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Levodopa Monotherapy May Be Adequate After DBS for Parkinson’s Disease
LAS VEGAS—For pharmacotherapy following deep brain stimulation (DBS), many patients can be adequately treated with levodopa alone, but only a small group can be managed with dopamine agonists alone, according to a study presented at the 21st Annual Meeting of the North American Neuromodulation Society. The data address a question about which there has been little objective guidance.
Based on the findings, efforts to reduce anti-Parkinson’s disease medications following DBS should be directed toward dopamine agonists first, according to Alfonso Fasano, MD, PhD, Codirector of the Surgical Program at the Movement Disorder Center of Toronto Western Hospital in Ontario. The data nevertheless provide the option for individualized therapy, he added. For example, for patients with good outcome after DBS and no significant history of impulse-
In the randomized controlled trial, 36 patients were assigned to receive monotherapy with a dopamine agonist or levodopa following subthalamic nucleus (STN) DBS. All patients were on both medications before surgery. The investigators did not identify any between-group differences in variables predicted to affect symptom control. Yet the proportion of patients that were able to stay on monotherapy at three months was different between the study arms.
“Perhaps the main result of this study was that we found it difficult to keep patients on dopamine-agonist monotherapy, even after a successful DBS procedure,” said Dr. Fasano.
At three months after surgery, the proportion of patients remaining on monotherapy was 81% in the levodopa group and 32% in the dopamine-agonist group. At that point in the follow-up, all other patients in the two groups were on both treatments. At six months, fewer patients were taking their assigned drug as a monotherapy. The proportion in the levodopa arm had decreased to 63%, and the proportion in the dopamine-agonist arm had decreased to 13%.
More of the failures in the dopamine-agonist arm, relative to the levodopa arm, resulted from inadequate control of motor symptoms. Failure in the levodopa arm more commonly occurred following mood and sleep disturbances. But the investigators observed failures for both reasons in both study arms.
DBS permits a reduction in anti-Parkinson’s disease medications, but dose reductions should be undertaken slowly, because mood disturbances have been reported after abrupt discontinuation of dopamine agonists, according to Dr. Fasano. Specific strategies for reducing anti-Parkinson’s disease medications following DBS have not been based on evidence, however.
Overall, the results of the randomized study “are in keeping with a common-sense” approach, Dr. Fasano said. While the results emphasize the limited proportion of patients who can remain on dopamine agonists alone following DBS, they also suggest that most patients receiving levodopa will require low doses of both therapies.
With these results and observations, “maybe we are getting closer to a guideline of what to do with respect to medication after surgery,” Dr. Fasano said.
—Ted Bosworth
Suggested Reading
Fasano A, Appel-Cresswell S, Jog M, et al. Medical management of Parkinson’s disease after initiation of deep brain stimulation. Can J Neurol Sci. 2016;43(5):626-634.
LAS VEGAS—For pharmacotherapy following deep brain stimulation (DBS), many patients can be adequately treated with levodopa alone, but only a small group can be managed with dopamine agonists alone, according to a study presented at the 21st Annual Meeting of the North American Neuromodulation Society. The data address a question about which there has been little objective guidance.
Based on the findings, efforts to reduce anti-Parkinson’s disease medications following DBS should be directed toward dopamine agonists first, according to Alfonso Fasano, MD, PhD, Codirector of the Surgical Program at the Movement Disorder Center of Toronto Western Hospital in Ontario. The data nevertheless provide the option for individualized therapy, he added. For example, for patients with good outcome after DBS and no significant history of impulse-
In the randomized controlled trial, 36 patients were assigned to receive monotherapy with a dopamine agonist or levodopa following subthalamic nucleus (STN) DBS. All patients were on both medications before surgery. The investigators did not identify any between-group differences in variables predicted to affect symptom control. Yet the proportion of patients that were able to stay on monotherapy at three months was different between the study arms.
“Perhaps the main result of this study was that we found it difficult to keep patients on dopamine-agonist monotherapy, even after a successful DBS procedure,” said Dr. Fasano.
At three months after surgery, the proportion of patients remaining on monotherapy was 81% in the levodopa group and 32% in the dopamine-agonist group. At that point in the follow-up, all other patients in the two groups were on both treatments. At six months, fewer patients were taking their assigned drug as a monotherapy. The proportion in the levodopa arm had decreased to 63%, and the proportion in the dopamine-agonist arm had decreased to 13%.
More of the failures in the dopamine-agonist arm, relative to the levodopa arm, resulted from inadequate control of motor symptoms. Failure in the levodopa arm more commonly occurred following mood and sleep disturbances. But the investigators observed failures for both reasons in both study arms.
DBS permits a reduction in anti-Parkinson’s disease medications, but dose reductions should be undertaken slowly, because mood disturbances have been reported after abrupt discontinuation of dopamine agonists, according to Dr. Fasano. Specific strategies for reducing anti-Parkinson’s disease medications following DBS have not been based on evidence, however.
Overall, the results of the randomized study “are in keeping with a common-sense” approach, Dr. Fasano said. While the results emphasize the limited proportion of patients who can remain on dopamine agonists alone following DBS, they also suggest that most patients receiving levodopa will require low doses of both therapies.
With these results and observations, “maybe we are getting closer to a guideline of what to do with respect to medication after surgery,” Dr. Fasano said.
—Ted Bosworth
Suggested Reading
Fasano A, Appel-Cresswell S, Jog M, et al. Medical management of Parkinson’s disease after initiation of deep brain stimulation. Can J Neurol Sci. 2016;43(5):626-634.
LAS VEGAS—For pharmacotherapy following deep brain stimulation (DBS), many patients can be adequately treated with levodopa alone, but only a small group can be managed with dopamine agonists alone, according to a study presented at the 21st Annual Meeting of the North American Neuromodulation Society. The data address a question about which there has been little objective guidance.
Based on the findings, efforts to reduce anti-Parkinson’s disease medications following DBS should be directed toward dopamine agonists first, according to Alfonso Fasano, MD, PhD, Codirector of the Surgical Program at the Movement Disorder Center of Toronto Western Hospital in Ontario. The data nevertheless provide the option for individualized therapy, he added. For example, for patients with good outcome after DBS and no significant history of impulse-
In the randomized controlled trial, 36 patients were assigned to receive monotherapy with a dopamine agonist or levodopa following subthalamic nucleus (STN) DBS. All patients were on both medications before surgery. The investigators did not identify any between-group differences in variables predicted to affect symptom control. Yet the proportion of patients that were able to stay on monotherapy at three months was different between the study arms.
“Perhaps the main result of this study was that we found it difficult to keep patients on dopamine-agonist monotherapy, even after a successful DBS procedure,” said Dr. Fasano.
At three months after surgery, the proportion of patients remaining on monotherapy was 81% in the levodopa group and 32% in the dopamine-agonist group. At that point in the follow-up, all other patients in the two groups were on both treatments. At six months, fewer patients were taking their assigned drug as a monotherapy. The proportion in the levodopa arm had decreased to 63%, and the proportion in the dopamine-agonist arm had decreased to 13%.
More of the failures in the dopamine-agonist arm, relative to the levodopa arm, resulted from inadequate control of motor symptoms. Failure in the levodopa arm more commonly occurred following mood and sleep disturbances. But the investigators observed failures for both reasons in both study arms.
DBS permits a reduction in anti-Parkinson’s disease medications, but dose reductions should be undertaken slowly, because mood disturbances have been reported after abrupt discontinuation of dopamine agonists, according to Dr. Fasano. Specific strategies for reducing anti-Parkinson’s disease medications following DBS have not been based on evidence, however.
Overall, the results of the randomized study “are in keeping with a common-sense” approach, Dr. Fasano said. While the results emphasize the limited proportion of patients who can remain on dopamine agonists alone following DBS, they also suggest that most patients receiving levodopa will require low doses of both therapies.
With these results and observations, “maybe we are getting closer to a guideline of what to do with respect to medication after surgery,” Dr. Fasano said.
—Ted Bosworth
Suggested Reading
Fasano A, Appel-Cresswell S, Jog M, et al. Medical management of Parkinson’s disease after initiation of deep brain stimulation. Can J Neurol Sci. 2016;43(5):626-634.
Good definitions, research lacking for COPD-asthma overlap
ORLANDO – to give clinicians data they can actually use.
The topic is even more pressing given the growing interest and research into biological treatments for asthma and consideration of their possible use in COPD, experts said at the joint congress of the American Academy of Allergy, Asthma, and Immunology and the World Asthma Organization. Their remarks came in what was ostensibly a “debate” on whether ACOS is a distinct entity requiring special treatment but largely turned into a discussion about gaps in knowledge on the topic.
“The problem here is that it has not been defined in a way that everyone agrees on – that does create a problem because, if there’s no consensus on the diagnostic criteria, then it may be difficult to study this overlap,” said Donald Tashkin, MD, director of the pulmonary function laboratories at the University of California, Los Angeles. “Because there is no agreement on how to diagnose ACOS, it hasn’t been studied with respect to its responsiveness to different treatment options.”R. Stokes Peebles Jr., MD, professor of allergy, pulmonary, and critical care medicine at Vanderbilt University Medical Center, Nashville, Tenn., said that, although the number of published articles on ACOS has skyrocketed over the last several years, review articles have outnumbered original research articles.
There is disagreement in published definitions: One set of definitions includes a criterion of fractional exhaled nitric oxide not seen in any other definitions, whereas some other definitions require a history of smoking while others don’t, he said.
“How does one manage a disease without a definition and without clinical studies? It’s impossible for me to know,” Dr. Peebles said.
Jeffrey Drazen, MD, the Distinguished Parker B. Francis Professor of Medicine at Harvard Medical School, Boston, and the editor of the New England Journal of Medicine, also lamented the polar nature of the research.
“We all treat patients in the middle, everybody does, all the time – and we would love more guidance,” he said. “One of the reasons the number of articles has gone up is that there have been lots of case definitions. But we can’t get consensus. So who do we have to bring to the table to get a consensus definition so we can get the funding we need from the drug companies or governmental bodies to do the research that we all want?”
Dr. Tashkin said the way forward could be to draw on the points of consensus that do exist on certain criteria.
Dr. Peebles said an international panel is needed to draw up a consensus guideline, with the panel including both pulmonologists and allergists – “people experienced with clinical trials, who take care of a lot of patients.”
ORLANDO – to give clinicians data they can actually use.
The topic is even more pressing given the growing interest and research into biological treatments for asthma and consideration of their possible use in COPD, experts said at the joint congress of the American Academy of Allergy, Asthma, and Immunology and the World Asthma Organization. Their remarks came in what was ostensibly a “debate” on whether ACOS is a distinct entity requiring special treatment but largely turned into a discussion about gaps in knowledge on the topic.
“The problem here is that it has not been defined in a way that everyone agrees on – that does create a problem because, if there’s no consensus on the diagnostic criteria, then it may be difficult to study this overlap,” said Donald Tashkin, MD, director of the pulmonary function laboratories at the University of California, Los Angeles. “Because there is no agreement on how to diagnose ACOS, it hasn’t been studied with respect to its responsiveness to different treatment options.”R. Stokes Peebles Jr., MD, professor of allergy, pulmonary, and critical care medicine at Vanderbilt University Medical Center, Nashville, Tenn., said that, although the number of published articles on ACOS has skyrocketed over the last several years, review articles have outnumbered original research articles.
There is disagreement in published definitions: One set of definitions includes a criterion of fractional exhaled nitric oxide not seen in any other definitions, whereas some other definitions require a history of smoking while others don’t, he said.
“How does one manage a disease without a definition and without clinical studies? It’s impossible for me to know,” Dr. Peebles said.
Jeffrey Drazen, MD, the Distinguished Parker B. Francis Professor of Medicine at Harvard Medical School, Boston, and the editor of the New England Journal of Medicine, also lamented the polar nature of the research.
“We all treat patients in the middle, everybody does, all the time – and we would love more guidance,” he said. “One of the reasons the number of articles has gone up is that there have been lots of case definitions. But we can’t get consensus. So who do we have to bring to the table to get a consensus definition so we can get the funding we need from the drug companies or governmental bodies to do the research that we all want?”
Dr. Tashkin said the way forward could be to draw on the points of consensus that do exist on certain criteria.
Dr. Peebles said an international panel is needed to draw up a consensus guideline, with the panel including both pulmonologists and allergists – “people experienced with clinical trials, who take care of a lot of patients.”
ORLANDO – to give clinicians data they can actually use.
The topic is even more pressing given the growing interest and research into biological treatments for asthma and consideration of their possible use in COPD, experts said at the joint congress of the American Academy of Allergy, Asthma, and Immunology and the World Asthma Organization. Their remarks came in what was ostensibly a “debate” on whether ACOS is a distinct entity requiring special treatment but largely turned into a discussion about gaps in knowledge on the topic.
“The problem here is that it has not been defined in a way that everyone agrees on – that does create a problem because, if there’s no consensus on the diagnostic criteria, then it may be difficult to study this overlap,” said Donald Tashkin, MD, director of the pulmonary function laboratories at the University of California, Los Angeles. “Because there is no agreement on how to diagnose ACOS, it hasn’t been studied with respect to its responsiveness to different treatment options.”R. Stokes Peebles Jr., MD, professor of allergy, pulmonary, and critical care medicine at Vanderbilt University Medical Center, Nashville, Tenn., said that, although the number of published articles on ACOS has skyrocketed over the last several years, review articles have outnumbered original research articles.
There is disagreement in published definitions: One set of definitions includes a criterion of fractional exhaled nitric oxide not seen in any other definitions, whereas some other definitions require a history of smoking while others don’t, he said.
“How does one manage a disease without a definition and without clinical studies? It’s impossible for me to know,” Dr. Peebles said.
Jeffrey Drazen, MD, the Distinguished Parker B. Francis Professor of Medicine at Harvard Medical School, Boston, and the editor of the New England Journal of Medicine, also lamented the polar nature of the research.
“We all treat patients in the middle, everybody does, all the time – and we would love more guidance,” he said. “One of the reasons the number of articles has gone up is that there have been lots of case definitions. But we can’t get consensus. So who do we have to bring to the table to get a consensus definition so we can get the funding we need from the drug companies or governmental bodies to do the research that we all want?”
Dr. Tashkin said the way forward could be to draw on the points of consensus that do exist on certain criteria.
Dr. Peebles said an international panel is needed to draw up a consensus guideline, with the panel including both pulmonologists and allergists – “people experienced with clinical trials, who take care of a lot of patients.”
EXPERT ANALYSIS FROM AAAAI/WAO JOINT CONGRESS
Commonality
I grew up in a diversity-free zone. The bubble surrounding Pleasantville, New York, in the 1950s and 1960s didn’t include people of color. We were all middle-class, some upper, some lower, some blue collar, some white collar – but, all of us comfortably in the middle. The children with disabilities must have been hidden in their homes or housed in institutions. They certainly weren’t our classmates. We were spread across the broad Judeo-Christian spectrum. Who knew there were other religions?
Of course, when I left for college I entered another even less inclusive bubble that didn’t admit women.
For many years, the process that brought about this dramatic change was a fortuitous conglomeration of brush wars fought by courageous individuals and minority groups. However, in the last decade or two, the struggle for inclusion has broadened under the banner of diversity, a term once primarily used to describe evolving ecologic populations. In light of this expanding definition, it is not surprising that the American Academy of Pediatrics has begun to consider its role in promoting diversity. As reported in AAP News (Anne Hegland, March 2018) the American Academy of Pediatrics board of directors recently discussed a plan for implementing at “all levels of the Academy” the suggestions of its Task Force on Diversity and Inclusion.
The academy is in the enviable positive of having a membership that agrees in general terms where its priorities should be – the health and welfare of children. It can afford to invest some of its energies in being more inclusive. However, the United States currently is struggling to rediscover a set of priorities that its citizens can agree on. We have politicians who would rather win a battle over their adversaries than address the obvious needs of the country. And, we have journalists who prefer to feast on these battles rather than search for evidence of cooperation. This is not a time to sharpen our focus on how different we are from one another. It is time to raise another flag along side the “diversity” banner. It should read “commonality,” and remind us that while we are celebrating our differences, we must work harder to uncover the core values that we share.
Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine for nearly 40 years. He has authored several books on behavioral pediatrics, including “How to Say No to Your Toddler.” Email him at [email protected].
I grew up in a diversity-free zone. The bubble surrounding Pleasantville, New York, in the 1950s and 1960s didn’t include people of color. We were all middle-class, some upper, some lower, some blue collar, some white collar – but, all of us comfortably in the middle. The children with disabilities must have been hidden in their homes or housed in institutions. They certainly weren’t our classmates. We were spread across the broad Judeo-Christian spectrum. Who knew there were other religions?
Of course, when I left for college I entered another even less inclusive bubble that didn’t admit women.
For many years, the process that brought about this dramatic change was a fortuitous conglomeration of brush wars fought by courageous individuals and minority groups. However, in the last decade or two, the struggle for inclusion has broadened under the banner of diversity, a term once primarily used to describe evolving ecologic populations. In light of this expanding definition, it is not surprising that the American Academy of Pediatrics has begun to consider its role in promoting diversity. As reported in AAP News (Anne Hegland, March 2018) the American Academy of Pediatrics board of directors recently discussed a plan for implementing at “all levels of the Academy” the suggestions of its Task Force on Diversity and Inclusion.
The academy is in the enviable positive of having a membership that agrees in general terms where its priorities should be – the health and welfare of children. It can afford to invest some of its energies in being more inclusive. However, the United States currently is struggling to rediscover a set of priorities that its citizens can agree on. We have politicians who would rather win a battle over their adversaries than address the obvious needs of the country. And, we have journalists who prefer to feast on these battles rather than search for evidence of cooperation. This is not a time to sharpen our focus on how different we are from one another. It is time to raise another flag along side the “diversity” banner. It should read “commonality,” and remind us that while we are celebrating our differences, we must work harder to uncover the core values that we share.
Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine for nearly 40 years. He has authored several books on behavioral pediatrics, including “How to Say No to Your Toddler.” Email him at [email protected].
I grew up in a diversity-free zone. The bubble surrounding Pleasantville, New York, in the 1950s and 1960s didn’t include people of color. We were all middle-class, some upper, some lower, some blue collar, some white collar – but, all of us comfortably in the middle. The children with disabilities must have been hidden in their homes or housed in institutions. They certainly weren’t our classmates. We were spread across the broad Judeo-Christian spectrum. Who knew there were other religions?
Of course, when I left for college I entered another even less inclusive bubble that didn’t admit women.
For many years, the process that brought about this dramatic change was a fortuitous conglomeration of brush wars fought by courageous individuals and minority groups. However, in the last decade or two, the struggle for inclusion has broadened under the banner of diversity, a term once primarily used to describe evolving ecologic populations. In light of this expanding definition, it is not surprising that the American Academy of Pediatrics has begun to consider its role in promoting diversity. As reported in AAP News (Anne Hegland, March 2018) the American Academy of Pediatrics board of directors recently discussed a plan for implementing at “all levels of the Academy” the suggestions of its Task Force on Diversity and Inclusion.
The academy is in the enviable positive of having a membership that agrees in general terms where its priorities should be – the health and welfare of children. It can afford to invest some of its energies in being more inclusive. However, the United States currently is struggling to rediscover a set of priorities that its citizens can agree on. We have politicians who would rather win a battle over their adversaries than address the obvious needs of the country. And, we have journalists who prefer to feast on these battles rather than search for evidence of cooperation. This is not a time to sharpen our focus on how different we are from one another. It is time to raise another flag along side the “diversity” banner. It should read “commonality,” and remind us that while we are celebrating our differences, we must work harder to uncover the core values that we share.
Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine for nearly 40 years. He has authored several books on behavioral pediatrics, including “How to Say No to Your Toddler.” Email him at [email protected].
New approaches needed for food allergies in minority children
ORLANDO – compared with their white counterparts, an expert said.
These ethnic groups have higher odds of food sensitization compared with whites, and an analysis of the U.S. National Mortality Database found a higher rate of food-related anaphylaxis that turned fatal more often among African-Americans than among whites, Mahboobeh Mahdavinia, MD, PhD, an allergist and immunologist at Rush University Medical Center, Chicago, said at the joint congress of the American Academy of Asthma, Allergy, and Immunology and the World Asthma Organization.
The “sadder news,” she said, is that the rate of fatal food-related anaphylaxis has been getting worse with time. Rates of fatal food-related anaphylaxis per million significantly increased in African American males from the period of 1999-2001 (.06), compared with 2008-2010 (.21) (P less than .001). Fatal anaphylaxis caused by food was significantly associated with African American race (P less than .001) (J Allergy Clin Immunol. 2014 Dec;134[6]:1318-28.e7).
“There has been a lot of research and increasing awareness about food allergy, but this has certainly not affected minorities, and they’re even dying more from these diseases,” Dr. Mahdavinia said.
Studies also have shown that African-American and Hispanic children have a higher rate of emergency department visits for food allergy, compared with white children. Dr. Mahdavinia said this might be because the severity of their allergies is worse, because they have less access to primary care, they have inferior practices at home to manage the allergies, and that higher asthma rates in these children is likely leading to worse food allergy incidents.
Compared with white children, African American children were significantly more likely to have allergy to wheat, soy, corn, fish, and shellfish (P less than .01). Compared with white children, Hispanic children were significantly more likely to have allergy to corn, fish, and shellfish (P less than .01) (J Allergy Clin Immunol Pract. 2017 Mar-Apr;5[2]:352-7.e1).
Children from low-income backgrounds, she noted, spend less on specialty outpatient care.
The difference in food allergy rates is likely linked, in part, to familial and cultural differences in childrearing, she said. African-American and Hispanic parents tend to introduce solid foods earlier, and breastfeed children at lower rates than those of white families.
Dr. Mahdavinia noted that while more affluent families are able to sidestep allergies by making a simple stop at a high-end grocer to get an allergen-free version of a food, poorer families are less able to buy these more expensive alternatives.
“The higher rate of asthma anaphylaxis observed in these minority children is concerning, especially when it’s considered in the context of the reported higher rate of fatal anaphylaxis associated food allergy in African Americans,” she said. “So there’s a tremendous need for future studies.”
ORLANDO – compared with their white counterparts, an expert said.
These ethnic groups have higher odds of food sensitization compared with whites, and an analysis of the U.S. National Mortality Database found a higher rate of food-related anaphylaxis that turned fatal more often among African-Americans than among whites, Mahboobeh Mahdavinia, MD, PhD, an allergist and immunologist at Rush University Medical Center, Chicago, said at the joint congress of the American Academy of Asthma, Allergy, and Immunology and the World Asthma Organization.
The “sadder news,” she said, is that the rate of fatal food-related anaphylaxis has been getting worse with time. Rates of fatal food-related anaphylaxis per million significantly increased in African American males from the period of 1999-2001 (.06), compared with 2008-2010 (.21) (P less than .001). Fatal anaphylaxis caused by food was significantly associated with African American race (P less than .001) (J Allergy Clin Immunol. 2014 Dec;134[6]:1318-28.e7).
“There has been a lot of research and increasing awareness about food allergy, but this has certainly not affected minorities, and they’re even dying more from these diseases,” Dr. Mahdavinia said.
Studies also have shown that African-American and Hispanic children have a higher rate of emergency department visits for food allergy, compared with white children. Dr. Mahdavinia said this might be because the severity of their allergies is worse, because they have less access to primary care, they have inferior practices at home to manage the allergies, and that higher asthma rates in these children is likely leading to worse food allergy incidents.
Compared with white children, African American children were significantly more likely to have allergy to wheat, soy, corn, fish, and shellfish (P less than .01). Compared with white children, Hispanic children were significantly more likely to have allergy to corn, fish, and shellfish (P less than .01) (J Allergy Clin Immunol Pract. 2017 Mar-Apr;5[2]:352-7.e1).
Children from low-income backgrounds, she noted, spend less on specialty outpatient care.
The difference in food allergy rates is likely linked, in part, to familial and cultural differences in childrearing, she said. African-American and Hispanic parents tend to introduce solid foods earlier, and breastfeed children at lower rates than those of white families.
Dr. Mahdavinia noted that while more affluent families are able to sidestep allergies by making a simple stop at a high-end grocer to get an allergen-free version of a food, poorer families are less able to buy these more expensive alternatives.
“The higher rate of asthma anaphylaxis observed in these minority children is concerning, especially when it’s considered in the context of the reported higher rate of fatal anaphylaxis associated food allergy in African Americans,” she said. “So there’s a tremendous need for future studies.”
ORLANDO – compared with their white counterparts, an expert said.
These ethnic groups have higher odds of food sensitization compared with whites, and an analysis of the U.S. National Mortality Database found a higher rate of food-related anaphylaxis that turned fatal more often among African-Americans than among whites, Mahboobeh Mahdavinia, MD, PhD, an allergist and immunologist at Rush University Medical Center, Chicago, said at the joint congress of the American Academy of Asthma, Allergy, and Immunology and the World Asthma Organization.
The “sadder news,” she said, is that the rate of fatal food-related anaphylaxis has been getting worse with time. Rates of fatal food-related anaphylaxis per million significantly increased in African American males from the period of 1999-2001 (.06), compared with 2008-2010 (.21) (P less than .001). Fatal anaphylaxis caused by food was significantly associated with African American race (P less than .001) (J Allergy Clin Immunol. 2014 Dec;134[6]:1318-28.e7).
“There has been a lot of research and increasing awareness about food allergy, but this has certainly not affected minorities, and they’re even dying more from these diseases,” Dr. Mahdavinia said.
Studies also have shown that African-American and Hispanic children have a higher rate of emergency department visits for food allergy, compared with white children. Dr. Mahdavinia said this might be because the severity of their allergies is worse, because they have less access to primary care, they have inferior practices at home to manage the allergies, and that higher asthma rates in these children is likely leading to worse food allergy incidents.
Compared with white children, African American children were significantly more likely to have allergy to wheat, soy, corn, fish, and shellfish (P less than .01). Compared with white children, Hispanic children were significantly more likely to have allergy to corn, fish, and shellfish (P less than .01) (J Allergy Clin Immunol Pract. 2017 Mar-Apr;5[2]:352-7.e1).
Children from low-income backgrounds, she noted, spend less on specialty outpatient care.
The difference in food allergy rates is likely linked, in part, to familial and cultural differences in childrearing, she said. African-American and Hispanic parents tend to introduce solid foods earlier, and breastfeed children at lower rates than those of white families.
Dr. Mahdavinia noted that while more affluent families are able to sidestep allergies by making a simple stop at a high-end grocer to get an allergen-free version of a food, poorer families are less able to buy these more expensive alternatives.
“The higher rate of asthma anaphylaxis observed in these minority children is concerning, especially when it’s considered in the context of the reported higher rate of fatal anaphylaxis associated food allergy in African Americans,” she said. “So there’s a tremendous need for future studies.”
EXPERT ANALYSIS FROM AAAAI/WAO JOINT CONGRESS
Transporting stroke patients directly to thrombectomy boosts outcomes
LOS ANGELES – Evidence continues to mount that in the new era of thrombectomy treatment for selected acute ischemic stroke patients outcomes are better when patients go directly to the closest comprehensive stroke center that offers intravascular procedures rather than first being taken to a closer hospital and then needing transfer.
Nils H. Mueller-Kronast, MD, presented a modeled analysis of data collected in a registry on 236 real-world U.S. patients who underwent mechanical thrombectomy for an acute, large-vessel occlusion stroke following transfer from a hospital that could perform thrombolysis but couldn’t offer thrombectomy. The analysis showed that if the patients had instead gone directly to the closest thrombectomy center the result would have been a 16-percentage-point increase in patients with a modified Rankin Scale (mRS) score of 0-1 after 90 days, and a 9-percentage-point increase in mRS 0-2 outcomes, Dr. Mueller-Kronast said at the International Stroke Conference, sponsored by the American Heart Association.
The analysis he presented used data from the Systematic Evaluation of Patients Treated With Stroke Devices for Acute Ischemic Stroke (STRATIS) registry, which included 984 acute ischemic stroke patients who underwent mechanical thrombectomy at any one of 55 participating U.S. sites (Stroke. 2017 Oct;48[10]:2760-8). A previously-reported analysis of the STRATIS data showed that the 55% of patients taken directly to a center that performed thrombectomy had a 60% rate of mRS score 0-2 after 90 days, compared with 52% of patients taken first to a hospital unable to perform thrombectomy and then transferred (Circulation. 2017 Dec 12;136[24]:2311-21).
The current analysis focused on 236 of the transferred patients with complete information on their location at the time of their stroke and subsequent time intervals during their transport and treatment, including 117 patients with ground transfer from their first hospital to the thrombectomy site, 114 with air transfer, and 5 with an unreported means of transport.
Dr. Mueller-Kronast and his associates calculated the time it would have taken each of the 117 ground transported patients to have gone directly to the closest thrombectomy center (adjusted by traffic conditions at the time of the stroke), and modeled the likely outcomes of these patients based on the data collected in the registry. This projected a 47% rate of mRS scores 0-1 (good outcomes) after 90 days, and a 60% rate of mRS 0-2 scores with a direct-to-thrombectomy strategy, compared with actual rates of 31% and 51%, respectively, among the patients who were transferred from their initial hospital.
“Bypass to an endovascular-capable center may be an option to improve rapid access to mechanical thrombectomy,” he concluded.
The STRATIS registry is sponsored by Medtronic. Dr. Mueller-Kronast has been a consultant to Medtronic.
SOURCE: Mueller-Kronast N et al. Abstract LB12.
LOS ANGELES – Evidence continues to mount that in the new era of thrombectomy treatment for selected acute ischemic stroke patients outcomes are better when patients go directly to the closest comprehensive stroke center that offers intravascular procedures rather than first being taken to a closer hospital and then needing transfer.
Nils H. Mueller-Kronast, MD, presented a modeled analysis of data collected in a registry on 236 real-world U.S. patients who underwent mechanical thrombectomy for an acute, large-vessel occlusion stroke following transfer from a hospital that could perform thrombolysis but couldn’t offer thrombectomy. The analysis showed that if the patients had instead gone directly to the closest thrombectomy center the result would have been a 16-percentage-point increase in patients with a modified Rankin Scale (mRS) score of 0-1 after 90 days, and a 9-percentage-point increase in mRS 0-2 outcomes, Dr. Mueller-Kronast said at the International Stroke Conference, sponsored by the American Heart Association.
The analysis he presented used data from the Systematic Evaluation of Patients Treated With Stroke Devices for Acute Ischemic Stroke (STRATIS) registry, which included 984 acute ischemic stroke patients who underwent mechanical thrombectomy at any one of 55 participating U.S. sites (Stroke. 2017 Oct;48[10]:2760-8). A previously-reported analysis of the STRATIS data showed that the 55% of patients taken directly to a center that performed thrombectomy had a 60% rate of mRS score 0-2 after 90 days, compared with 52% of patients taken first to a hospital unable to perform thrombectomy and then transferred (Circulation. 2017 Dec 12;136[24]:2311-21).
The current analysis focused on 236 of the transferred patients with complete information on their location at the time of their stroke and subsequent time intervals during their transport and treatment, including 117 patients with ground transfer from their first hospital to the thrombectomy site, 114 with air transfer, and 5 with an unreported means of transport.
Dr. Mueller-Kronast and his associates calculated the time it would have taken each of the 117 ground transported patients to have gone directly to the closest thrombectomy center (adjusted by traffic conditions at the time of the stroke), and modeled the likely outcomes of these patients based on the data collected in the registry. This projected a 47% rate of mRS scores 0-1 (good outcomes) after 90 days, and a 60% rate of mRS 0-2 scores with a direct-to-thrombectomy strategy, compared with actual rates of 31% and 51%, respectively, among the patients who were transferred from their initial hospital.
“Bypass to an endovascular-capable center may be an option to improve rapid access to mechanical thrombectomy,” he concluded.
The STRATIS registry is sponsored by Medtronic. Dr. Mueller-Kronast has been a consultant to Medtronic.
SOURCE: Mueller-Kronast N et al. Abstract LB12.
LOS ANGELES – Evidence continues to mount that in the new era of thrombectomy treatment for selected acute ischemic stroke patients outcomes are better when patients go directly to the closest comprehensive stroke center that offers intravascular procedures rather than first being taken to a closer hospital and then needing transfer.
Nils H. Mueller-Kronast, MD, presented a modeled analysis of data collected in a registry on 236 real-world U.S. patients who underwent mechanical thrombectomy for an acute, large-vessel occlusion stroke following transfer from a hospital that could perform thrombolysis but couldn’t offer thrombectomy. The analysis showed that if the patients had instead gone directly to the closest thrombectomy center the result would have been a 16-percentage-point increase in patients with a modified Rankin Scale (mRS) score of 0-1 after 90 days, and a 9-percentage-point increase in mRS 0-2 outcomes, Dr. Mueller-Kronast said at the International Stroke Conference, sponsored by the American Heart Association.
The analysis he presented used data from the Systematic Evaluation of Patients Treated With Stroke Devices for Acute Ischemic Stroke (STRATIS) registry, which included 984 acute ischemic stroke patients who underwent mechanical thrombectomy at any one of 55 participating U.S. sites (Stroke. 2017 Oct;48[10]:2760-8). A previously-reported analysis of the STRATIS data showed that the 55% of patients taken directly to a center that performed thrombectomy had a 60% rate of mRS score 0-2 after 90 days, compared with 52% of patients taken first to a hospital unable to perform thrombectomy and then transferred (Circulation. 2017 Dec 12;136[24]:2311-21).
The current analysis focused on 236 of the transferred patients with complete information on their location at the time of their stroke and subsequent time intervals during their transport and treatment, including 117 patients with ground transfer from their first hospital to the thrombectomy site, 114 with air transfer, and 5 with an unreported means of transport.
Dr. Mueller-Kronast and his associates calculated the time it would have taken each of the 117 ground transported patients to have gone directly to the closest thrombectomy center (adjusted by traffic conditions at the time of the stroke), and modeled the likely outcomes of these patients based on the data collected in the registry. This projected a 47% rate of mRS scores 0-1 (good outcomes) after 90 days, and a 60% rate of mRS 0-2 scores with a direct-to-thrombectomy strategy, compared with actual rates of 31% and 51%, respectively, among the patients who were transferred from their initial hospital.
“Bypass to an endovascular-capable center may be an option to improve rapid access to mechanical thrombectomy,” he concluded.
The STRATIS registry is sponsored by Medtronic. Dr. Mueller-Kronast has been a consultant to Medtronic.
SOURCE: Mueller-Kronast N et al. Abstract LB12.
REPORTING FROM ISC 2018
Key clinical point: A direct-to-thrombectomy strategy maximizes good stroke outcomes.
Major finding: Modeling showed a 47% rate of good 90-day outcomes by taking patients to the closest thrombectomy center, compared with an actual 31% rate with transfers.
Study details: A simulation-model analysis of data collected by the STRATIS registry of acute stroke thrombectomies.
Disclosures: The STRATIS registry is sponsored by Medtronic. Dr. Mueller-Kronast has been a consultant to Medtronic.
Source: Mueller-Kronast N et al. Abstract LB12.
Nonmyeloablative conditioning gets a radiation boost for severe hemoglobinopathies
SALT LAKE CITY – A nonmyeloablative conditioning regimen with a boosted dose of total body irradiation yielded success for a cohort of patients with severe hemoglobinopathy and haploidentical donors.
Of 17 patients with severe sickle cell disease or beta-thalassemia who received allogeneic bone marrow transplants, all but one had successful engraftment, and 13 have achieved full donor chimerism, said Javier Bolaños-Meade, MD.
“Cure of severe hemoglobinopathies is now possible for most patients,” said Dr. Bolaños-Meade. “It should no longer be considered as available to only a fraction of such patients,” such as those who come with a fully-matched donor and those able to tolerate myeloablative conditioning, he said.
Of the patients who received bone marrow transplants, five patients have stopped immunosuppressive therapy, and all patients are alive, having been followed for a median of 15 months (range, 3-34 months).
The rate of graft versus host disease (GVHD) was low: Two patients developed grade 2 acute GVHD, and one patient developed grade 3 acute GVHD; another three patients had mild to moderate chronic GVHD, but all GVHD has resolved, said Dr. Bolaños-Meade.
Historically, the difficulties with transplant in this population were numerous. “No. 1, it’s very difficult to find an HLA-matched donor,” said Dr. Bolaños-Meade. Also, since there’s no target for graft-versus-tumor effect post-transplant, any amount of chronic GVHD is also high on the list of concerns when considering a transplant for hemoglobinopathy.
“The other problem in this group of patients is their ability to tolerate myeloablation,” he said. The accumulated burden of disease, as well as sequelae of transfusion dependence for some, may make a myeloablative regime too risky.
Dr. Bolaños-Meade said that he and his collaborators at Johns Hopkins University, Baltimore, wanted to be able to address all of these concerns in one regimen. “We were trying to work out a system that may be able to solve all the problems – to use nonmyeloablation and to use whatever donor is available.”
His research group had previously shown that nonmyeloablative transplants were well tolerated in patients with sickle cell disease and that haploidentical donors could be used (Blood. 2012 Nov 22;120[22]:4285-91). “However, we had a very high incidence of graft failure,” Dr. Bolaños-Meade said.
A strategy to increase the engraftment rate while still limiting toxicity, he said, would be to increase the dose of total body irradiation used in the conditioning regimen, from 200 to 400 centigray (cGy); this higher dose was incorporated into the study protocol.
Patients were enrolled if they had severe sickle cell disease (SCD; n = 12) or beta-thalassemia (n = 5).
To enroll in the study, SCD patients had to have been hospitalized at least twice a year in the preceding 2 years. The patients with SCD were a median 26 years of age (range, 6-31 years); four were male, and eight were female. Three of the SCD patients were transfusion dependent, and several had such serious complications as osteonecrosis, brain changes seen in medical imaging, and acute coronary syndrome.
The beta-thalassemia patients were a median 7 years of age (range, 6-16 years); all but one were female, and all had been transfusion dependent since infancy.
Bone marrow donors were not all first degree relatives: There were five mothers, four fathers, four brothers, and three sisters, but also an aunt. Two pairs had major ABO incompatibility, and five had minor ABO incompatibility. Ten were ABO compatible.
The conditioning regimen for all patients involved rabbit antithymocyte globulin, fludarabine, and cyclophosphamide, and then total body irradiation given the day before transplant.
After transplant, in addition to standard supportive care, patients received cyclophosphamide on days 3 and 4. Beginning on day 5, patients received mycophenolate mofetil through day 35 and sirolimus for 1 full year after transplant.
The antithymocyte globulin induced sickle cell crises in all SCD patients, and one patient developed sirolimus-induced diabetes. One other patient had a worsening of Meniere disease, and another patient developed BK virus cystitis.
Breaking down outcomes by disease type, Dr. Bolaños-Meade said that the one engraftment failure occurred in an SCD patient. Of the remaining 11 engrafted patients, 9 have full donor chimerism, and all but 1 of the 11 are transfusion independent now. The patient who remains transfusion dependent has mixed chimerism and received bone marrow from a donor with major ABO mismatch. Although one of the five beta-thalassemia patients also has mixed chimerism, all are now transfusion independent.
The boost in hemoglobin post-transplant was relatively modest for the beta-thalassemia group, from a median 9.5 to 10.1 g/dL at the most recent visit. However, the pretransplant levels were boosted by transfusions for all patients in this group, Dr. Bolaños-Meade pointed out.
The SCD patients saw their hemoglobin go from a median 8.65 to 11.4 g/dL (P = .001). Median bilirubin for this group dropped from 2.4 to 0.2 mg/dL (P = .002) with the cessation of sickling-related hemolysis; significant improvements were also seen in absolute reticulocyte counts and lactate dehydrogenase levels.
Dr. Bolaños-Meade reported that he is on the data safety monitoring board of Incyte.
SOURCE: Bolaños-Meade J et al. BMT Tandem Meetings, Abstract LBA-3.
SALT LAKE CITY – A nonmyeloablative conditioning regimen with a boosted dose of total body irradiation yielded success for a cohort of patients with severe hemoglobinopathy and haploidentical donors.
Of 17 patients with severe sickle cell disease or beta-thalassemia who received allogeneic bone marrow transplants, all but one had successful engraftment, and 13 have achieved full donor chimerism, said Javier Bolaños-Meade, MD.
“Cure of severe hemoglobinopathies is now possible for most patients,” said Dr. Bolaños-Meade. “It should no longer be considered as available to only a fraction of such patients,” such as those who come with a fully-matched donor and those able to tolerate myeloablative conditioning, he said.
Of the patients who received bone marrow transplants, five patients have stopped immunosuppressive therapy, and all patients are alive, having been followed for a median of 15 months (range, 3-34 months).
The rate of graft versus host disease (GVHD) was low: Two patients developed grade 2 acute GVHD, and one patient developed grade 3 acute GVHD; another three patients had mild to moderate chronic GVHD, but all GVHD has resolved, said Dr. Bolaños-Meade.
Historically, the difficulties with transplant in this population were numerous. “No. 1, it’s very difficult to find an HLA-matched donor,” said Dr. Bolaños-Meade. Also, since there’s no target for graft-versus-tumor effect post-transplant, any amount of chronic GVHD is also high on the list of concerns when considering a transplant for hemoglobinopathy.
“The other problem in this group of patients is their ability to tolerate myeloablation,” he said. The accumulated burden of disease, as well as sequelae of transfusion dependence for some, may make a myeloablative regime too risky.
Dr. Bolaños-Meade said that he and his collaborators at Johns Hopkins University, Baltimore, wanted to be able to address all of these concerns in one regimen. “We were trying to work out a system that may be able to solve all the problems – to use nonmyeloablation and to use whatever donor is available.”
His research group had previously shown that nonmyeloablative transplants were well tolerated in patients with sickle cell disease and that haploidentical donors could be used (Blood. 2012 Nov 22;120[22]:4285-91). “However, we had a very high incidence of graft failure,” Dr. Bolaños-Meade said.
A strategy to increase the engraftment rate while still limiting toxicity, he said, would be to increase the dose of total body irradiation used in the conditioning regimen, from 200 to 400 centigray (cGy); this higher dose was incorporated into the study protocol.
Patients were enrolled if they had severe sickle cell disease (SCD; n = 12) or beta-thalassemia (n = 5).
To enroll in the study, SCD patients had to have been hospitalized at least twice a year in the preceding 2 years. The patients with SCD were a median 26 years of age (range, 6-31 years); four were male, and eight were female. Three of the SCD patients were transfusion dependent, and several had such serious complications as osteonecrosis, brain changes seen in medical imaging, and acute coronary syndrome.
The beta-thalassemia patients were a median 7 years of age (range, 6-16 years); all but one were female, and all had been transfusion dependent since infancy.
Bone marrow donors were not all first degree relatives: There were five mothers, four fathers, four brothers, and three sisters, but also an aunt. Two pairs had major ABO incompatibility, and five had minor ABO incompatibility. Ten were ABO compatible.
The conditioning regimen for all patients involved rabbit antithymocyte globulin, fludarabine, and cyclophosphamide, and then total body irradiation given the day before transplant.
After transplant, in addition to standard supportive care, patients received cyclophosphamide on days 3 and 4. Beginning on day 5, patients received mycophenolate mofetil through day 35 and sirolimus for 1 full year after transplant.
The antithymocyte globulin induced sickle cell crises in all SCD patients, and one patient developed sirolimus-induced diabetes. One other patient had a worsening of Meniere disease, and another patient developed BK virus cystitis.
Breaking down outcomes by disease type, Dr. Bolaños-Meade said that the one engraftment failure occurred in an SCD patient. Of the remaining 11 engrafted patients, 9 have full donor chimerism, and all but 1 of the 11 are transfusion independent now. The patient who remains transfusion dependent has mixed chimerism and received bone marrow from a donor with major ABO mismatch. Although one of the five beta-thalassemia patients also has mixed chimerism, all are now transfusion independent.
The boost in hemoglobin post-transplant was relatively modest for the beta-thalassemia group, from a median 9.5 to 10.1 g/dL at the most recent visit. However, the pretransplant levels were boosted by transfusions for all patients in this group, Dr. Bolaños-Meade pointed out.
The SCD patients saw their hemoglobin go from a median 8.65 to 11.4 g/dL (P = .001). Median bilirubin for this group dropped from 2.4 to 0.2 mg/dL (P = .002) with the cessation of sickling-related hemolysis; significant improvements were also seen in absolute reticulocyte counts and lactate dehydrogenase levels.
Dr. Bolaños-Meade reported that he is on the data safety monitoring board of Incyte.
SOURCE: Bolaños-Meade J et al. BMT Tandem Meetings, Abstract LBA-3.
SALT LAKE CITY – A nonmyeloablative conditioning regimen with a boosted dose of total body irradiation yielded success for a cohort of patients with severe hemoglobinopathy and haploidentical donors.
Of 17 patients with severe sickle cell disease or beta-thalassemia who received allogeneic bone marrow transplants, all but one had successful engraftment, and 13 have achieved full donor chimerism, said Javier Bolaños-Meade, MD.
“Cure of severe hemoglobinopathies is now possible for most patients,” said Dr. Bolaños-Meade. “It should no longer be considered as available to only a fraction of such patients,” such as those who come with a fully-matched donor and those able to tolerate myeloablative conditioning, he said.
Of the patients who received bone marrow transplants, five patients have stopped immunosuppressive therapy, and all patients are alive, having been followed for a median of 15 months (range, 3-34 months).
The rate of graft versus host disease (GVHD) was low: Two patients developed grade 2 acute GVHD, and one patient developed grade 3 acute GVHD; another three patients had mild to moderate chronic GVHD, but all GVHD has resolved, said Dr. Bolaños-Meade.
Historically, the difficulties with transplant in this population were numerous. “No. 1, it’s very difficult to find an HLA-matched donor,” said Dr. Bolaños-Meade. Also, since there’s no target for graft-versus-tumor effect post-transplant, any amount of chronic GVHD is also high on the list of concerns when considering a transplant for hemoglobinopathy.
“The other problem in this group of patients is their ability to tolerate myeloablation,” he said. The accumulated burden of disease, as well as sequelae of transfusion dependence for some, may make a myeloablative regime too risky.
Dr. Bolaños-Meade said that he and his collaborators at Johns Hopkins University, Baltimore, wanted to be able to address all of these concerns in one regimen. “We were trying to work out a system that may be able to solve all the problems – to use nonmyeloablation and to use whatever donor is available.”
His research group had previously shown that nonmyeloablative transplants were well tolerated in patients with sickle cell disease and that haploidentical donors could be used (Blood. 2012 Nov 22;120[22]:4285-91). “However, we had a very high incidence of graft failure,” Dr. Bolaños-Meade said.
A strategy to increase the engraftment rate while still limiting toxicity, he said, would be to increase the dose of total body irradiation used in the conditioning regimen, from 200 to 400 centigray (cGy); this higher dose was incorporated into the study protocol.
Patients were enrolled if they had severe sickle cell disease (SCD; n = 12) or beta-thalassemia (n = 5).
To enroll in the study, SCD patients had to have been hospitalized at least twice a year in the preceding 2 years. The patients with SCD were a median 26 years of age (range, 6-31 years); four were male, and eight were female. Three of the SCD patients were transfusion dependent, and several had such serious complications as osteonecrosis, brain changes seen in medical imaging, and acute coronary syndrome.
The beta-thalassemia patients were a median 7 years of age (range, 6-16 years); all but one were female, and all had been transfusion dependent since infancy.
Bone marrow donors were not all first degree relatives: There were five mothers, four fathers, four brothers, and three sisters, but also an aunt. Two pairs had major ABO incompatibility, and five had minor ABO incompatibility. Ten were ABO compatible.
The conditioning regimen for all patients involved rabbit antithymocyte globulin, fludarabine, and cyclophosphamide, and then total body irradiation given the day before transplant.
After transplant, in addition to standard supportive care, patients received cyclophosphamide on days 3 and 4. Beginning on day 5, patients received mycophenolate mofetil through day 35 and sirolimus for 1 full year after transplant.
The antithymocyte globulin induced sickle cell crises in all SCD patients, and one patient developed sirolimus-induced diabetes. One other patient had a worsening of Meniere disease, and another patient developed BK virus cystitis.
Breaking down outcomes by disease type, Dr. Bolaños-Meade said that the one engraftment failure occurred in an SCD patient. Of the remaining 11 engrafted patients, 9 have full donor chimerism, and all but 1 of the 11 are transfusion independent now. The patient who remains transfusion dependent has mixed chimerism and received bone marrow from a donor with major ABO mismatch. Although one of the five beta-thalassemia patients also has mixed chimerism, all are now transfusion independent.
The boost in hemoglobin post-transplant was relatively modest for the beta-thalassemia group, from a median 9.5 to 10.1 g/dL at the most recent visit. However, the pretransplant levels were boosted by transfusions for all patients in this group, Dr. Bolaños-Meade pointed out.
The SCD patients saw their hemoglobin go from a median 8.65 to 11.4 g/dL (P = .001). Median bilirubin for this group dropped from 2.4 to 0.2 mg/dL (P = .002) with the cessation of sickling-related hemolysis; significant improvements were also seen in absolute reticulocyte counts and lactate dehydrogenase levels.
Dr. Bolaños-Meade reported that he is on the data safety monitoring board of Incyte.
SOURCE: Bolaños-Meade J et al. BMT Tandem Meetings, Abstract LBA-3.
REPORTING FROM THE 2018 BMT TANDEM MEETINGS
Key clinical point:
Major finding: Of the 17 patients who received haploidentical bone marrow transplant, 13 have achieved full chimerism.
Study details: Report of 17 consecutive patients with severe sickle cell disease or beta-thalassemia who received nonmyeloablative conditioning and bone marrow transplant from haploidentical donors.
Disclosures: Dr. Bolaños-Meade reported no outside sources of funding for the study. He is on the data safety monitoring board of Incyte.
Source: Bolaños-Meade J et al. 2018 BMT Tandem Meetings, Abstract LBA-3.
Consider steroid-induced hypertension when treating pediatric ALL
Nearly 15% of children undergoing induction therapy for acute lymphoblastic leukemia (ALL) developed and were treated for steroid-induced hypertension, according to a study conducted by researchers at the Ohio State University in Columbus.
Ian Bakk and his associates performed a retrospective review of data from the Pediatric Health Information System, a database of the Child Health Corporation of America consisting of inpatient information from 40 free-standing children’s hospitals in the United States. They looked at new cases of ALL from the period of 2009-2013 and analyzed data from 5,578 children who received induction chemotherapy for ALL. In all, .
An adjusted regression analysis showed that infants less than 1 year of age had the highest odds of developing steroid-induced hypertension (adjusted odds ratio, 4.05), followed by children with abnormal glucose (aOR, 2.09), those with secondary diabetes mellitus (aOR, 1.67), and obese patients (aOR, 1.63).
“These findings can help physicians identify patients at high risk for [hypertension] at the time of ALL diagnosis,” the researchers wrote.
SOURCE: Bakk, I et al. Am J Pediatr Hematol Oncol. 2018;40:27-30.
Nearly 15% of children undergoing induction therapy for acute lymphoblastic leukemia (ALL) developed and were treated for steroid-induced hypertension, according to a study conducted by researchers at the Ohio State University in Columbus.
Ian Bakk and his associates performed a retrospective review of data from the Pediatric Health Information System, a database of the Child Health Corporation of America consisting of inpatient information from 40 free-standing children’s hospitals in the United States. They looked at new cases of ALL from the period of 2009-2013 and analyzed data from 5,578 children who received induction chemotherapy for ALL. In all, .
An adjusted regression analysis showed that infants less than 1 year of age had the highest odds of developing steroid-induced hypertension (adjusted odds ratio, 4.05), followed by children with abnormal glucose (aOR, 2.09), those with secondary diabetes mellitus (aOR, 1.67), and obese patients (aOR, 1.63).
“These findings can help physicians identify patients at high risk for [hypertension] at the time of ALL diagnosis,” the researchers wrote.
SOURCE: Bakk, I et al. Am J Pediatr Hematol Oncol. 2018;40:27-30.
Nearly 15% of children undergoing induction therapy for acute lymphoblastic leukemia (ALL) developed and were treated for steroid-induced hypertension, according to a study conducted by researchers at the Ohio State University in Columbus.
Ian Bakk and his associates performed a retrospective review of data from the Pediatric Health Information System, a database of the Child Health Corporation of America consisting of inpatient information from 40 free-standing children’s hospitals in the United States. They looked at new cases of ALL from the period of 2009-2013 and analyzed data from 5,578 children who received induction chemotherapy for ALL. In all, .
An adjusted regression analysis showed that infants less than 1 year of age had the highest odds of developing steroid-induced hypertension (adjusted odds ratio, 4.05), followed by children with abnormal glucose (aOR, 2.09), those with secondary diabetes mellitus (aOR, 1.67), and obese patients (aOR, 1.63).
“These findings can help physicians identify patients at high risk for [hypertension] at the time of ALL diagnosis,” the researchers wrote.
SOURCE: Bakk, I et al. Am J Pediatr Hematol Oncol. 2018;40:27-30.
Intramuscular steroid injection reduced hip OA pain up to 12 weeks
Systemic treatment with an intramuscular glucocorticoid injection is effective, compared with placebo, in reducing pain in people with hip osteoarthritis for up to 12 weeks, a double-blinded, placebo-controlled, randomized trial suggests.
However, the study found benefit with intramuscular (IM) glucocorticoid injection at 2 weeks only when patients were at rest, and did not find any significant benefit with the injection in reducing pain while walking or in reducing Western Ontario and McMaster University Osteoarthritis Index (WOMAC) pain subscale scores. The report was published in Annals of the Rheumatic Diseases.
The multicenter, double-blinded, superiority trial randomized 106 patients with painful hip OA who were not responding to oral analgesics to either 40 mg triamcinolone acetate (n = 52) or placebo injection (n = 54) into the gluteus muscle. Overall, 73 patients (68%) were women, and the average age of the cohort was 64 years. Hip OA symptoms had occurred for at least 1 year in 70% of the patients.
The study’s three primary outcomes of hip pain severity 2 weeks after the injection on a 0-10 scale at rest and during walking and on the WOMAC pain subscale revealed inconsistent results with the treatment.
At the 2-week follow-up, patients who had received the IM glucocorticoid injection had a significant and clinically relevant difference in hip pain at rest (between-group difference = –1.3; 95% confidence interval, –2.3 to –0.3; P = .01). But at this time point there were no significant associations between glucocorticoid injection and hip pain during walking (difference = –0.9; 95% CI, –1.9 to 0.1; P = .07) and WOMAC pain subscale score (difference = –6.1; 95% CI, –13.4 to 1.2; P = .10), the researchers reported.
At 2-week follow-up, recipients of the glucocorticoid injection were significantly more likely to perceive improvement (relative risk = 1.7; 95% CI, 1.1 to 2.7; P = .02) or achieve OMERACT-OARSI level of response (RR = 2.0; 95% CI, 1.1 to 3.6; P = .03).
The authors described this finding as “surprising,” speculating that the 7-point Likert scale used to measure perceived improvement could have resulted in less power.
Nineteen patients in the glucocorticoid group reported 27 nonserious adverse events, compared with 13 patients in the placebo group who reported 18 adverse events.
The authors said the greatest effects of the glucocorticoid injection were seen at 4- to 12-week follow-up (the secondary outcomes of the study), instead of at the 2-week follow-up. For example, at 4-week follow-up, the glucocorticoid injection was associated with a significant hip pain reduction at rest (between-group difference = –1.2; 95% CI, –2.1 to –0.2; P = .01) and during walking (difference = –1.1; 95% CI, –2.0 to –0.2; P = .01). At 6 weeks, the corresponding figures for hip pain reduction were –1.4 at rest (95% CI, –2.4 to –0.5; P = .005) and –1.4 while walking (95% CI, –2.3 to –0.4; P = .004). The between-group differences were still significant at 12 weeks while at rest (difference = –1.2; 95% CI, –2.3 to –0.2; P = .02) and during walking (difference = –1.3; 95% CI, –2.2 to –0.3; P = .01).
Significant differences in favor of the glucocorticoid injection overall occurred on the WOMAC subscale scores for pain, function, and stiffness, as well as total Hip disability and Osteoarthritis Outcome Score for pain and total, intermittent, and constant pain measures on the Intermittent and Constant Osteoarthritis Pain scale. At 12 weeks, the between-group difference on the WOMAC total score was –9.4 (95% CI, –17.8 to –0.9; P = .03).
The researchers said it was surprising that hip pain reduction after IM glucocorticoid injection was still present at a similar degree at 12 weeks since previous studies had shown the effect usually peaked after 1-3 weeks.
“Our findings should be replicated in future research,” they said.
“An IM glucocorticoid injection showed effectiveness in patients with hip OA on one of the three primary outcomes at a 2 weeks post injection ... The effect is probably clinically relevant,” the authors concluded.
The investigators noted that in clinical practice patients are sometimes offered multiple injections per year, whereas in the current study patients received only one injection. There has also been concern that intra-articular glucocorticoid injections could cause toxicity to chondrocytes and potentially lead to OA progression, but the effect of a single IM injection is unknown.
Financial support for the study came from the Dutch Arthritis Foundation and the NutsOhra fund. Two of the authors reported receiving grants from several pharmaceutical companies, research consortia, and foundations.
SOURCE: Dorleijn D et al. Ann Rheum Dis. 2018 March 7. doi: 10.1136/annrheumdis-2017-212628
Systemic treatment with an intramuscular glucocorticoid injection is effective, compared with placebo, in reducing pain in people with hip osteoarthritis for up to 12 weeks, a double-blinded, placebo-controlled, randomized trial suggests.
However, the study found benefit with intramuscular (IM) glucocorticoid injection at 2 weeks only when patients were at rest, and did not find any significant benefit with the injection in reducing pain while walking or in reducing Western Ontario and McMaster University Osteoarthritis Index (WOMAC) pain subscale scores. The report was published in Annals of the Rheumatic Diseases.
The multicenter, double-blinded, superiority trial randomized 106 patients with painful hip OA who were not responding to oral analgesics to either 40 mg triamcinolone acetate (n = 52) or placebo injection (n = 54) into the gluteus muscle. Overall, 73 patients (68%) were women, and the average age of the cohort was 64 years. Hip OA symptoms had occurred for at least 1 year in 70% of the patients.
The study’s three primary outcomes of hip pain severity 2 weeks after the injection on a 0-10 scale at rest and during walking and on the WOMAC pain subscale revealed inconsistent results with the treatment.
At the 2-week follow-up, patients who had received the IM glucocorticoid injection had a significant and clinically relevant difference in hip pain at rest (between-group difference = –1.3; 95% confidence interval, –2.3 to –0.3; P = .01). But at this time point there were no significant associations between glucocorticoid injection and hip pain during walking (difference = –0.9; 95% CI, –1.9 to 0.1; P = .07) and WOMAC pain subscale score (difference = –6.1; 95% CI, –13.4 to 1.2; P = .10), the researchers reported.
At 2-week follow-up, recipients of the glucocorticoid injection were significantly more likely to perceive improvement (relative risk = 1.7; 95% CI, 1.1 to 2.7; P = .02) or achieve OMERACT-OARSI level of response (RR = 2.0; 95% CI, 1.1 to 3.6; P = .03).
The authors described this finding as “surprising,” speculating that the 7-point Likert scale used to measure perceived improvement could have resulted in less power.
Nineteen patients in the glucocorticoid group reported 27 nonserious adverse events, compared with 13 patients in the placebo group who reported 18 adverse events.
The authors said the greatest effects of the glucocorticoid injection were seen at 4- to 12-week follow-up (the secondary outcomes of the study), instead of at the 2-week follow-up. For example, at 4-week follow-up, the glucocorticoid injection was associated with a significant hip pain reduction at rest (between-group difference = –1.2; 95% CI, –2.1 to –0.2; P = .01) and during walking (difference = –1.1; 95% CI, –2.0 to –0.2; P = .01). At 6 weeks, the corresponding figures for hip pain reduction were –1.4 at rest (95% CI, –2.4 to –0.5; P = .005) and –1.4 while walking (95% CI, –2.3 to –0.4; P = .004). The between-group differences were still significant at 12 weeks while at rest (difference = –1.2; 95% CI, –2.3 to –0.2; P = .02) and during walking (difference = –1.3; 95% CI, –2.2 to –0.3; P = .01).
Significant differences in favor of the glucocorticoid injection overall occurred on the WOMAC subscale scores for pain, function, and stiffness, as well as total Hip disability and Osteoarthritis Outcome Score for pain and total, intermittent, and constant pain measures on the Intermittent and Constant Osteoarthritis Pain scale. At 12 weeks, the between-group difference on the WOMAC total score was –9.4 (95% CI, –17.8 to –0.9; P = .03).
The researchers said it was surprising that hip pain reduction after IM glucocorticoid injection was still present at a similar degree at 12 weeks since previous studies had shown the effect usually peaked after 1-3 weeks.
“Our findings should be replicated in future research,” they said.
“An IM glucocorticoid injection showed effectiveness in patients with hip OA on one of the three primary outcomes at a 2 weeks post injection ... The effect is probably clinically relevant,” the authors concluded.
The investigators noted that in clinical practice patients are sometimes offered multiple injections per year, whereas in the current study patients received only one injection. There has also been concern that intra-articular glucocorticoid injections could cause toxicity to chondrocytes and potentially lead to OA progression, but the effect of a single IM injection is unknown.
Financial support for the study came from the Dutch Arthritis Foundation and the NutsOhra fund. Two of the authors reported receiving grants from several pharmaceutical companies, research consortia, and foundations.
SOURCE: Dorleijn D et al. Ann Rheum Dis. 2018 March 7. doi: 10.1136/annrheumdis-2017-212628
Systemic treatment with an intramuscular glucocorticoid injection is effective, compared with placebo, in reducing pain in people with hip osteoarthritis for up to 12 weeks, a double-blinded, placebo-controlled, randomized trial suggests.
However, the study found benefit with intramuscular (IM) glucocorticoid injection at 2 weeks only when patients were at rest, and did not find any significant benefit with the injection in reducing pain while walking or in reducing Western Ontario and McMaster University Osteoarthritis Index (WOMAC) pain subscale scores. The report was published in Annals of the Rheumatic Diseases.
The multicenter, double-blinded, superiority trial randomized 106 patients with painful hip OA who were not responding to oral analgesics to either 40 mg triamcinolone acetate (n = 52) or placebo injection (n = 54) into the gluteus muscle. Overall, 73 patients (68%) were women, and the average age of the cohort was 64 years. Hip OA symptoms had occurred for at least 1 year in 70% of the patients.
The study’s three primary outcomes of hip pain severity 2 weeks after the injection on a 0-10 scale at rest and during walking and on the WOMAC pain subscale revealed inconsistent results with the treatment.
At the 2-week follow-up, patients who had received the IM glucocorticoid injection had a significant and clinically relevant difference in hip pain at rest (between-group difference = –1.3; 95% confidence interval, –2.3 to –0.3; P = .01). But at this time point there were no significant associations between glucocorticoid injection and hip pain during walking (difference = –0.9; 95% CI, –1.9 to 0.1; P = .07) and WOMAC pain subscale score (difference = –6.1; 95% CI, –13.4 to 1.2; P = .10), the researchers reported.
At 2-week follow-up, recipients of the glucocorticoid injection were significantly more likely to perceive improvement (relative risk = 1.7; 95% CI, 1.1 to 2.7; P = .02) or achieve OMERACT-OARSI level of response (RR = 2.0; 95% CI, 1.1 to 3.6; P = .03).
The authors described this finding as “surprising,” speculating that the 7-point Likert scale used to measure perceived improvement could have resulted in less power.
Nineteen patients in the glucocorticoid group reported 27 nonserious adverse events, compared with 13 patients in the placebo group who reported 18 adverse events.
The authors said the greatest effects of the glucocorticoid injection were seen at 4- to 12-week follow-up (the secondary outcomes of the study), instead of at the 2-week follow-up. For example, at 4-week follow-up, the glucocorticoid injection was associated with a significant hip pain reduction at rest (between-group difference = –1.2; 95% CI, –2.1 to –0.2; P = .01) and during walking (difference = –1.1; 95% CI, –2.0 to –0.2; P = .01). At 6 weeks, the corresponding figures for hip pain reduction were –1.4 at rest (95% CI, –2.4 to –0.5; P = .005) and –1.4 while walking (95% CI, –2.3 to –0.4; P = .004). The between-group differences were still significant at 12 weeks while at rest (difference = –1.2; 95% CI, –2.3 to –0.2; P = .02) and during walking (difference = –1.3; 95% CI, –2.2 to –0.3; P = .01).
Significant differences in favor of the glucocorticoid injection overall occurred on the WOMAC subscale scores for pain, function, and stiffness, as well as total Hip disability and Osteoarthritis Outcome Score for pain and total, intermittent, and constant pain measures on the Intermittent and Constant Osteoarthritis Pain scale. At 12 weeks, the between-group difference on the WOMAC total score was –9.4 (95% CI, –17.8 to –0.9; P = .03).
The researchers said it was surprising that hip pain reduction after IM glucocorticoid injection was still present at a similar degree at 12 weeks since previous studies had shown the effect usually peaked after 1-3 weeks.
“Our findings should be replicated in future research,” they said.
“An IM glucocorticoid injection showed effectiveness in patients with hip OA on one of the three primary outcomes at a 2 weeks post injection ... The effect is probably clinically relevant,” the authors concluded.
The investigators noted that in clinical practice patients are sometimes offered multiple injections per year, whereas in the current study patients received only one injection. There has also been concern that intra-articular glucocorticoid injections could cause toxicity to chondrocytes and potentially lead to OA progression, but the effect of a single IM injection is unknown.
Financial support for the study came from the Dutch Arthritis Foundation and the NutsOhra fund. Two of the authors reported receiving grants from several pharmaceutical companies, research consortia, and foundations.
SOURCE: Dorleijn D et al. Ann Rheum Dis. 2018 March 7. doi: 10.1136/annrheumdis-2017-212628
FROM ANNALS OF THE RHEUMATIC DISEASES
Key clinical point:
Major finding: At 2 weeks, patients who had received the intramuscular glucocorticoid injection had a significant and clinically relevant difference in hip pain at rest (between-group difference = –1.3; 95% CI, –2.3 to –0.3; P = .01).
Study details: A 12-week, double blinded, placebo-controlled trial of 106 patients with hip OA randomized to 40 mg triamcinolone acetate or placebo injection.
Disclosures: Financial support for the study came from the Dutch Arthritis Foundation and the NutsOhra fund. Two of the authors reported receiving grants from several pharmaceutical companies, research consortia, and foundations.
Source: Dorleijn D et al. Ann Rheum Dis. 2018 Mar 7. doi: 10.1136/annrheumdis-2017-212628.
Swamp coolers not linked to dust mite sensitization in atopic children
ORLANDO – Swamp coolers – a low-cost alternative to air-conditioning in dry regions – weren’t found to increase sensitization to house dust mites or mold in atopic pediatric patients, researchers reported.
Neema Izadi, MD, and his associates say the findings, seen in a pediatric Colorado population in a study evaluating data over 10 years, could mean that not everyone at risk of dust mite and mold sensitization needs to avoid these cooling systems.
“Evaporative coolers have been shown to raise relative humidity by about 10%,” said Dr. Izadi, a pediatric allergy and immunology fellow at National Jewish Health, Denver, presenting at the joint congress of the American Academy of Asthma, Allergy and Immunology and the World Asthma Organization. “They work best in environments where the air is very warm and dry.”
House dust mites and mold thrive in higher humidity. Small studies performed in Colorado, Utah, and other locations have shown that the swamp coolers increase house dust mite allergen content, but there have been very few studies that have looked at actual sensitization. One smaller study in Nevada did find that the coolers increased sensitization to dust mites and mold.
In this study – thought to be the largest ever to look at this question – Dr. Izadi and his colleagues assessed data on patients aged 21 years and younger who were seen at National Jewish Health during 2008-2017 and who had at least one positive environmental skin-prick test. The average age was about 9 years. The cohort included 8,503 patients with sensitization to house dust mites and 9,286 with sensitization to mold. Researchers examined data on swamp coolers in their homes.
The researchers found that 29% of those with swamp coolers were dust-mite positive on skin testing, and 28% of those without one were positive. This was not a significant difference (P = .85). They found that 45% of those with the coolers were positive for sensitization to any mold, compared with 44% without one – also not a significant difference (P = .43).
They also found no difference according to age group, sex, or individually for atopic dermatitis, asthma, or allergic rhinitis.
He acknowledged that the study had no way to reliably account for patients who were transplants to Colorado, having moved there from somewhere else. The study also didn’t examine the age of homes, whether it had carpeting, or other factors.
He noted that the amount of time the coolers were run in the home was not examined and that “it might matter how much it is on.” This, he said, might account for differences in these results, compared with the Nevada study that did find a sensitization increase cause by the coolers.
“Evaporative coolers or swamp coolers are a great low-cost alternative in semiarid and arid environments – they can cut costs from 15%-35%,” Dr. Izadi said. “These data may indicate that it may be unnecessary to recommend that patients remove their swamp cooler, at least from a dust-mite and mold-sensitization standpoint.”
Dr. Izadi had no relevant financial disclosures.
SOURCE: Izadi N et al. AAAAI/WAO Joint Congress, Abstract 586
Susan Millard, MD, FCCP, comments: Swamp coolers are used in semi-arid and arid climates like Arizona, where I did my fellowship training but they didn't work well to keep apartments and homes cool enough if over about 100°F outside! The system is cheaper than air conditioning. So it is great to know that this type of cooling system does not cause more mold and dust mite allergies.
Susan Millard, MD, FCCP, comments: Swamp coolers are used in semi-arid and arid climates like Arizona, where I did my fellowship training but they didn't work well to keep apartments and homes cool enough if over about 100°F outside! The system is cheaper than air conditioning. So it is great to know that this type of cooling system does not cause more mold and dust mite allergies.
Susan Millard, MD, FCCP, comments: Swamp coolers are used in semi-arid and arid climates like Arizona, where I did my fellowship training but they didn't work well to keep apartments and homes cool enough if over about 100°F outside! The system is cheaper than air conditioning. So it is great to know that this type of cooling system does not cause more mold and dust mite allergies.
ORLANDO – Swamp coolers – a low-cost alternative to air-conditioning in dry regions – weren’t found to increase sensitization to house dust mites or mold in atopic pediatric patients, researchers reported.
Neema Izadi, MD, and his associates say the findings, seen in a pediatric Colorado population in a study evaluating data over 10 years, could mean that not everyone at risk of dust mite and mold sensitization needs to avoid these cooling systems.
“Evaporative coolers have been shown to raise relative humidity by about 10%,” said Dr. Izadi, a pediatric allergy and immunology fellow at National Jewish Health, Denver, presenting at the joint congress of the American Academy of Asthma, Allergy and Immunology and the World Asthma Organization. “They work best in environments where the air is very warm and dry.”
House dust mites and mold thrive in higher humidity. Small studies performed in Colorado, Utah, and other locations have shown that the swamp coolers increase house dust mite allergen content, but there have been very few studies that have looked at actual sensitization. One smaller study in Nevada did find that the coolers increased sensitization to dust mites and mold.
In this study – thought to be the largest ever to look at this question – Dr. Izadi and his colleagues assessed data on patients aged 21 years and younger who were seen at National Jewish Health during 2008-2017 and who had at least one positive environmental skin-prick test. The average age was about 9 years. The cohort included 8,503 patients with sensitization to house dust mites and 9,286 with sensitization to mold. Researchers examined data on swamp coolers in their homes.
The researchers found that 29% of those with swamp coolers were dust-mite positive on skin testing, and 28% of those without one were positive. This was not a significant difference (P = .85). They found that 45% of those with the coolers were positive for sensitization to any mold, compared with 44% without one – also not a significant difference (P = .43).
They also found no difference according to age group, sex, or individually for atopic dermatitis, asthma, or allergic rhinitis.
He acknowledged that the study had no way to reliably account for patients who were transplants to Colorado, having moved there from somewhere else. The study also didn’t examine the age of homes, whether it had carpeting, or other factors.
He noted that the amount of time the coolers were run in the home was not examined and that “it might matter how much it is on.” This, he said, might account for differences in these results, compared with the Nevada study that did find a sensitization increase cause by the coolers.
“Evaporative coolers or swamp coolers are a great low-cost alternative in semiarid and arid environments – they can cut costs from 15%-35%,” Dr. Izadi said. “These data may indicate that it may be unnecessary to recommend that patients remove their swamp cooler, at least from a dust-mite and mold-sensitization standpoint.”
Dr. Izadi had no relevant financial disclosures.
SOURCE: Izadi N et al. AAAAI/WAO Joint Congress, Abstract 586
ORLANDO – Swamp coolers – a low-cost alternative to air-conditioning in dry regions – weren’t found to increase sensitization to house dust mites or mold in atopic pediatric patients, researchers reported.
Neema Izadi, MD, and his associates say the findings, seen in a pediatric Colorado population in a study evaluating data over 10 years, could mean that not everyone at risk of dust mite and mold sensitization needs to avoid these cooling systems.
“Evaporative coolers have been shown to raise relative humidity by about 10%,” said Dr. Izadi, a pediatric allergy and immunology fellow at National Jewish Health, Denver, presenting at the joint congress of the American Academy of Asthma, Allergy and Immunology and the World Asthma Organization. “They work best in environments where the air is very warm and dry.”
House dust mites and mold thrive in higher humidity. Small studies performed in Colorado, Utah, and other locations have shown that the swamp coolers increase house dust mite allergen content, but there have been very few studies that have looked at actual sensitization. One smaller study in Nevada did find that the coolers increased sensitization to dust mites and mold.
In this study – thought to be the largest ever to look at this question – Dr. Izadi and his colleagues assessed data on patients aged 21 years and younger who were seen at National Jewish Health during 2008-2017 and who had at least one positive environmental skin-prick test. The average age was about 9 years. The cohort included 8,503 patients with sensitization to house dust mites and 9,286 with sensitization to mold. Researchers examined data on swamp coolers in their homes.
The researchers found that 29% of those with swamp coolers were dust-mite positive on skin testing, and 28% of those without one were positive. This was not a significant difference (P = .85). They found that 45% of those with the coolers were positive for sensitization to any mold, compared with 44% without one – also not a significant difference (P = .43).
They also found no difference according to age group, sex, or individually for atopic dermatitis, asthma, or allergic rhinitis.
He acknowledged that the study had no way to reliably account for patients who were transplants to Colorado, having moved there from somewhere else. The study also didn’t examine the age of homes, whether it had carpeting, or other factors.
He noted that the amount of time the coolers were run in the home was not examined and that “it might matter how much it is on.” This, he said, might account for differences in these results, compared with the Nevada study that did find a sensitization increase cause by the coolers.
“Evaporative coolers or swamp coolers are a great low-cost alternative in semiarid and arid environments – they can cut costs from 15%-35%,” Dr. Izadi said. “These data may indicate that it may be unnecessary to recommend that patients remove their swamp cooler, at least from a dust-mite and mold-sensitization standpoint.”
Dr. Izadi had no relevant financial disclosures.
SOURCE: Izadi N et al. AAAAI/WAO Joint Congress, Abstract 586
REPORTING FROM AAAAI/WAO JOINT CONGRESS
Key clinical point:
Major finding: Researchers found that 29% of those with swamp coolers were dust-mite positive on skin testing, and 28% of those without one were as well. This was not a significant difference (P = .85).
Study details: A retrospective review of more than 17,000 cases of atopic children aged 21 years and younger who were seen at National Jewish Health and had a positive environmental skin prick test.
Disclosures: Dr. Izadi had no relevant financial disclosures.
Source: Izadi N et al. AAAAI/WAO Joint Congress, Abstract 586
MDedge Daily News: Have ‘The Talk’ about medical marijuana
, uniformity comes to inflammatory bowel disease severity, diabetes drives the nation’s drug bills, and there’s pushback against new blood sugar targets.
Listen to the MDedge Daily News podcast for all the details on today’s top news.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
, uniformity comes to inflammatory bowel disease severity, diabetes drives the nation’s drug bills, and there’s pushback against new blood sugar targets.
Listen to the MDedge Daily News podcast for all the details on today’s top news.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
, uniformity comes to inflammatory bowel disease severity, diabetes drives the nation’s drug bills, and there’s pushback against new blood sugar targets.
Listen to the MDedge Daily News podcast for all the details on today’s top news.
