.2014.888572]).
Texting also looked good in another literature review that found 13 controlled clinical trials of interventions using text messages, audiovisual reminders from electronic reminder devices, or pagers for patients on chronic medication. Of the four studies using texting, medication adherence improved in the one study of asthma and in two studies of HIV, but made no difference in one study of women on oral contraceptives (J. Am. Med. Inform. Assoc. 2012 [doi: 10.1136/amiajnl-2011-00748]). The one study on patients with asthma in that review was, again, a small, short study of 26 adults. Adherence to treatment improved after 12 weeks by an absolute rate of 18% in the texting group compared with controls (Respir. Med. 2010;104:166-71).
There are hints elsewhere that texting may not always help. At the 2011 meeting of the American Academy of Allergy, Asthma and Immunology, Dr. Jennifer S. Lee reported that two of seven patients aged 6-17 years improved their asthma control after receiving text message reminders. Texting influenced children but not adolescents, according to news interviews with Dr. Lee, an allergist and ear, nose, and throat specialist in Brooklyn, N.Y.
Dr. Bhatti had no financial disclosures.
Evidence-Based Apps: Texting reminders improved pediatric asthma control
A small study presented at the American Academy of Allergy, Asthma, and Immunology meeting in San Diego adds to a growing body of evidence that texting patients reminders to take their medication may improve asthma control.
Dr. Humaa M. Bhatti’s ongoing study is one of the few so far to look not just at medication adherence but at health outcomes. But, like similar studies before it, the trial’s small size and short duration so far preclude any definitive pronouncements about the effectiveness of using text messages (also known as short message service) via mobile phones to influence patient behavior. A couple of recent reviews of the literature, however, show mostly positive results.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
Starting in April 2013, Dr. Bhatti and her associates recruited 37 patients up to 18 years of age with asthma to receive twice-daily texts from a research assistant reminding them to take medication. Texts went to the parents of children and/or directly to the adolescents. Patients or parents also could reply to communicate with the research assistant.
For the 29 patients who received 3-9 months of texting at the time of preliminary analysis of results (8 patients dropped out), records showed that 21 patients had two or more steroid bursts in the 12 months prior to the start of texting (72%), 28 had at least one urgent visit (96%) in that year, and 28 had been hospitalized for asthma at least once (96%).
The number of asthma exacerbations requiring prednisone decreased from a mean of 3.4/patient before the trial to 1.6/patient with texted reminders. Hospitalizations decreased from a mean of 1.6/patient before the trial to 0.8/patient. Urgent or emergency visits decreased from a mean of 3/patient before the trial to 1.4/patient. Those differences were statistically significant, reported Dr. Bhatti, an allergy and immunology fellow at the Children’s Hospital of Michigan, Detroit.
Since the texting started, 16 of the 29 patients (55%) had no steroid bursts, emergency department visits, or hospitalizations. Similar results were seen for 25 patients who were added to the study since November 2013, a preliminary analysis found.
The study soon will open to all patients with asthma at the hospital to see if results remain positive and are sustained over longer periods. With more patients to text, the investigators are considering using an automated text-sending program that would not allow the recipients to reply, and patients may be randomized to receive texts from either the research assistant or the text program to see if there is a difference in outcomes.
A separate systematic review of the literature found five randomized controlled trials and one "pragmatic" randomized controlled trial reporting evidence that daily technology-based reminders improved asthma medication adherence. None of these trials documented improved clinical outcomes or changes in asthma-related quality of life. The reminder systems studied included text messages, automated phone calls, or audiovisual reminder devices. The median follow-up time was 16 weeks (J. Asthma 2014 Feb. 13 [doi: 10.3109/02770903.2014.888572]).
Texting also looked good in another literature review that found 13 controlled clinical trials of interventions using text messages, audiovisual reminders from electronic reminder devices, or pagers for patients on chronic medication. Of the four studies using texting, medication adherence improved in the one study of asthma and in two studies of HIV, but made no difference in one study of women on oral contraceptives (J. Am. Med. Inform. Assoc. 2012 [doi: 10.1136/amiajnl-2011-00748]). The one study on patients with asthma in that review was, again, a small, short study of 26 adults. Adherence to treatment improved after 12 weeks by an absolute rate of 18% in the texting group compared with controls (Respir. Med. 2010;104:166-71).
There are hints elsewhere that texting may not always help. At the 2011 meeting of the American Academy of Allergy, Asthma and Immunology, Dr. Jennifer S. Lee reported that two of seven patients aged 6-17 years improved their asthma control after receiving text message reminders. Texting influenced children but not adolescents, according to news interviews with Dr. Lee, an allergist and ear, nose, and throat specialist in Brooklyn, N.Y.
Dr. Bhatti had no financial disclosures.
A small study presented at the American Academy of Allergy, Asthma, and Immunology meeting in San Diego adds to a growing body of evidence that texting patients reminders to take their medication may improve asthma control.
Dr. Humaa M. Bhatti’s ongoing study is one of the few so far to look not just at medication adherence but at health outcomes. But, like similar studies before it, the trial’s small size and short duration so far preclude any definitive pronouncements about the effectiveness of using text messages (also known as short message service) via mobile phones to influence patient behavior. A couple of recent reviews of the literature, however, show mostly positive results.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
Starting in April 2013, Dr. Bhatti and her associates recruited 37 patients up to 18 years of age with asthma to receive twice-daily texts from a research assistant reminding them to take medication. Texts went to the parents of children and/or directly to the adolescents. Patients or parents also could reply to communicate with the research assistant.
For the 29 patients who received 3-9 months of texting at the time of preliminary analysis of results (8 patients dropped out), records showed that 21 patients had two or more steroid bursts in the 12 months prior to the start of texting (72%), 28 had at least one urgent visit (96%) in that year, and 28 had been hospitalized for asthma at least once (96%).
The number of asthma exacerbations requiring prednisone decreased from a mean of 3.4/patient before the trial to 1.6/patient with texted reminders. Hospitalizations decreased from a mean of 1.6/patient before the trial to 0.8/patient. Urgent or emergency visits decreased from a mean of 3/patient before the trial to 1.4/patient. Those differences were statistically significant, reported Dr. Bhatti, an allergy and immunology fellow at the Children’s Hospital of Michigan, Detroit.
Since the texting started, 16 of the 29 patients (55%) had no steroid bursts, emergency department visits, or hospitalizations. Similar results were seen for 25 patients who were added to the study since November 2013, a preliminary analysis found.
The study soon will open to all patients with asthma at the hospital to see if results remain positive and are sustained over longer periods. With more patients to text, the investigators are considering using an automated text-sending program that would not allow the recipients to reply, and patients may be randomized to receive texts from either the research assistant or the text program to see if there is a difference in outcomes.
A separate systematic review of the literature found five randomized controlled trials and one "pragmatic" randomized controlled trial reporting evidence that daily technology-based reminders improved asthma medication adherence. None of these trials documented improved clinical outcomes or changes in asthma-related quality of life. The reminder systems studied included text messages, automated phone calls, or audiovisual reminder devices. The median follow-up time was 16 weeks (J. Asthma 2014 Feb. 13 [doi: 10.3109/02770903.2014.888572]).
Texting also looked good in another literature review that found 13 controlled clinical trials of interventions using text messages, audiovisual reminders from electronic reminder devices, or pagers for patients on chronic medication. Of the four studies using texting, medication adherence improved in the one study of asthma and in two studies of HIV, but made no difference in one study of women on oral contraceptives (J. Am. Med. Inform. Assoc. 2012 [doi: 10.1136/amiajnl-2011-00748]). The one study on patients with asthma in that review was, again, a small, short study of 26 adults. Adherence to treatment improved after 12 weeks by an absolute rate of 18% in the texting group compared with controls (Respir. Med. 2010;104:166-71).
There are hints elsewhere that texting may not always help. At the 2011 meeting of the American Academy of Allergy, Asthma and Immunology, Dr. Jennifer S. Lee reported that two of seven patients aged 6-17 years improved their asthma control after receiving text message reminders. Texting influenced children but not adolescents, according to news interviews with Dr. Lee, an allergist and ear, nose, and throat specialist in Brooklyn, N.Y.
Dr. Bhatti had no financial disclosures.
A small study presented at the American Academy of Allergy, Asthma, and Immunology meeting in San Diego adds to a growing body of evidence that texting patients reminders to take their medication may improve asthma control.
Dr. Humaa M. Bhatti’s ongoing study is one of the few so far to look not just at medication adherence but at health outcomes. But, like similar studies before it, the trial’s small size and short duration so far preclude any definitive pronouncements about the effectiveness of using text messages (also known as short message service) via mobile phones to influence patient behavior. A couple of recent reviews of the literature, however, show mostly positive results.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
Starting in April 2013, Dr. Bhatti and her associates recruited 37 patients up to 18 years of age with asthma to receive twice-daily texts from a research assistant reminding them to take medication. Texts went to the parents of children and/or directly to the adolescents. Patients or parents also could reply to communicate with the research assistant.
For the 29 patients who received 3-9 months of texting at the time of preliminary analysis of results (8 patients dropped out), records showed that 21 patients had two or more steroid bursts in the 12 months prior to the start of texting (72%), 28 had at least one urgent visit (96%) in that year, and 28 had been hospitalized for asthma at least once (96%).
The number of asthma exacerbations requiring prednisone decreased from a mean of 3.4/patient before the trial to 1.6/patient with texted reminders. Hospitalizations decreased from a mean of 1.6/patient before the trial to 0.8/patient. Urgent or emergency visits decreased from a mean of 3/patient before the trial to 1.4/patient. Those differences were statistically significant, reported Dr. Bhatti, an allergy and immunology fellow at the Children’s Hospital of Michigan, Detroit.
Since the texting started, 16 of the 29 patients (55%) had no steroid bursts, emergency department visits, or hospitalizations. Similar results were seen for 25 patients who were added to the study since November 2013, a preliminary analysis found.
The study soon will open to all patients with asthma at the hospital to see if results remain positive and are sustained over longer periods. With more patients to text, the investigators are considering using an automated text-sending program that would not allow the recipients to reply, and patients may be randomized to receive texts from either the research assistant or the text program to see if there is a difference in outcomes.
A separate systematic review of the literature found five randomized controlled trials and one "pragmatic" randomized controlled trial reporting evidence that daily technology-based reminders improved asthma medication adherence. None of these trials documented improved clinical outcomes or changes in asthma-related quality of life. The reminder systems studied included text messages, automated phone calls, or audiovisual reminder devices. The median follow-up time was 16 weeks (J. Asthma 2014 Feb. 13 [doi: 10.3109/02770903.2014.888572]).
Texting also looked good in another literature review that found 13 controlled clinical trials of interventions using text messages, audiovisual reminders from electronic reminder devices, or pagers for patients on chronic medication. Of the four studies using texting, medication adherence improved in the one study of asthma and in two studies of HIV, but made no difference in one study of women on oral contraceptives (J. Am. Med. Inform. Assoc. 2012 [doi: 10.1136/amiajnl-2011-00748]). The one study on patients with asthma in that review was, again, a small, short study of 26 adults. Adherence to treatment improved after 12 weeks by an absolute rate of 18% in the texting group compared with controls (Respir. Med. 2010;104:166-71).
There are hints elsewhere that texting may not always help. At the 2011 meeting of the American Academy of Allergy, Asthma and Immunology, Dr. Jennifer S. Lee reported that two of seven patients aged 6-17 years improved their asthma control after receiving text message reminders. Texting influenced children but not adolescents, according to news interviews with Dr. Lee, an allergist and ear, nose, and throat specialist in Brooklyn, N.Y.
Dr. Bhatti had no financial disclosures.
Asthma may increase risk of cardiovascular events
SAN DIEGO – Having asthma appears to significantly increase a patient’s risk for cardiovascular events, while having allergic rhinitis appears to lower a patient’s risk of some such events, results from a large cohort study demonstrated.
Studies of mouse models have suggested that Th1 inflammation "is associated with atherosclerosis and plaque development, while the Th2 or general allergic response seems to be protective against atherosclerosis," Dr. Angelina Crans Yoon said during a press briefing at the annual meeting of the American Academy of Allergy, Asthma, and Immunology. At the same time, results from human studies regarding the association between allergic rhinitis and cardiovascular events are mixed, said Dr. Crans Yoon, a first-year allergy fellow at Kaiser Permanente Los Angeles Medical Center.
In an effort to assess the relationship between cardiovascular disease and allergic rhinitis, she and her associates used the Kaiser Permanente Southern California regional database and ICD-9 codes to compare the incidence of cardiovascular and cerebrovascular events and all-cause mortality in a cohort of 109,229 allergic rhinitis patients and 92,775 asthma patients who were seen between Jan. 1, 1995, and Dec. 31, 2012. The cohorts were matched by age, sex, and ethnicity to reference cohorts and followed for a median of 8 years.
Patients with allergic rhinitis had a significantly lower risk of myocardial infarction (hazard ratio, 0.75), cerebrovascular disease (HR, 0.81), and all-cause mortality (HR, 0.51), yet their risk of all cardiovascular events was equal to that of the control cohort (HR, 0.97). At the same time, patients with asthma had a significantly higher risk of all cardiovascular disease (HR, 1.36), yet no significantly higher risk of cerebrovascular disease (HR, 1.03) or all-cause mortality (HR, 1.00).
The findings "led us to think of more questions," Dr. Crans Yoon said. "Why is there this decreased risk of events in patients with allergic rhinitis? What explains the risk of cardiovascular events in patients with asthma? Is atopy related to these differences? We started some secondary analyses looking at medication use. It looks like if you use any medications for allergic rhinitis or asthma, you have a decreased risk of some of these events, except for long-acting beta-agonists, which is consistent with previous reports."We’re also starting to look at specific IgE data on these patients. It also looks like positive IgE testing may be associated with a decreased risk of these events., she said".
She speculated that asthma physiology may explain why patients with asthma had significantly higher risk of cardiovascular disease but not cerebrovascular disease. "The interesting point is that, potentially, atopic asthmatics may not have the same increased risk," she said.
Dr. Crans Yoon reported she had no relevant financial conflicts.
Dr. Jun Chiong, FCCP, comments: Clinicians have yet to sort out a clear connection between asthma and heart disease, but the link is a statistical fact. In some studies, the link persist even after adjusting the smoking history and other risk factors. A variety of theories about the possible link such as genetics and inflammation has come up, as that's also what makes the arteries harden.
A more defined and directed study is necessary in order to better don’t understand exactly what the connection is. People who are having heart failure, angina, or heart pain such as tightness in the chest may mistake those symptoms for breathing difficulty and other asthma symptoms. Heart failure can cause fluid to build up in the lungs and airways, and can lead to symptoms that resemble asthma symptoms such as wheezing, coughing, and shortness of breath.
SAN DIEGO – Having asthma appears to significantly increase a patient’s risk for cardiovascular events, while having allergic rhinitis appears to lower a patient’s risk of some such events, results from a large cohort study demonstrated.
Studies of mouse models have suggested that Th1 inflammation "is associated with atherosclerosis and plaque development, while the Th2 or general allergic response seems to be protective against atherosclerosis," Dr. Angelina Crans Yoon said during a press briefing at the annual meeting of the American Academy of Allergy, Asthma, and Immunology. At the same time, results from human studies regarding the association between allergic rhinitis and cardiovascular events are mixed, said Dr. Crans Yoon, a first-year allergy fellow at Kaiser Permanente Los Angeles Medical Center.
In an effort to assess the relationship between cardiovascular disease and allergic rhinitis, she and her associates used the Kaiser Permanente Southern California regional database and ICD-9 codes to compare the incidence of cardiovascular and cerebrovascular events and all-cause mortality in a cohort of 109,229 allergic rhinitis patients and 92,775 asthma patients who were seen between Jan. 1, 1995, and Dec. 31, 2012. The cohorts were matched by age, sex, and ethnicity to reference cohorts and followed for a median of 8 years.
Patients with allergic rhinitis had a significantly lower risk of myocardial infarction (hazard ratio, 0.75), cerebrovascular disease (HR, 0.81), and all-cause mortality (HR, 0.51), yet their risk of all cardiovascular events was equal to that of the control cohort (HR, 0.97). At the same time, patients with asthma had a significantly higher risk of all cardiovascular disease (HR, 1.36), yet no significantly higher risk of cerebrovascular disease (HR, 1.03) or all-cause mortality (HR, 1.00).
The findings "led us to think of more questions," Dr. Crans Yoon said. "Why is there this decreased risk of events in patients with allergic rhinitis? What explains the risk of cardiovascular events in patients with asthma? Is atopy related to these differences? We started some secondary analyses looking at medication use. It looks like if you use any medications for allergic rhinitis or asthma, you have a decreased risk of some of these events, except for long-acting beta-agonists, which is consistent with previous reports."We’re also starting to look at specific IgE data on these patients. It also looks like positive IgE testing may be associated with a decreased risk of these events., she said".
She speculated that asthma physiology may explain why patients with asthma had significantly higher risk of cardiovascular disease but not cerebrovascular disease. "The interesting point is that, potentially, atopic asthmatics may not have the same increased risk," she said.
Dr. Crans Yoon reported she had no relevant financial conflicts.
Dr. Jun Chiong, FCCP, comments: Clinicians have yet to sort out a clear connection between asthma and heart disease, but the link is a statistical fact. In some studies, the link persist even after adjusting the smoking history and other risk factors. A variety of theories about the possible link such as genetics and inflammation has come up, as that's also what makes the arteries harden.
A more defined and directed study is necessary in order to better don’t understand exactly what the connection is. People who are having heart failure, angina, or heart pain such as tightness in the chest may mistake those symptoms for breathing difficulty and other asthma symptoms. Heart failure can cause fluid to build up in the lungs and airways, and can lead to symptoms that resemble asthma symptoms such as wheezing, coughing, and shortness of breath.
SAN DIEGO – Having asthma appears to significantly increase a patient’s risk for cardiovascular events, while having allergic rhinitis appears to lower a patient’s risk of some such events, results from a large cohort study demonstrated.
Studies of mouse models have suggested that Th1 inflammation "is associated with atherosclerosis and plaque development, while the Th2 or general allergic response seems to be protective against atherosclerosis," Dr. Angelina Crans Yoon said during a press briefing at the annual meeting of the American Academy of Allergy, Asthma, and Immunology. At the same time, results from human studies regarding the association between allergic rhinitis and cardiovascular events are mixed, said Dr. Crans Yoon, a first-year allergy fellow at Kaiser Permanente Los Angeles Medical Center.
In an effort to assess the relationship between cardiovascular disease and allergic rhinitis, she and her associates used the Kaiser Permanente Southern California regional database and ICD-9 codes to compare the incidence of cardiovascular and cerebrovascular events and all-cause mortality in a cohort of 109,229 allergic rhinitis patients and 92,775 asthma patients who were seen between Jan. 1, 1995, and Dec. 31, 2012. The cohorts were matched by age, sex, and ethnicity to reference cohorts and followed for a median of 8 years.
Patients with allergic rhinitis had a significantly lower risk of myocardial infarction (hazard ratio, 0.75), cerebrovascular disease (HR, 0.81), and all-cause mortality (HR, 0.51), yet their risk of all cardiovascular events was equal to that of the control cohort (HR, 0.97). At the same time, patients with asthma had a significantly higher risk of all cardiovascular disease (HR, 1.36), yet no significantly higher risk of cerebrovascular disease (HR, 1.03) or all-cause mortality (HR, 1.00).
The findings "led us to think of more questions," Dr. Crans Yoon said. "Why is there this decreased risk of events in patients with allergic rhinitis? What explains the risk of cardiovascular events in patients with asthma? Is atopy related to these differences? We started some secondary analyses looking at medication use. It looks like if you use any medications for allergic rhinitis or asthma, you have a decreased risk of some of these events, except for long-acting beta-agonists, which is consistent with previous reports."We’re also starting to look at specific IgE data on these patients. It also looks like positive IgE testing may be associated with a decreased risk of these events., she said".
She speculated that asthma physiology may explain why patients with asthma had significantly higher risk of cardiovascular disease but not cerebrovascular disease. "The interesting point is that, potentially, atopic asthmatics may not have the same increased risk," she said.
Dr. Crans Yoon reported she had no relevant financial conflicts.
Dr. Jun Chiong, FCCP, comments: Clinicians have yet to sort out a clear connection between asthma and heart disease, but the link is a statistical fact. In some studies, the link persist even after adjusting the smoking history and other risk factors. A variety of theories about the possible link such as genetics and inflammation has come up, as that's also what makes the arteries harden.
A more defined and directed study is necessary in order to better don’t understand exactly what the connection is. People who are having heart failure, angina, or heart pain such as tightness in the chest may mistake those symptoms for breathing difficulty and other asthma symptoms. Heart failure can cause fluid to build up in the lungs and airways, and can lead to symptoms that resemble asthma symptoms such as wheezing, coughing, and shortness of breath.
AT THE 2014 AAAAI ANNUAL MEETING
Major finding: Compared with matched controls, patients with asthma had a significantly higher risk of all cardiovascular disease (HR, 1.36) while patients with allergic rhinitis had a significantly lower risk for myocardial infarction (HR, 0.75).
Data source: A study of 109,229 patients with allergic rhinitis and 92,775 patients with asthma who were treated at Kaiser Permanente Southern California and followed for a median of 8 years.
Disclosures: Dr. Crans Yoon said that she had no relevant financial conflicts to disclose.
