2014 AAAAI Annual Meeting

SAN DIEGO – Could increased consumption of phytoestrogens help prevent or treat asthma and allergy?

Dr. Jessica Savage, an allergist and immunologist at Brigham and Women’s Hospital, Boston, and her colleagues correlated one-time urinary phytoestrogen measurements from 7,909 subjects in the National Health and Nutrition Examination Survey, 2003-2010, with histories of physician-diagnosed asthma and self-reported wheezing.

The investigators also considered serum total and specific IgE levels obtained from a subset of 2,218 subjects. They defined atopy as having at least one positive IgE level (0.35 kU/L or above) to an aeroallergen.

Adjusting for a wide range of potential cofounders, including age, gender, race, urinary creatinine, poverty, body mass index, smoking, and smoke exposure, they found that, for every natural log increase in urinary enterolactone, the odds of asthma decreased by 8%. Enterolactone also was significantly inversely associated with asthma prevalence and had the strongest inverse association with wheezing.

For every natural log increase in urinary o-desmethylangolensin (ODMA), there was a 7% decrease in the odds of wheeze. The odds of atopy significantly decreased with increasing ODMA levels.

"We can’t say anything about cause and effect" yet, but if the association holds up with further investigation, it might suggest a role for phytoestrogen probiotics to help treat the conditions, Dr. Savagesaid at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

Phytoestrogens are plant-derived compounds. Gut bacteria convert lignans, which are particularly plentiful in flax seeds, into enterolactone, and the isoflavone daidzein, particularly plentiful in soybeans, into ODMA.

"Increased consumption of sources of phytoestrogens or probiotics to increase precursor conversion may help prevent or treat asthma and allergic disease," Dr. Savage said. "I was really surprised that the enterolactone signal is very strong both for asthma and for wheezing."

Although soy-derived compounds have been associated with better lung function and decreased lung symptoms in the past, "there’s really not a lot known about enterolactone," she said. "The idea is that somehow these metabolites are anti-inflammatory. Urinary levels are partly due to your diet and partly to having the right bacterial flora in your gut. Our findings could be explained by people just having different diets; they could also be explained by people with asthma having lower levels of the right kind of bacteria."

About half the subjects were female, and about 80% were over age 18 years; 70% of the study population was white.

Enterolactone tertiles were defined as 0.2-178; 179-644; and 645-122,000 ng/mL urine. ODMA tertiles were defined as 0.1-1.4; 1.5-12.8; and 12.9-18,500 ng/mL urine.

The study was funded by the National Institutes of Health. The investigators reported no relevant disclosures.

[email protected]

SAN DIEGO – Could increased consumption of phytoestrogens help prevent or treat asthma and allergy?

Dr. Jessica Savage, an allergist and immunologist at Brigham and Women’s Hospital, Boston, and her colleagues correlated one-time urinary phytoestrogen measurements from 7,909 subjects in the National Health and Nutrition Examination Survey, 2003-2010, with histories of physician-diagnosed asthma and self-reported wheezing.

The investigators also considered serum total and specific IgE levels obtained from a subset of 2,218 subjects. They defined atopy as having at least one positive IgE level (0.35 kU/L or above) to an aeroallergen.

Adjusting for a wide range of potential cofounders, including age, gender, race, urinary creatinine, poverty, body mass index, smoking, and smoke exposure, they found that, for every natural log increase in urinary enterolactone, the odds of asthma decreased by 8%. Enterolactone also was significantly inversely associated with asthma prevalence and had the strongest inverse association with wheezing.

For every natural log increase in urinary o-desmethylangolensin (ODMA), there was a 7% decrease in the odds of wheeze. The odds of atopy significantly decreased with increasing ODMA levels.

"We can’t say anything about cause and effect" yet, but if the association holds up with further investigation, it might suggest a role for phytoestrogen probiotics to help treat the conditions, Dr. Savagesaid at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

Phytoestrogens are plant-derived compounds. Gut bacteria convert lignans, which are particularly plentiful in flax seeds, into enterolactone, and the isoflavone daidzein, particularly plentiful in soybeans, into ODMA.

"Increased consumption of sources of phytoestrogens or probiotics to increase precursor conversion may help prevent or treat asthma and allergic disease," Dr. Savage said. "I was really surprised that the enterolactone signal is very strong both for asthma and for wheezing."

Although soy-derived compounds have been associated with better lung function and decreased lung symptoms in the past, "there’s really not a lot known about enterolactone," she said. "The idea is that somehow these metabolites are anti-inflammatory. Urinary levels are partly due to your diet and partly to having the right bacterial flora in your gut. Our findings could be explained by people just having different diets; they could also be explained by people with asthma having lower levels of the right kind of bacteria."

About half the subjects were female, and about 80% were over age 18 years; 70% of the study population was white.

Enterolactone tertiles were defined as 0.2-178; 179-644; and 645-122,000 ng/mL urine. ODMA tertiles were defined as 0.1-1.4; 1.5-12.8; and 12.9-18,500 ng/mL urine.

The study was funded by the National Institutes of Health. The investigators reported no relevant disclosures.

[email protected]

SAN DIEGO – Could increased consumption of phytoestrogens help prevent or treat asthma and allergy?

Dr. Jessica Savage, an allergist and immunologist at Brigham and Women’s Hospital, Boston, and her colleagues correlated one-time urinary phytoestrogen measurements from 7,909 subjects in the National Health and Nutrition Examination Survey, 2003-2010, with histories of physician-diagnosed asthma and self-reported wheezing.

The investigators also considered serum total and specific IgE levels obtained from a subset of 2,218 subjects. They defined atopy as having at least one positive IgE level (0.35 kU/L or above) to an aeroallergen.

Adjusting for a wide range of potential cofounders, including age, gender, race, urinary creatinine, poverty, body mass index, smoking, and smoke exposure, they found that, for every natural log increase in urinary enterolactone, the odds of asthma decreased by 8%. Enterolactone also was significantly inversely associated with asthma prevalence and had the strongest inverse association with wheezing.

For every natural log increase in urinary o-desmethylangolensin (ODMA), there was a 7% decrease in the odds of wheeze. The odds of atopy significantly decreased with increasing ODMA levels.

"We can’t say anything about cause and effect" yet, but if the association holds up with further investigation, it might suggest a role for phytoestrogen probiotics to help treat the conditions, Dr. Savagesaid at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

Phytoestrogens are plant-derived compounds. Gut bacteria convert lignans, which are particularly plentiful in flax seeds, into enterolactone, and the isoflavone daidzein, particularly plentiful in soybeans, into ODMA.

"Increased consumption of sources of phytoestrogens or probiotics to increase precursor conversion may help prevent or treat asthma and allergic disease," Dr. Savage said. "I was really surprised that the enterolactone signal is very strong both for asthma and for wheezing."

Although soy-derived compounds have been associated with better lung function and decreased lung symptoms in the past, "there’s really not a lot known about enterolactone," she said. "The idea is that somehow these metabolites are anti-inflammatory. Urinary levels are partly due to your diet and partly to having the right bacterial flora in your gut. Our findings could be explained by people just having different diets; they could also be explained by people with asthma having lower levels of the right kind of bacteria."

About half the subjects were female, and about 80% were over age 18 years; 70% of the study population was white.

Enterolactone tertiles were defined as 0.2-178; 179-644; and 645-122,000 ng/mL urine. ODMA tertiles were defined as 0.1-1.4; 1.5-12.8; and 12.9-18,500 ng/mL urine.

The study was funded by the National Institutes of Health. The investigators reported no relevant disclosures.

[email protected]

SAN DIEGO– Omalizumab appears to significantly reduce adverse effects from oral immunotherapy for cows’ milk allergy, allowing patients to reach maintenance doses of powdered skim milk sooner, according to the first double-blind, randomized, placebo-controlled trial to see if omalizumab makes oral immunotherapy safer.

The investigators randomized 28 milk-allergic subjects to omalizumab (Xolair) injections during oral immunotherapy (OIT) and 29 others to dummy shots for 16 months. The median age in the trial was about 10 years; 70% of the subjects were male; and most had asthma, allergic rhinitis, and other food allergies.

© Jupiterimages/Getty Images

Milk OIT was started after 4 months, with the goal of escalating patients to a maintenance dose of 3.84 g/day of powdered skim milk.

Just one omalizumab patient needed an epinephrine shot, while nine placebo subjects needed a total of 17 epinephrine shots. Omalizumab subjects had a median of five OIT symptoms – for instance, perioral itching, tingling, or hives; mild throat symptoms; and abdominal cramps – during escalation and maintenance therapy, while the placebo group had a median of 47.5 (P =.0001).

Omalizumab subjects needed a median of 198 OIT doses to reach maintenance dosing in a median of 25.9 weeks; placebo patients needed a median of 224.5 doses to reach maintenance in a median of 30.8 weeks. The differences were significant.

"OIT is very promising" as a way to desensitize patients, but "it’s still very experimental. The major limitation is the frequency of side effects. The reactions are unpredictable and [mostly] occur at home, so there’s a real risk to this therapy. We don’t really have a good idea of who is not going to do well until they actually develop the reactions. There’s a risk that some of these kids might develop other allergic problems like eosinophilic esophagitis, or you could make them more sensitive," said lead investigator Dr. Jennifer S. Kim, a pediatric allergist and immunologist at the North Shore University Health System in Chicago.

"To make OIT safer, omalizumab is being studied. When our results were unblinded, I was happy to see that it works," she said at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

There were no statistically significant baseline differences between the two study arms for age or baseline milk specific IgE (median 39.4 kUA/L omalizumab vs. 42.0 kUA/L control), milk PST wheal (median 10.0 mm omalizumab vs. 8.0 mm control), or food challenge doses at first symptoms (20 mg in both groups).

Omalizumab is a subcutaneous injection currently indicated only for allergic asthma. It was dosed according to product labelling – every 2-4 weeks depending on weight and IgE levels. "We did not really have any adverse effects from the injection," Dr. Kim said.

Powdered milk was used for OIT because it’s easier to dispense to subjects and less likely to spoil than fresh milk, among other reasons. Patients dissolved it in whatever they chose, often Gatorade. "It wasn’t peoples’ favorite thing to take on a daily basis," she said.

The results are from an interim analysis, and the study is ongoing.

The National Institutes of Health funded the project. The omalizumab used in the trial was donated by its maker, Genentech, and comarketer, Novartis. Dr. Kim said that she has no disclosures. The senior author, Dr. Hugh Sampson of Mount Sinai Hospital in New York, is an unpaid advisor to Novartis.

[email protected]

SAN DIEGO– Omalizumab appears to significantly reduce adverse effects from oral immunotherapy for cows’ milk allergy, allowing patients to reach maintenance doses of powdered skim milk sooner, according to the first double-blind, randomized, placebo-controlled trial to see if omalizumab makes oral immunotherapy safer.

The investigators randomized 28 milk-allergic subjects to omalizumab (Xolair) injections during oral immunotherapy (OIT) and 29 others to dummy shots for 16 months. The median age in the trial was about 10 years; 70% of the subjects were male; and most had asthma, allergic rhinitis, and other food allergies.

© Jupiterimages/Getty Images

Milk OIT was started after 4 months, with the goal of escalating patients to a maintenance dose of 3.84 g/day of powdered skim milk.

Just one omalizumab patient needed an epinephrine shot, while nine placebo subjects needed a total of 17 epinephrine shots. Omalizumab subjects had a median of five OIT symptoms – for instance, perioral itching, tingling, or hives; mild throat symptoms; and abdominal cramps – during escalation and maintenance therapy, while the placebo group had a median of 47.5 (P =.0001).

Omalizumab subjects needed a median of 198 OIT doses to reach maintenance dosing in a median of 25.9 weeks; placebo patients needed a median of 224.5 doses to reach maintenance in a median of 30.8 weeks. The differences were significant.

"OIT is very promising" as a way to desensitize patients, but "it’s still very experimental. The major limitation is the frequency of side effects. The reactions are unpredictable and [mostly] occur at home, so there’s a real risk to this therapy. We don’t really have a good idea of who is not going to do well until they actually develop the reactions. There’s a risk that some of these kids might develop other allergic problems like eosinophilic esophagitis, or you could make them more sensitive," said lead investigator Dr. Jennifer S. Kim, a pediatric allergist and immunologist at the North Shore University Health System in Chicago.

"To make OIT safer, omalizumab is being studied. When our results were unblinded, I was happy to see that it works," she said at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

There were no statistically significant baseline differences between the two study arms for age or baseline milk specific IgE (median 39.4 kUA/L omalizumab vs. 42.0 kUA/L control), milk PST wheal (median 10.0 mm omalizumab vs. 8.0 mm control), or food challenge doses at first symptoms (20 mg in both groups).

Omalizumab is a subcutaneous injection currently indicated only for allergic asthma. It was dosed according to product labelling – every 2-4 weeks depending on weight and IgE levels. "We did not really have any adverse effects from the injection," Dr. Kim said.

Powdered milk was used for OIT because it’s easier to dispense to subjects and less likely to spoil than fresh milk, among other reasons. Patients dissolved it in whatever they chose, often Gatorade. "It wasn’t peoples’ favorite thing to take on a daily basis," she said.

The results are from an interim analysis, and the study is ongoing.

The National Institutes of Health funded the project. The omalizumab used in the trial was donated by its maker, Genentech, and comarketer, Novartis. Dr. Kim said that she has no disclosures. The senior author, Dr. Hugh Sampson of Mount Sinai Hospital in New York, is an unpaid advisor to Novartis.

[email protected]

SAN DIEGO– Omalizumab appears to significantly reduce adverse effects from oral immunotherapy for cows’ milk allergy, allowing patients to reach maintenance doses of powdered skim milk sooner, according to the first double-blind, randomized, placebo-controlled trial to see if omalizumab makes oral immunotherapy safer.

The investigators randomized 28 milk-allergic subjects to omalizumab (Xolair) injections during oral immunotherapy (OIT) and 29 others to dummy shots for 16 months. The median age in the trial was about 10 years; 70% of the subjects were male; and most had asthma, allergic rhinitis, and other food allergies.

© Jupiterimages/Getty Images

Milk OIT was started after 4 months, with the goal of escalating patients to a maintenance dose of 3.84 g/day of powdered skim milk.

Just one omalizumab patient needed an epinephrine shot, while nine placebo subjects needed a total of 17 epinephrine shots. Omalizumab subjects had a median of five OIT symptoms – for instance, perioral itching, tingling, or hives; mild throat symptoms; and abdominal cramps – during escalation and maintenance therapy, while the placebo group had a median of 47.5 (P =.0001).

Omalizumab subjects needed a median of 198 OIT doses to reach maintenance dosing in a median of 25.9 weeks; placebo patients needed a median of 224.5 doses to reach maintenance in a median of 30.8 weeks. The differences were significant.

"OIT is very promising" as a way to desensitize patients, but "it’s still very experimental. The major limitation is the frequency of side effects. The reactions are unpredictable and [mostly] occur at home, so there’s a real risk to this therapy. We don’t really have a good idea of who is not going to do well until they actually develop the reactions. There’s a risk that some of these kids might develop other allergic problems like eosinophilic esophagitis, or you could make them more sensitive," said lead investigator Dr. Jennifer S. Kim, a pediatric allergist and immunologist at the North Shore University Health System in Chicago.

"To make OIT safer, omalizumab is being studied. When our results were unblinded, I was happy to see that it works," she said at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

There were no statistically significant baseline differences between the two study arms for age or baseline milk specific IgE (median 39.4 kUA/L omalizumab vs. 42.0 kUA/L control), milk PST wheal (median 10.0 mm omalizumab vs. 8.0 mm control), or food challenge doses at first symptoms (20 mg in both groups).

Omalizumab is a subcutaneous injection currently indicated only for allergic asthma. It was dosed according to product labelling – every 2-4 weeks depending on weight and IgE levels. "We did not really have any adverse effects from the injection," Dr. Kim said.

Powdered milk was used for OIT because it’s easier to dispense to subjects and less likely to spoil than fresh milk, among other reasons. Patients dissolved it in whatever they chose, often Gatorade. "It wasn’t peoples’ favorite thing to take on a daily basis," she said.

The results are from an interim analysis, and the study is ongoing.

The National Institutes of Health funded the project. The omalizumab used in the trial was donated by its maker, Genentech, and comarketer, Novartis. Dr. Kim said that she has no disclosures. The senior author, Dr. Hugh Sampson of Mount Sinai Hospital in New York, is an unpaid advisor to Novartis.

[email protected]

SAN DIEGO – During 20 months of follow-up, the diagnosis of penicillin "allergy" in hospitalized patients was associated with 10% more total hospital days and a spike in Clostridium difficile and other infections, a large 3-year study demonstrated.

"Based on other work, penicillin ‘allergy’ is inaccurate about 95% of the time," Dr. Eric M. Macy said in an interview prior to the annual meeting of the American Academy of Allergy, Asthma, and Immunology, where the work was presented. "More penicillin allergy testing of hospitalized individuals with a history of penicillin ‘allergy’ to document true penicillin allergy has the potential to reduce hospital days and serious infection prevalence," he said.

In an effort to determine hospital utilization and prevalence rates of Clostridium difficile, methicillin resistant Staphylococcus aureus (MRSA), and vancomycin-resistant enterococci (VRE) in patients with and without penicillin allergy, the researchers conducted a retrospective, matched cohort study of 51,807 individuals admitted to Kaiser Foundation hospitals in Southern California during 2010-2012 out of about 3.2 million health plan members, a sample that represents about 1% of the United States population.

Dr. Macy and his associates matched 51,582 of the individuals (99.6% of all cases) to two unique control subjects without an active penicillin allergy. Cases and controls were matched by category for discharge diagnosis, sex, age, and date of admission.

Over the 3-year study period, the penicillin allergic cases averaged 0.59 (9.9%) more total hospital days during 20 months of follow-up, compared with controls. Cases were treated with significantly more fluoroquinolones, clindamycin, and vancomycin, compared with controls (P less than .0001), and cases had 30.1% more VRE infections, 23.4% more C. diff. infections, and 14.1% more MRSA than expected, compared with controls, reported Dr. Macy of the Southern California Permanente Medical Group, San Diego.

When the researchers controlled for the number of drug allergies, differences between cases and controls disappeared. Overall, Dr. Macy and his associates observed a strong positive correlation for all four outcome variables and increasing drug allergy number in both cases and controls.

"This is the largest study ever done looking at the influence of a history of penicillin allergy, hospital utilization, and serious infection prevalence," Dr. Macy remarked. "This type of study could not be done any better." Full findings appear in the March 2014 issue of the Journal of Allergy and Clinical Immunology.

The study was supported by the Kaiser Permanente Health Care Program and by ALK-Abelló, a Danish company that sells an essential penicillin skin test reagent called Pre-Pen. Dr. Macy said that he had no relevant financial conflicts to disclose.

[email protected]

SAN DIEGO – During 20 months of follow-up, the diagnosis of penicillin "allergy" in hospitalized patients was associated with 10% more total hospital days and a spike in Clostridium difficile and other infections, a large 3-year study demonstrated.

"Based on other work, penicillin ‘allergy’ is inaccurate about 95% of the time," Dr. Eric M. Macy said in an interview prior to the annual meeting of the American Academy of Allergy, Asthma, and Immunology, where the work was presented. "More penicillin allergy testing of hospitalized individuals with a history of penicillin ‘allergy’ to document true penicillin allergy has the potential to reduce hospital days and serious infection prevalence," he said.

In an effort to determine hospital utilization and prevalence rates of Clostridium difficile, methicillin resistant Staphylococcus aureus (MRSA), and vancomycin-resistant enterococci (VRE) in patients with and without penicillin allergy, the researchers conducted a retrospective, matched cohort study of 51,807 individuals admitted to Kaiser Foundation hospitals in Southern California during 2010-2012 out of about 3.2 million health plan members, a sample that represents about 1% of the United States population.

Dr. Macy and his associates matched 51,582 of the individuals (99.6% of all cases) to two unique control subjects without an active penicillin allergy. Cases and controls were matched by category for discharge diagnosis, sex, age, and date of admission.

Over the 3-year study period, the penicillin allergic cases averaged 0.59 (9.9%) more total hospital days during 20 months of follow-up, compared with controls. Cases were treated with significantly more fluoroquinolones, clindamycin, and vancomycin, compared with controls (P less than .0001), and cases had 30.1% more VRE infections, 23.4% more C. diff. infections, and 14.1% more MRSA than expected, compared with controls, reported Dr. Macy of the Southern California Permanente Medical Group, San Diego.

When the researchers controlled for the number of drug allergies, differences between cases and controls disappeared. Overall, Dr. Macy and his associates observed a strong positive correlation for all four outcome variables and increasing drug allergy number in both cases and controls.

"This is the largest study ever done looking at the influence of a history of penicillin allergy, hospital utilization, and serious infection prevalence," Dr. Macy remarked. "This type of study could not be done any better." Full findings appear in the March 2014 issue of the Journal of Allergy and Clinical Immunology.

The study was supported by the Kaiser Permanente Health Care Program and by ALK-Abelló, a Danish company that sells an essential penicillin skin test reagent called Pre-Pen. Dr. Macy said that he had no relevant financial conflicts to disclose.

[email protected]

SAN DIEGO – During 20 months of follow-up, the diagnosis of penicillin "allergy" in hospitalized patients was associated with 10% more total hospital days and a spike in Clostridium difficile and other infections, a large 3-year study demonstrated.

"Based on other work, penicillin ‘allergy’ is inaccurate about 95% of the time," Dr. Eric M. Macy said in an interview prior to the annual meeting of the American Academy of Allergy, Asthma, and Immunology, where the work was presented. "More penicillin allergy testing of hospitalized individuals with a history of penicillin ‘allergy’ to document true penicillin allergy has the potential to reduce hospital days and serious infection prevalence," he said.

In an effort to determine hospital utilization and prevalence rates of Clostridium difficile, methicillin resistant Staphylococcus aureus (MRSA), and vancomycin-resistant enterococci (VRE) in patients with and without penicillin allergy, the researchers conducted a retrospective, matched cohort study of 51,807 individuals admitted to Kaiser Foundation hospitals in Southern California during 2010-2012 out of about 3.2 million health plan members, a sample that represents about 1% of the United States population.

Dr. Macy and his associates matched 51,582 of the individuals (99.6% of all cases) to two unique control subjects without an active penicillin allergy. Cases and controls were matched by category for discharge diagnosis, sex, age, and date of admission.

Over the 3-year study period, the penicillin allergic cases averaged 0.59 (9.9%) more total hospital days during 20 months of follow-up, compared with controls. Cases were treated with significantly more fluoroquinolones, clindamycin, and vancomycin, compared with controls (P less than .0001), and cases had 30.1% more VRE infections, 23.4% more C. diff. infections, and 14.1% more MRSA than expected, compared with controls, reported Dr. Macy of the Southern California Permanente Medical Group, San Diego.

When the researchers controlled for the number of drug allergies, differences between cases and controls disappeared. Overall, Dr. Macy and his associates observed a strong positive correlation for all four outcome variables and increasing drug allergy number in both cases and controls.

"This is the largest study ever done looking at the influence of a history of penicillin allergy, hospital utilization, and serious infection prevalence," Dr. Macy remarked. "This type of study could not be done any better." Full findings appear in the March 2014 issue of the Journal of Allergy and Clinical Immunology.

The study was supported by the Kaiser Permanente Health Care Program and by ALK-Abelló, a Danish company that sells an essential penicillin skin test reagent called Pre-Pen. Dr. Macy said that he had no relevant financial conflicts to disclose.

[email protected]

SAN DIEGO – Patients with food allergies – including those with a history of anaphylaxis – had no adverse reactions to propofol administered for anesthesia during endoscopy, based on a study that included 160 patients with food allergies.

Intravenous propofol (2,6-diisopropylphenol) includes lipid suspensions that contain egg lecithin/phosphatide and soy oil, ingredients that have raised "concern regarding administration of propofol in patients with egg and soy allergy," explained Dr. Harshna Mehta, a pediatric allergist-immunologist at the Icahn School of Medicine at Mount Sinai, New York. "Additionally, since the peanut is a legume similar to soy, there is also potential concern for peanut allergic patients."

Case reports of propofol-associated allergic reactions – presumably related to cross-reactivity to foods – have appeared in the medical literature. "However, most of these cases lacked confirmatory testing for actual food allergy vs. mere sensitization," Dr. Mehta said in an interview before the annual meeting of the American Academy of Allergy, Asthma, and Immunology, where the study results were presented.

Prior to this study, the largest study included 28 egg allergic patients, with two having a history of anaphylaxis (Anesth. Analg. 2011;113: 140-4).

Dr. Mehta and her associates reviewed the records of 563 patients who had endoscopies performed at the Mount Sinai Center for Eosinophilic Disorders from November 2004 to January 2014.

The researchers identified 160 patients with a median age of 14 years who had one or more food allergies, including 31 with a history of anaphylaxis. Egg, peanut, and soy allergies were confirmed based on finding elevated food specific serum IgE levels, positive skin prick tests and/or convincing allergic reaction history. Patients were included in the study if anesthesia records indicated propofol as the chief anesthetic administered.

Of the 160 patients, 95 had evidence of egg allergy (median egg-IgE = 9.57 kIU/L); 15 of these patients had a history of an anaphylactic reaction to egg. Of the 28 patients with confirmed soy allergy (median soy-IgE = 6.63 kU/L), 2 had a history of anaphylaxis. Dr. Mehta also reported that 117 patients had peanut allergy (median peanut-IgE =38.8 kIU/L); 11 o these patients had a history of anaphylaxis to peanuts.

There were no reported reactions to propofol in any of the patients.

"The most surprising finding was the number of egg/peanut/soy patients who have significant allergic comorbidities – such as history of anaphylaxis, allergic rhinitis, asthma, and atopic disease – that have safely received this medication," Dr. Mehta noted. "We are still in the process of determining the statistical confidence with which we can say how safe propofol is for administration to egg/soy/peanut allergic patients. We are also planning to test the product in the laboratory for the presence of egg protein."

Dr. Mehta said that she had no relevant financial conflicts to disclose.

[email protected]

SAN DIEGO – Patients with food allergies – including those with a history of anaphylaxis – had no adverse reactions to propofol administered for anesthesia during endoscopy, based on a study that included 160 patients with food allergies.

Intravenous propofol (2,6-diisopropylphenol) includes lipid suspensions that contain egg lecithin/phosphatide and soy oil, ingredients that have raised "concern regarding administration of propofol in patients with egg and soy allergy," explained Dr. Harshna Mehta, a pediatric allergist-immunologist at the Icahn School of Medicine at Mount Sinai, New York. "Additionally, since the peanut is a legume similar to soy, there is also potential concern for peanut allergic patients."

Case reports of propofol-associated allergic reactions – presumably related to cross-reactivity to foods – have appeared in the medical literature. "However, most of these cases lacked confirmatory testing for actual food allergy vs. mere sensitization," Dr. Mehta said in an interview before the annual meeting of the American Academy of Allergy, Asthma, and Immunology, where the study results were presented.

Prior to this study, the largest study included 28 egg allergic patients, with two having a history of anaphylaxis (Anesth. Analg. 2011;113: 140-4).

Dr. Mehta and her associates reviewed the records of 563 patients who had endoscopies performed at the Mount Sinai Center for Eosinophilic Disorders from November 2004 to January 2014.

The researchers identified 160 patients with a median age of 14 years who had one or more food allergies, including 31 with a history of anaphylaxis. Egg, peanut, and soy allergies were confirmed based on finding elevated food specific serum IgE levels, positive skin prick tests and/or convincing allergic reaction history. Patients were included in the study if anesthesia records indicated propofol as the chief anesthetic administered.

Of the 160 patients, 95 had evidence of egg allergy (median egg-IgE = 9.57 kIU/L); 15 of these patients had a history of an anaphylactic reaction to egg. Of the 28 patients with confirmed soy allergy (median soy-IgE = 6.63 kU/L), 2 had a history of anaphylaxis. Dr. Mehta also reported that 117 patients had peanut allergy (median peanut-IgE =38.8 kIU/L); 11 o these patients had a history of anaphylaxis to peanuts.

There were no reported reactions to propofol in any of the patients.

"The most surprising finding was the number of egg/peanut/soy patients who have significant allergic comorbidities – such as history of anaphylaxis, allergic rhinitis, asthma, and atopic disease – that have safely received this medication," Dr. Mehta noted. "We are still in the process of determining the statistical confidence with which we can say how safe propofol is for administration to egg/soy/peanut allergic patients. We are also planning to test the product in the laboratory for the presence of egg protein."

Dr. Mehta said that she had no relevant financial conflicts to disclose.

[email protected]

SAN DIEGO – Patients with food allergies – including those with a history of anaphylaxis – had no adverse reactions to propofol administered for anesthesia during endoscopy, based on a study that included 160 patients with food allergies.

Intravenous propofol (2,6-diisopropylphenol) includes lipid suspensions that contain egg lecithin/phosphatide and soy oil, ingredients that have raised "concern regarding administration of propofol in patients with egg and soy allergy," explained Dr. Harshna Mehta, a pediatric allergist-immunologist at the Icahn School of Medicine at Mount Sinai, New York. "Additionally, since the peanut is a legume similar to soy, there is also potential concern for peanut allergic patients."

Case reports of propofol-associated allergic reactions – presumably related to cross-reactivity to foods – have appeared in the medical literature. "However, most of these cases lacked confirmatory testing for actual food allergy vs. mere sensitization," Dr. Mehta said in an interview before the annual meeting of the American Academy of Allergy, Asthma, and Immunology, where the study results were presented.

Prior to this study, the largest study included 28 egg allergic patients, with two having a history of anaphylaxis (Anesth. Analg. 2011;113: 140-4).

Dr. Mehta and her associates reviewed the records of 563 patients who had endoscopies performed at the Mount Sinai Center for Eosinophilic Disorders from November 2004 to January 2014.

The researchers identified 160 patients with a median age of 14 years who had one or more food allergies, including 31 with a history of anaphylaxis. Egg, peanut, and soy allergies were confirmed based on finding elevated food specific serum IgE levels, positive skin prick tests and/or convincing allergic reaction history. Patients were included in the study if anesthesia records indicated propofol as the chief anesthetic administered.

Of the 160 patients, 95 had evidence of egg allergy (median egg-IgE = 9.57 kIU/L); 15 of these patients had a history of an anaphylactic reaction to egg. Of the 28 patients with confirmed soy allergy (median soy-IgE = 6.63 kU/L), 2 had a history of anaphylaxis. Dr. Mehta also reported that 117 patients had peanut allergy (median peanut-IgE =38.8 kIU/L); 11 o these patients had a history of anaphylaxis to peanuts.

There were no reported reactions to propofol in any of the patients.

"The most surprising finding was the number of egg/peanut/soy patients who have significant allergic comorbidities – such as history of anaphylaxis, allergic rhinitis, asthma, and atopic disease – that have safely received this medication," Dr. Mehta noted. "We are still in the process of determining the statistical confidence with which we can say how safe propofol is for administration to egg/soy/peanut allergic patients. We are also planning to test the product in the laboratory for the presence of egg protein."

Dr. Mehta said that she had no relevant financial conflicts to disclose.

[email protected]

SAN DIEGO – Patients with atopic dermatitis should routinely receive the intramuscular form of the influenza vaccine Fluzone unless the affected area of skin has been swabbed and found to have normal skin flora, data from a controlled study suggested.

"The original studies leading to approval of intradermal vaccination with Fluzone were done only in normal subjects," Dr. Donald Y.M. Leung said in an interview prior to the annual meeting of the American Academy of Allergy, Asthma, and Immunology, where the findings were presented. "Patients with atopic dermatitis [AD], the most common skin disease in the general population, were not included in previous studies. AD patients are prone to skin infection and may have an abnormal immune response in their skin."

To determine whether patients with AD had a normal skin immune response to Fluzone, Dr. Leung and his associates at five medical centers measured hemagglutination inhibition antibody (HAI) titers at baseline and 28 days post vaccination in 223 subjects with AD (including a subset with Staphylococcus aureus colonization) and 135 nonatopic controls after administration per label of either a single dose of the seasonal 2012-2013 intradermal Fluzone or Fluzone for intramuscular injection. They excluded subjects who were seroprotected at baseline (defined as an HAI of greater than 1:40).

Dr. Leung, who heads the division of pediatric allergy and immunology at National Jewish Health, Denver, reported that seroprotection and seroconversion rates for the three influenza strains included in the vaccine (B, H1N1, and H3N2) were not significantly different for AD and control subjects who received intradermal vaccination. Seroprotection and seroconversion rates were similar for AD subjects who received intradermal vaccination compared with AD subjects who received intramuscular vaccination.

Following intradermal vaccination, AD patients colonized with S. aureus had notably lower seroprotection and seroconversion rates to the B strain (12% vs. 47%, P less than .001, and 21% vs. 51%, P = .002, respectively) and a lower seroconversion rate for H1N1 (77% vs. 95%, P = .029) compared with subjects with uncolonized AD. There were no notable differences for H3N2. No differences were observed between AD subjects colonized with S. aureus and uncolonized AD subjects following intramuscular Fluzone for any strain.

"Although the AD group as a whole had a normal response to Fluzone given in the skin, the large subset of AD patients who were colonized with Staphylococcus aureus had a reduced response to Fluzone vaccination when the vaccine was introduced into the skin as opposed to the conventional intramuscular injection," Dr. Leung said. "Studies are needed to find out why colonization of the skin with S. aureus is associated with reduced skin immune responses."

The study was funded by the National Institute of Allergy and Infectious Diseases. Dr. Leung said he had no relevant financial conflicts to disclose.

[email protected]

SAN DIEGO – Patients with atopic dermatitis should routinely receive the intramuscular form of the influenza vaccine Fluzone unless the affected area of skin has been swabbed and found to have normal skin flora, data from a controlled study suggested.

"The original studies leading to approval of intradermal vaccination with Fluzone were done only in normal subjects," Dr. Donald Y.M. Leung said in an interview prior to the annual meeting of the American Academy of Allergy, Asthma, and Immunology, where the findings were presented. "Patients with atopic dermatitis [AD], the most common skin disease in the general population, were not included in previous studies. AD patients are prone to skin infection and may have an abnormal immune response in their skin."

To determine whether patients with AD had a normal skin immune response to Fluzone, Dr. Leung and his associates at five medical centers measured hemagglutination inhibition antibody (HAI) titers at baseline and 28 days post vaccination in 223 subjects with AD (including a subset with Staphylococcus aureus colonization) and 135 nonatopic controls after administration per label of either a single dose of the seasonal 2012-2013 intradermal Fluzone or Fluzone for intramuscular injection. They excluded subjects who were seroprotected at baseline (defined as an HAI of greater than 1:40).

Dr. Leung, who heads the division of pediatric allergy and immunology at National Jewish Health, Denver, reported that seroprotection and seroconversion rates for the three influenza strains included in the vaccine (B, H1N1, and H3N2) were not significantly different for AD and control subjects who received intradermal vaccination. Seroprotection and seroconversion rates were similar for AD subjects who received intradermal vaccination compared with AD subjects who received intramuscular vaccination.

Following intradermal vaccination, AD patients colonized with S. aureus had notably lower seroprotection and seroconversion rates to the B strain (12% vs. 47%, P less than .001, and 21% vs. 51%, P = .002, respectively) and a lower seroconversion rate for H1N1 (77% vs. 95%, P = .029) compared with subjects with uncolonized AD. There were no notable differences for H3N2. No differences were observed between AD subjects colonized with S. aureus and uncolonized AD subjects following intramuscular Fluzone for any strain.

"Although the AD group as a whole had a normal response to Fluzone given in the skin, the large subset of AD patients who were colonized with Staphylococcus aureus had a reduced response to Fluzone vaccination when the vaccine was introduced into the skin as opposed to the conventional intramuscular injection," Dr. Leung said. "Studies are needed to find out why colonization of the skin with S. aureus is associated with reduced skin immune responses."

The study was funded by the National Institute of Allergy and Infectious Diseases. Dr. Leung said he had no relevant financial conflicts to disclose.

[email protected]

SAN DIEGO – Patients with atopic dermatitis should routinely receive the intramuscular form of the influenza vaccine Fluzone unless the affected area of skin has been swabbed and found to have normal skin flora, data from a controlled study suggested.

"The original studies leading to approval of intradermal vaccination with Fluzone were done only in normal subjects," Dr. Donald Y.M. Leung said in an interview prior to the annual meeting of the American Academy of Allergy, Asthma, and Immunology, where the findings were presented. "Patients with atopic dermatitis [AD], the most common skin disease in the general population, were not included in previous studies. AD patients are prone to skin infection and may have an abnormal immune response in their skin."

To determine whether patients with AD had a normal skin immune response to Fluzone, Dr. Leung and his associates at five medical centers measured hemagglutination inhibition antibody (HAI) titers at baseline and 28 days post vaccination in 223 subjects with AD (including a subset with Staphylococcus aureus colonization) and 135 nonatopic controls after administration per label of either a single dose of the seasonal 2012-2013 intradermal Fluzone or Fluzone for intramuscular injection. They excluded subjects who were seroprotected at baseline (defined as an HAI of greater than 1:40).

Dr. Leung, who heads the division of pediatric allergy and immunology at National Jewish Health, Denver, reported that seroprotection and seroconversion rates for the three influenza strains included in the vaccine (B, H1N1, and H3N2) were not significantly different for AD and control subjects who received intradermal vaccination. Seroprotection and seroconversion rates were similar for AD subjects who received intradermal vaccination compared with AD subjects who received intramuscular vaccination.

Following intradermal vaccination, AD patients colonized with S. aureus had notably lower seroprotection and seroconversion rates to the B strain (12% vs. 47%, P less than .001, and 21% vs. 51%, P = .002, respectively) and a lower seroconversion rate for H1N1 (77% vs. 95%, P = .029) compared with subjects with uncolonized AD. There were no notable differences for H3N2. No differences were observed between AD subjects colonized with S. aureus and uncolonized AD subjects following intramuscular Fluzone for any strain.

"Although the AD group as a whole had a normal response to Fluzone given in the skin, the large subset of AD patients who were colonized with Staphylococcus aureus had a reduced response to Fluzone vaccination when the vaccine was introduced into the skin as opposed to the conventional intramuscular injection," Dr. Leung said. "Studies are needed to find out why colonization of the skin with S. aureus is associated with reduced skin immune responses."

The study was funded by the National Institute of Allergy and Infectious Diseases. Dr. Leung said he had no relevant financial conflicts to disclose.

[email protected]