Immunology

Lower respiratory illness in childhood is associated with later development of asthma and wheezing that can persist into adulthood, and may be a risk factor for adult chronic obstructive pulmonary disease (COPD), a prospective study has found.

Researchers assessed the lung function of 646 children – 338 of whom had experienced lower respiratory illness before age 3 years, and 308 controls – and found those who had early pneumonia had a nearly twofold increase in the risk of asthma and wheeze up to age 26 years.

They also had the most severe subsequent deficits in lung function, while those with early non-pneumonia lower respiratory illness had smaller but still significant impairments in lung function and increased risk of wheezing, according to a paper published online in Pediatrics (2015;135:607-15 [10.1542/peds.2014-3060]).

“Because there is considerable evidence that asthma associated with airflow limitation is a strong risk factor for subsequent chronic obstructive pulmonary disease, the prevention of early-life pneumonia and of the factors that determine low lung function in infancy may contribute significantly to decrease the public health burden of chronic obstructive pulmonary disease,” wrote Dr. Johnny Y.C. Chan of the Kwong Wah Hospital, Hong Kong, and his associates.

The study was funded by the National Institutes of Health, and no conflicts of interest were declared.

Lower respiratory illness in childhood is associated with later development of asthma and wheezing that can persist into adulthood, and may be a risk factor for adult chronic obstructive pulmonary disease (COPD), a prospective study has found.

Researchers assessed the lung function of 646 children – 338 of whom had experienced lower respiratory illness before age 3 years, and 308 controls – and found those who had early pneumonia had a nearly twofold increase in the risk of asthma and wheeze up to age 26 years.

They also had the most severe subsequent deficits in lung function, while those with early non-pneumonia lower respiratory illness had smaller but still significant impairments in lung function and increased risk of wheezing, according to a paper published online in Pediatrics (2015;135:607-15 [10.1542/peds.2014-3060]).

“Because there is considerable evidence that asthma associated with airflow limitation is a strong risk factor for subsequent chronic obstructive pulmonary disease, the prevention of early-life pneumonia and of the factors that determine low lung function in infancy may contribute significantly to decrease the public health burden of chronic obstructive pulmonary disease,” wrote Dr. Johnny Y.C. Chan of the Kwong Wah Hospital, Hong Kong, and his associates.

The study was funded by the National Institutes of Health, and no conflicts of interest were declared.

Lower respiratory illness in childhood is associated with later development of asthma and wheezing that can persist into adulthood, and may be a risk factor for adult chronic obstructive pulmonary disease (COPD), a prospective study has found.

Researchers assessed the lung function of 646 children – 338 of whom had experienced lower respiratory illness before age 3 years, and 308 controls – and found those who had early pneumonia had a nearly twofold increase in the risk of asthma and wheeze up to age 26 years.

They also had the most severe subsequent deficits in lung function, while those with early non-pneumonia lower respiratory illness had smaller but still significant impairments in lung function and increased risk of wheezing, according to a paper published online in Pediatrics (2015;135:607-15 [10.1542/peds.2014-3060]).

“Because there is considerable evidence that asthma associated with airflow limitation is a strong risk factor for subsequent chronic obstructive pulmonary disease, the prevention of early-life pneumonia and of the factors that determine low lung function in infancy may contribute significantly to decrease the public health burden of chronic obstructive pulmonary disease,” wrote Dr. Johnny Y.C. Chan of the Kwong Wah Hospital, Hong Kong, and his associates.

The study was funded by the National Institutes of Health, and no conflicts of interest were declared.

A customized vaccine targeting patient-specific, tumor neoantigens evoked an immune response in three adults with advanced cutaneous melanoma in a proof-of-principle study that paves the way for a phase I trial.

The data are “too premature to conclude that the treatment had any therapeutic benefit to the patients,” Dr. Gerald P. Linette of Washington University in St. Louis, Mo., said in a teleconference. However, he noted that a phase I trial would likely begin within the next 9-12 months.

“Our primary goal was to see if this was safe, and if we could elicit an immune response,” Dr. Linette said.

Vaccination not only augmented T-cell immunity directed against naturally occurring, dominant tumor neoantigens, but also expanded the breadth of the immune response by revealing additional subdominant neoantigens, lead author Beatriz M. Carreno, Ph.D., of Washington University in St. Louis and her associates reported online April 2 in Science (doi:10.1126/science.aaa3828).

All three patients had stage IIIC, resected, cutaneous melanoma and had failed prior therapy with ipilimumab (Yervoy).

C. Bickel, Science

Some melanoma patients harbor tumor missense mutations, translated into amino acid substitutions (AAS). These mutations are thought to produce antigens that the immune system perceives as foreign, prompting a tumor-specific T-cell response. Heretofore, there has been no systematic evaluation of these neoantigens or whether vaccination can enhance these responses.

The aim of the current study was to determine the safety, tolerability, and immunologic responses to AAS peptides inside a modified dendritic cell vaccine. Seven AAS peptide candidates were selected among validated HLA-A*02:01 binders, along with the melanoma peptides G209-2M and G280-9V as positive controls for vaccination.

In each patient, T cell immunity to one AAS peptide was detected in prevaccine peripheral blood mononuclear cell samples.

The treatment differs from other personalized cancer vaccines in two key ways, Dr. Carreno said in the teleconference.

“We mature the [dendritic] cells before we give them back to the patients; the cells make growth factors that we have previously shown are important to the generation of the immune response,” she said. In addition, the vaccine was given as an infusion, rather than an injection, she noted.

Vaccination augmented the T-cell response to the three neoantigens – TMEM48 F169L, SEC24A P469, EXOC8 Q656P – with observed frequencies of 23%, 64%, and 89%, respectively.

Immune monitoring also detected T-cell immunity to two additional neoantigens per patient, Dr. Carreno and her associates reported.

Robust immune responses were detected as early as week 2 and peaked at weeks 8-9 after the initial dose. Each patient received three vaccine doses, without side effects or toxicity.

“Vaccination against tumor antigens appears safe as all three patients are alive and well, with no autoimmune adverse events,” the researchers wrote. Post vaccine restaging CT revealed stable disease in a 54-year-old man with BRAF V6003 mutation-positive melanoma. A second man, who had achieved a complete response to ipilimumab for BRAF V6003-positive disease, remains in complete remission after receiving the vaccine in the adjuvant setting.

The vaccine induced 30% tumor reduction in a woman with extensive skin metastases and 5-12 mm lung nodules after ipilimumab and vemurafenib (Zelboraf), but tumor size returned back to baseline dimensions 12 weeks later with no new disease sites. Her disease has remained stable for the past 8 months, the researchers said.

However, it is too soon to attribute a clinical benefit to the observed immune response to the vaccine, Dr. Linette emphasized. “I would be speculating if I said the vaccine had any benefit to the patients,” he said.

Vaccination increased the frequency of most existing prevaccine T-cell receptor-beta (TCR-beta) clonotypes and revealed new clonotypes for 6 neoantigens.

For both dominant and subdominant neoantigens, the TCR-beta repertoire was increased significantly after vaccination. For example, 84 clonotypes representing 19 TCR-beta families were detected for TKT R438W, 61 clonotypes representing 12 TCR-beta families were detected for SEC24A P469L, and 12 clonotypes representing 8 TCR-beta families were detected for EXOC8 Q656P.

“The revelation of a highly diverse TCR-beta repertoire specific for dominant and subdominant neoantigens was surprising and points to a potentially rich pool of naive tumor-specific T cells that remain ignorant unless activated by vaccination,” the researchers wrote.

Recent data indicate that CTLA-4 monoclonal antibody use can alter TCR repertoire diversity in patients, suggesting a potential strategy of combination checkpoint inhibitors, including ipilimumab, and neoantigen vaccines. The novel vaccine strategy also could be used to treat other malignancies with high mutational burdens such as lung, bladder, and colorectal cancers, while other genomic alterations may generate potential neoantigens relevant in low–mutational burden cancers such as leukemia, the authors suggest.

Although the cells in this study were grown in a specialized laboratory, “as the technology improves, I think this [strategy] will become reproducible and available at other medical centers,” Dr. Linette said.

This work was supported by Barnes-Jewish Hospital Foundation, Siteman Cancer Frontier Fund, Our Mark on Melanoma (MOM) Foundation, Come Out Swinging (COS) Foundation, Blackout Melanoma Foundation and the National Cancer Institute.

Heidi Splete contributed to this story.

A customized vaccine targeting patient-specific, tumor neoantigens evoked an immune response in three adults with advanced cutaneous melanoma in a proof-of-principle study that paves the way for a phase I trial.

The data are “too premature to conclude that the treatment had any therapeutic benefit to the patients,” Dr. Gerald P. Linette of Washington University in St. Louis, Mo., said in a teleconference. However, he noted that a phase I trial would likely begin within the next 9-12 months.

“Our primary goal was to see if this was safe, and if we could elicit an immune response,” Dr. Linette said.

Vaccination not only augmented T-cell immunity directed against naturally occurring, dominant tumor neoantigens, but also expanded the breadth of the immune response by revealing additional subdominant neoantigens, lead author Beatriz M. Carreno, Ph.D., of Washington University in St. Louis and her associates reported online April 2 in Science (doi:10.1126/science.aaa3828).

All three patients had stage IIIC, resected, cutaneous melanoma and had failed prior therapy with ipilimumab (Yervoy).

C. Bickel, Science

Some melanoma patients harbor tumor missense mutations, translated into amino acid substitutions (AAS). These mutations are thought to produce antigens that the immune system perceives as foreign, prompting a tumor-specific T-cell response. Heretofore, there has been no systematic evaluation of these neoantigens or whether vaccination can enhance these responses.

The aim of the current study was to determine the safety, tolerability, and immunologic responses to AAS peptides inside a modified dendritic cell vaccine. Seven AAS peptide candidates were selected among validated HLA-A*02:01 binders, along with the melanoma peptides G209-2M and G280-9V as positive controls for vaccination.

In each patient, T cell immunity to one AAS peptide was detected in prevaccine peripheral blood mononuclear cell samples.

The treatment differs from other personalized cancer vaccines in two key ways, Dr. Carreno said in the teleconference.

“We mature the [dendritic] cells before we give them back to the patients; the cells make growth factors that we have previously shown are important to the generation of the immune response,” she said. In addition, the vaccine was given as an infusion, rather than an injection, she noted.

Vaccination augmented the T-cell response to the three neoantigens – TMEM48 F169L, SEC24A P469, EXOC8 Q656P – with observed frequencies of 23%, 64%, and 89%, respectively.

Immune monitoring also detected T-cell immunity to two additional neoantigens per patient, Dr. Carreno and her associates reported.

Robust immune responses were detected as early as week 2 and peaked at weeks 8-9 after the initial dose. Each patient received three vaccine doses, without side effects or toxicity.

“Vaccination against tumor antigens appears safe as all three patients are alive and well, with no autoimmune adverse events,” the researchers wrote. Post vaccine restaging CT revealed stable disease in a 54-year-old man with BRAF V6003 mutation-positive melanoma. A second man, who had achieved a complete response to ipilimumab for BRAF V6003-positive disease, remains in complete remission after receiving the vaccine in the adjuvant setting.

The vaccine induced 30% tumor reduction in a woman with extensive skin metastases and 5-12 mm lung nodules after ipilimumab and vemurafenib (Zelboraf), but tumor size returned back to baseline dimensions 12 weeks later with no new disease sites. Her disease has remained stable for the past 8 months, the researchers said.

However, it is too soon to attribute a clinical benefit to the observed immune response to the vaccine, Dr. Linette emphasized. “I would be speculating if I said the vaccine had any benefit to the patients,” he said.

Vaccination increased the frequency of most existing prevaccine T-cell receptor-beta (TCR-beta) clonotypes and revealed new clonotypes for 6 neoantigens.

For both dominant and subdominant neoantigens, the TCR-beta repertoire was increased significantly after vaccination. For example, 84 clonotypes representing 19 TCR-beta families were detected for TKT R438W, 61 clonotypes representing 12 TCR-beta families were detected for SEC24A P469L, and 12 clonotypes representing 8 TCR-beta families were detected for EXOC8 Q656P.

“The revelation of a highly diverse TCR-beta repertoire specific for dominant and subdominant neoantigens was surprising and points to a potentially rich pool of naive tumor-specific T cells that remain ignorant unless activated by vaccination,” the researchers wrote.

Recent data indicate that CTLA-4 monoclonal antibody use can alter TCR repertoire diversity in patients, suggesting a potential strategy of combination checkpoint inhibitors, including ipilimumab, and neoantigen vaccines. The novel vaccine strategy also could be used to treat other malignancies with high mutational burdens such as lung, bladder, and colorectal cancers, while other genomic alterations may generate potential neoantigens relevant in low–mutational burden cancers such as leukemia, the authors suggest.

Although the cells in this study were grown in a specialized laboratory, “as the technology improves, I think this [strategy] will become reproducible and available at other medical centers,” Dr. Linette said.

This work was supported by Barnes-Jewish Hospital Foundation, Siteman Cancer Frontier Fund, Our Mark on Melanoma (MOM) Foundation, Come Out Swinging (COS) Foundation, Blackout Melanoma Foundation and the National Cancer Institute.

Heidi Splete contributed to this story.

A customized vaccine targeting patient-specific, tumor neoantigens evoked an immune response in three adults with advanced cutaneous melanoma in a proof-of-principle study that paves the way for a phase I trial.

The data are “too premature to conclude that the treatment had any therapeutic benefit to the patients,” Dr. Gerald P. Linette of Washington University in St. Louis, Mo., said in a teleconference. However, he noted that a phase I trial would likely begin within the next 9-12 months.

“Our primary goal was to see if this was safe, and if we could elicit an immune response,” Dr. Linette said.

Vaccination not only augmented T-cell immunity directed against naturally occurring, dominant tumor neoantigens, but also expanded the breadth of the immune response by revealing additional subdominant neoantigens, lead author Beatriz M. Carreno, Ph.D., of Washington University in St. Louis and her associates reported online April 2 in Science (doi:10.1126/science.aaa3828).

All three patients had stage IIIC, resected, cutaneous melanoma and had failed prior therapy with ipilimumab (Yervoy).

C. Bickel, Science

Some melanoma patients harbor tumor missense mutations, translated into amino acid substitutions (AAS). These mutations are thought to produce antigens that the immune system perceives as foreign, prompting a tumor-specific T-cell response. Heretofore, there has been no systematic evaluation of these neoantigens or whether vaccination can enhance these responses.

The aim of the current study was to determine the safety, tolerability, and immunologic responses to AAS peptides inside a modified dendritic cell vaccine. Seven AAS peptide candidates were selected among validated HLA-A*02:01 binders, along with the melanoma peptides G209-2M and G280-9V as positive controls for vaccination.

In each patient, T cell immunity to one AAS peptide was detected in prevaccine peripheral blood mononuclear cell samples.

The treatment differs from other personalized cancer vaccines in two key ways, Dr. Carreno said in the teleconference.

“We mature the [dendritic] cells before we give them back to the patients; the cells make growth factors that we have previously shown are important to the generation of the immune response,” she said. In addition, the vaccine was given as an infusion, rather than an injection, she noted.

Vaccination augmented the T-cell response to the three neoantigens – TMEM48 F169L, SEC24A P469, EXOC8 Q656P – with observed frequencies of 23%, 64%, and 89%, respectively.

Immune monitoring also detected T-cell immunity to two additional neoantigens per patient, Dr. Carreno and her associates reported.

Robust immune responses were detected as early as week 2 and peaked at weeks 8-9 after the initial dose. Each patient received three vaccine doses, without side effects or toxicity.

“Vaccination against tumor antigens appears safe as all three patients are alive and well, with no autoimmune adverse events,” the researchers wrote. Post vaccine restaging CT revealed stable disease in a 54-year-old man with BRAF V6003 mutation-positive melanoma. A second man, who had achieved a complete response to ipilimumab for BRAF V6003-positive disease, remains in complete remission after receiving the vaccine in the adjuvant setting.

The vaccine induced 30% tumor reduction in a woman with extensive skin metastases and 5-12 mm lung nodules after ipilimumab and vemurafenib (Zelboraf), but tumor size returned back to baseline dimensions 12 weeks later with no new disease sites. Her disease has remained stable for the past 8 months, the researchers said.

However, it is too soon to attribute a clinical benefit to the observed immune response to the vaccine, Dr. Linette emphasized. “I would be speculating if I said the vaccine had any benefit to the patients,” he said.

Vaccination increased the frequency of most existing prevaccine T-cell receptor-beta (TCR-beta) clonotypes and revealed new clonotypes for 6 neoantigens.

For both dominant and subdominant neoantigens, the TCR-beta repertoire was increased significantly after vaccination. For example, 84 clonotypes representing 19 TCR-beta families were detected for TKT R438W, 61 clonotypes representing 12 TCR-beta families were detected for SEC24A P469L, and 12 clonotypes representing 8 TCR-beta families were detected for EXOC8 Q656P.

“The revelation of a highly diverse TCR-beta repertoire specific for dominant and subdominant neoantigens was surprising and points to a potentially rich pool of naive tumor-specific T cells that remain ignorant unless activated by vaccination,” the researchers wrote.

Recent data indicate that CTLA-4 monoclonal antibody use can alter TCR repertoire diversity in patients, suggesting a potential strategy of combination checkpoint inhibitors, including ipilimumab, and neoantigen vaccines. The novel vaccine strategy also could be used to treat other malignancies with high mutational burdens such as lung, bladder, and colorectal cancers, while other genomic alterations may generate potential neoantigens relevant in low–mutational burden cancers such as leukemia, the authors suggest.

Although the cells in this study were grown in a specialized laboratory, “as the technology improves, I think this [strategy] will become reproducible and available at other medical centers,” Dr. Linette said.

This work was supported by Barnes-Jewish Hospital Foundation, Siteman Cancer Frontier Fund, Our Mark on Melanoma (MOM) Foundation, Come Out Swinging (COS) Foundation, Blackout Melanoma Foundation and the National Cancer Institute.

Heidi Splete contributed to this story.

HOUSTON– Given the low incidence of adverse drug reactions to cephalosporin antibiotics among nearly a million California health plan patients, patients with a history of penicillin allergy can safely be given cephalosporins, according to Dr. Eric M. Macy.

The recommendation is based on the findings of a retrospective, population-based analysis of the records of 949,323 Kaiser Permanente Southern California health plan members, which was presented by Dr. Macy, of the Kaiser Permanente Medical Center in San Diego, at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

Dr. Macy and his colleagues examined the records of 622,456 health plan members who were given 901,908 regimens of oral cephalosporins and 326,867 members given 487,630 parenteral cephalosporin regimens between Jan. 1, 2010, and Dec. 31, 2012.

Clostridium difficile infection within 90 days, nephropathy within 30 days, and all-cause death within 1 day were the most common cephalosporin-associated adverse drug reactions (ADRs) reported by physicians, with rates of 0.91%, 0.15%, and 0.10%, respectively. Cephalosporin-associated anaphylaxis was documented by physicians a total of five times in oral patients and eight times in parenteral patients (P = .0761), while only three serious cutaneous adverse reactions (SCARs) were recorded. All of those SCARS were attributable to other antibiotics taken at the same time as the cephalosporins, according to Dr. Macy.

Patients who reported developing new cephalosporin allergies over the course of the study period were significantly more likely to be female than male: 0.56% vs. 0.43% (P < .0001). And patients with a history of penicillin allergy were more likely to report a new cephalosporin allergy within 30 days than patients with no drug allergy, another cephalosporin allergy, or a non–beta-lactam allergy.

The numbers are smaller than those reported recently in the American Journal of Medicine (2009;122: 778.e1–7), Dr. Macy noted, “because there it was new allergy reports in the year after any cephalosporin exposure, as opposed to our new report, which looks at reactions within 30 days of exposure.”

Dr. Macy disclosed that he has received research support from ALK and BioMarin.

[email protected]

HOUSTON– Given the low incidence of adverse drug reactions to cephalosporin antibiotics among nearly a million California health plan patients, patients with a history of penicillin allergy can safely be given cephalosporins, according to Dr. Eric M. Macy.

The recommendation is based on the findings of a retrospective, population-based analysis of the records of 949,323 Kaiser Permanente Southern California health plan members, which was presented by Dr. Macy, of the Kaiser Permanente Medical Center in San Diego, at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

Dr. Macy and his colleagues examined the records of 622,456 health plan members who were given 901,908 regimens of oral cephalosporins and 326,867 members given 487,630 parenteral cephalosporin regimens between Jan. 1, 2010, and Dec. 31, 2012.

Clostridium difficile infection within 90 days, nephropathy within 30 days, and all-cause death within 1 day were the most common cephalosporin-associated adverse drug reactions (ADRs) reported by physicians, with rates of 0.91%, 0.15%, and 0.10%, respectively. Cephalosporin-associated anaphylaxis was documented by physicians a total of five times in oral patients and eight times in parenteral patients (P = .0761), while only three serious cutaneous adverse reactions (SCARs) were recorded. All of those SCARS were attributable to other antibiotics taken at the same time as the cephalosporins, according to Dr. Macy.

Patients who reported developing new cephalosporin allergies over the course of the study period were significantly more likely to be female than male: 0.56% vs. 0.43% (P < .0001). And patients with a history of penicillin allergy were more likely to report a new cephalosporin allergy within 30 days than patients with no drug allergy, another cephalosporin allergy, or a non–beta-lactam allergy.

The numbers are smaller than those reported recently in the American Journal of Medicine (2009;122: 778.e1–7), Dr. Macy noted, “because there it was new allergy reports in the year after any cephalosporin exposure, as opposed to our new report, which looks at reactions within 30 days of exposure.”

Dr. Macy disclosed that he has received research support from ALK and BioMarin.

[email protected]

HOUSTON– Given the low incidence of adverse drug reactions to cephalosporin antibiotics among nearly a million California health plan patients, patients with a history of penicillin allergy can safely be given cephalosporins, according to Dr. Eric M. Macy.

The recommendation is based on the findings of a retrospective, population-based analysis of the records of 949,323 Kaiser Permanente Southern California health plan members, which was presented by Dr. Macy, of the Kaiser Permanente Medical Center in San Diego, at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

Dr. Macy and his colleagues examined the records of 622,456 health plan members who were given 901,908 regimens of oral cephalosporins and 326,867 members given 487,630 parenteral cephalosporin regimens between Jan. 1, 2010, and Dec. 31, 2012.

Clostridium difficile infection within 90 days, nephropathy within 30 days, and all-cause death within 1 day were the most common cephalosporin-associated adverse drug reactions (ADRs) reported by physicians, with rates of 0.91%, 0.15%, and 0.10%, respectively. Cephalosporin-associated anaphylaxis was documented by physicians a total of five times in oral patients and eight times in parenteral patients (P = .0761), while only three serious cutaneous adverse reactions (SCARs) were recorded. All of those SCARS were attributable to other antibiotics taken at the same time as the cephalosporins, according to Dr. Macy.

Patients who reported developing new cephalosporin allergies over the course of the study period were significantly more likely to be female than male: 0.56% vs. 0.43% (P < .0001). And patients with a history of penicillin allergy were more likely to report a new cephalosporin allergy within 30 days than patients with no drug allergy, another cephalosporin allergy, or a non–beta-lactam allergy.

The numbers are smaller than those reported recently in the American Journal of Medicine (2009;122: 778.e1–7), Dr. Macy noted, “because there it was new allergy reports in the year after any cephalosporin exposure, as opposed to our new report, which looks at reactions within 30 days of exposure.”

Dr. Macy disclosed that he has received research support from ALK and BioMarin.

[email protected]

HOUSTON– Dr. Amber M. Patterson of Nationwide Children’s Hospital and Research Institute in Columbus, Ohio, provides the lowdown on intralymphatic immunotherapy, in which a three-injection protocol of ultrasound-guided lymph node injections spaced 4 weeks apart is being investigated as a treatment for grass pollen-induced rhinoconjunctivitis in adolescents. It’s an attractive alternative to the conventional 3-year regimen of weekly, then monthly subcutaneous immunotherapy injections.

HOUSTON– Dr. Amber M. Patterson of Nationwide Children’s Hospital and Research Institute in Columbus, Ohio, provides the lowdown on intralymphatic immunotherapy, in which a three-injection protocol of ultrasound-guided lymph node injections spaced 4 weeks apart is being investigated as a treatment for grass pollen-induced rhinoconjunctivitis in adolescents. It’s an attractive alternative to the conventional 3-year regimen of weekly, then monthly subcutaneous immunotherapy injections.

HOUSTON– Dr. Amber M. Patterson of Nationwide Children’s Hospital and Research Institute in Columbus, Ohio, provides the lowdown on intralymphatic immunotherapy, in which a three-injection protocol of ultrasound-guided lymph node injections spaced 4 weeks apart is being investigated as a treatment for grass pollen-induced rhinoconjunctivitis in adolescents. It’s an attractive alternative to the conventional 3-year regimen of weekly, then monthly subcutaneous immunotherapy injections.

Using pimecrolimus cream as a first-line treatment for atopic dermatitis in infants spares the need for topical corticosteroids as frequently and appears safe over the long term, according to a study published online March 23 in Pediatrics.

“The efficacy results suggest that pimecrolimus has similar efficacy to topical corticosteroids in a real-world setting, which is noteworthy because pimecrolimus is not currently widely used as first-line therapy for atopic dermatitis, given the perception of lower efficacy than topical corticosteroids,” Dr. Bardur Sigurgeirsson of the University of Iceland, Reykjavik, and his associates said.

The researchers randomized 2,418 infants, between ages 3 and 12 months, to receive either pimecrolimus 1% cream, a noncorticosteroid topical calcineurin inhibitor that selectively suppresses activation of T cells and mast cells, or topical corticosteroids to treat mild to moderate atopic dermatitis affecting at least 5% of body surface area. The 1,205 infants receiving the pimecrolimus cream also received topical corticosteroids to treat short-term disease flares. Corticosteroids used were typically either 1% hydrocortisone or 0.1% hydrocortisone butyrate cream.

Success was defined as a 0 (clear) or 1 (mostly clear) on the Investigator’s Global Assessment scale, which ranges from 0 to 5.

More than half of the patients in both groups experienced cleared symptoms within the first three weeks (52.6% with pimecrolimus and 50.5% with corticosteroids). Five years later, among 1,710 patients still enrolled, 88.7% receiving pimecrolimus and 92.3% receiving corticosteroids had overall success. Facial treatment success was seen in 96.6% of infants in the pimecrolimus group and 97.2% of of those in the corticosteroids group, Dr. Sigurgeirsson and associates reported (Pediatrics 2015 March 23 [doi: 10.1542/peds.2014-1990]).

Those receiving pimecrolimus only required topical corticosteroids for a median 7 days, compared to 178 days in the corticosteroids group over the 5-year period. Just over a third (36%) of pimecrolimus patients never used topical corticosteroids.

Both groups experienced similar rates of adverse events, and neither showed negative effects on children’s humoral or cellular immunity, with similar antibody responses in both groups to routine vaccinations. Both groups also had similar growth rates, the investigators reported.

Using pimecrolimus cream as a first-line treatment for atopic dermatitis in infants spares the need for topical corticosteroids as frequently and appears safe over the long term, according to a study published online March 23 in Pediatrics.

“The efficacy results suggest that pimecrolimus has similar efficacy to topical corticosteroids in a real-world setting, which is noteworthy because pimecrolimus is not currently widely used as first-line therapy for atopic dermatitis, given the perception of lower efficacy than topical corticosteroids,” Dr. Bardur Sigurgeirsson of the University of Iceland, Reykjavik, and his associates said.

The researchers randomized 2,418 infants, between ages 3 and 12 months, to receive either pimecrolimus 1% cream, a noncorticosteroid topical calcineurin inhibitor that selectively suppresses activation of T cells and mast cells, or topical corticosteroids to treat mild to moderate atopic dermatitis affecting at least 5% of body surface area. The 1,205 infants receiving the pimecrolimus cream also received topical corticosteroids to treat short-term disease flares. Corticosteroids used were typically either 1% hydrocortisone or 0.1% hydrocortisone butyrate cream.

Success was defined as a 0 (clear) or 1 (mostly clear) on the Investigator’s Global Assessment scale, which ranges from 0 to 5.

More than half of the patients in both groups experienced cleared symptoms within the first three weeks (52.6% with pimecrolimus and 50.5% with corticosteroids). Five years later, among 1,710 patients still enrolled, 88.7% receiving pimecrolimus and 92.3% receiving corticosteroids had overall success. Facial treatment success was seen in 96.6% of infants in the pimecrolimus group and 97.2% of of those in the corticosteroids group, Dr. Sigurgeirsson and associates reported (Pediatrics 2015 March 23 [doi: 10.1542/peds.2014-1990]).

Those receiving pimecrolimus only required topical corticosteroids for a median 7 days, compared to 178 days in the corticosteroids group over the 5-year period. Just over a third (36%) of pimecrolimus patients never used topical corticosteroids.

Both groups experienced similar rates of adverse events, and neither showed negative effects on children’s humoral or cellular immunity, with similar antibody responses in both groups to routine vaccinations. Both groups also had similar growth rates, the investigators reported.

Using pimecrolimus cream as a first-line treatment for atopic dermatitis in infants spares the need for topical corticosteroids as frequently and appears safe over the long term, according to a study published online March 23 in Pediatrics.

“The efficacy results suggest that pimecrolimus has similar efficacy to topical corticosteroids in a real-world setting, which is noteworthy because pimecrolimus is not currently widely used as first-line therapy for atopic dermatitis, given the perception of lower efficacy than topical corticosteroids,” Dr. Bardur Sigurgeirsson of the University of Iceland, Reykjavik, and his associates said.

The researchers randomized 2,418 infants, between ages 3 and 12 months, to receive either pimecrolimus 1% cream, a noncorticosteroid topical calcineurin inhibitor that selectively suppresses activation of T cells and mast cells, or topical corticosteroids to treat mild to moderate atopic dermatitis affecting at least 5% of body surface area. The 1,205 infants receiving the pimecrolimus cream also received topical corticosteroids to treat short-term disease flares. Corticosteroids used were typically either 1% hydrocortisone or 0.1% hydrocortisone butyrate cream.

Success was defined as a 0 (clear) or 1 (mostly clear) on the Investigator’s Global Assessment scale, which ranges from 0 to 5.

More than half of the patients in both groups experienced cleared symptoms within the first three weeks (52.6% with pimecrolimus and 50.5% with corticosteroids). Five years later, among 1,710 patients still enrolled, 88.7% receiving pimecrolimus and 92.3% receiving corticosteroids had overall success. Facial treatment success was seen in 96.6% of infants in the pimecrolimus group and 97.2% of of those in the corticosteroids group, Dr. Sigurgeirsson and associates reported (Pediatrics 2015 March 23 [doi: 10.1542/peds.2014-1990]).

Those receiving pimecrolimus only required topical corticosteroids for a median 7 days, compared to 178 days in the corticosteroids group over the 5-year period. Just over a third (36%) of pimecrolimus patients never used topical corticosteroids.

Both groups experienced similar rates of adverse events, and neither showed negative effects on children’s humoral or cellular immunity, with similar antibody responses in both groups to routine vaccinations. Both groups also had similar growth rates, the investigators reported.

SAN FRANCISCO – Formaldehyde has been named the American Contact Dermatitis Society Contact Allergen of the Year for 2015, Dr. David E. Cohen said in the hot topics session at the annual meeting of the American Academy of Dermatology.

Formaldehyde has been a factor in contact dermatitis for a long time, and exposure to it is widespread, said Dr. Cohen of New York University.

However, recent studies have reassessed the clinical relevance of formaldehyde allergy, and a patch test concentration of 2.0% has been recommended by the European Environmental Contact Dermatitis Research group, according to a report published in the journal Dermatitis (Dermatitis 2015;26:3-6).

“Without causing any more irritant reactions, the patch test concentration of 2.0% detects twice as many contact allergies and enables the diagnosis of formaldehyde-allergic patients who otherwise would have been missed,” the authors wrote.

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SAN FRANCISCO – Formaldehyde has been named the American Contact Dermatitis Society Contact Allergen of the Year for 2015, Dr. David E. Cohen said in the hot topics session at the annual meeting of the American Academy of Dermatology.

Formaldehyde has been a factor in contact dermatitis for a long time, and exposure to it is widespread, said Dr. Cohen of New York University.

However, recent studies have reassessed the clinical relevance of formaldehyde allergy, and a patch test concentration of 2.0% has been recommended by the European Environmental Contact Dermatitis Research group, according to a report published in the journal Dermatitis (Dermatitis 2015;26:3-6).

“Without causing any more irritant reactions, the patch test concentration of 2.0% detects twice as many contact allergies and enables the diagnosis of formaldehyde-allergic patients who otherwise would have been missed,” the authors wrote.

[email protected]

SAN FRANCISCO – Formaldehyde has been named the American Contact Dermatitis Society Contact Allergen of the Year for 2015, Dr. David E. Cohen said in the hot topics session at the annual meeting of the American Academy of Dermatology.

Formaldehyde has been a factor in contact dermatitis for a long time, and exposure to it is widespread, said Dr. Cohen of New York University.

However, recent studies have reassessed the clinical relevance of formaldehyde allergy, and a patch test concentration of 2.0% has been recommended by the European Environmental Contact Dermatitis Research group, according to a report published in the journal Dermatitis (Dermatitis 2015;26:3-6).

“Without causing any more irritant reactions, the patch test concentration of 2.0% detects twice as many contact allergies and enables the diagnosis of formaldehyde-allergic patients who otherwise would have been missed,” the authors wrote.

[email protected]

GAITHERSBURG, MD.– A Food and Drug Administration advisory panel supported approval of a fluticasone and vilanterol combination to treat asthma in adults – but the majority voted against approval for adolescents, citing a need for more safety and effectiveness data in that younger population.

GlaxoSmithKline has proposed that two fixed-dose combinations, 100 mcg or 200 mcg of the inhaled corticosteroid (ICS) fluticasone with 25 mcg of the long-acting beta-agonist (LABA) vilanterol in a dry powder inhaler, be approved for maintenance treatment of asthma in patients age 12 years and older, administered once per day.

The FDA approved the 100 mcg/25 mcg dose in 2013 to treat chronic obstructive pulmonary disease; GSK markets it as Breo Ellipta. To earn an asthma indication, the company submitted data from four studies, including a large safety study that addressed safety concerns associated with LABAs in the treatment of asthma.

At the March 19 joint meeting of the FDA’s Pulmonary-Allergy Drugs Advisory Committee and Drug Safety and Risk Management Advisory Committee, the panels voted 16-4 that the efficacy and safety data supported the approval of both proposed doses in adults.

Many panelists noted the benefit of having a once-daily inhaled treatment to treat asthma, which could improve compliance. Most agreed that the efficacy data in adults provided a substantial amount of evidence that the two doses had a “clinically meaningful benefit” in adults, with beneficial effects on lung function and exacerbation rates.

But the panelists voted 19-1 that the data did not support approval in adolescents, aged 12-17 years. Members expressed uncertainty about safety in that age group, which was studied in the same trials as adults.

In addition, study data indicated that the combination’s beneficial effects were no better than fluticasone alone, panelists said. They also noted a numerical imbalance in hospitalizations among adolescents in a large safety study, and they pointed to the availability of other treatments for that age group.

Panelists voting no also said the efficacy results in adolescents were inconsistent, with “no clear trends in the positive direction,” as one panelist noted. Furthermore, there was no evidence that the combination of fluticasone and vilanterol at either dose was more effective than the ICS alone on forced expiratory volume in 1 second or asthma exacerbations.

Panelists also cautioned that the positive results in adults, who made up the majority of patients enrolled in the studies, could not be extrapolated to adolescents. Thus, there was a need for a separate safety and efficacy study in adolescents.

“At least in the adults, it offers something, perhaps the additional benefit of better compliance,” said the panel chair, Dr. Erik Swenson, professor of medicine and physiology, pulmonary and critical care medicine, University of Washington, Seattle. The combination also was superior at both doses at improving lung function and reducing exacerbations.

But among patients age 12-17 years, “there seems to be no obvious superiority and possibly inferiority against just fluticasone alone,” Dr. Swenson said.

Considering that results of large, ongoing LABA safety trials may soon become available, “I don’t feel comfortable adding a new LABA to the mix right now,” said Dr. Judith Kramer, professor emerita of medicine, Duke University, Durham, N.C., who voted against approval both for pediatric and adult patients.

Because it is taken once a day, the combination’s main advantage would be adherence, Dr. Kramer added. But “it’s not adding any major new therapeutic benefit, and there is the safety concern in the adolescents, and there may well be off-label use.”

Given longstanding concerns about serious asthma-related events associated with LABAs – particularly in pediatric and black patients – the FDA has required manufacturers to conduct postmarketing safety studies evaluating the risks of LABAs when added to an ICS.

Those studies include a GSK study of more than 11,000 patients aged 12 years and older evaluating the safety of Advair, a combination of fluticasone and the LABA salmeterol. Results from that study could be available in early 2016.

For the fluticasone-vilanterol asthma indication, GSK submitted the results of two 12-week and one 24-week lung function studies, enrolling a total of about 2,200 patients whose mean age was 44 years (about 8% were aged 12-17 years).

Another study evaluated the time to first asthma exacerbation in more than 2,000 patients, which included almost 300 patients aged 12-17 years. In that study, the risk of asthma exacerbations was reduced by about 20% among those on the combination, compared with those on fluticasone alone. There were no intubations or deaths from asthma exacerbations.

But in a subgroup analysis of patients aged 12-17 years, conducted by the FDA, the risk of asthma exacerbations was higher among those treated with fluticasone-vilanterol, compared with patients 18 years and older.

In addition, an FDA meta-analysis of asthma-related serious adverse events in the four studies found a numerical imbalance in hospitalizations among adolescents: four hospitalizations among those on the combination drug, but none on fluticasone alone.

If approved, fluticasone-vilanterol would be the first once-daily inhaled ICS/LABA combination treatment for asthma. Fluticasone (100 mcg and 200 mcg) is approved for treating asthma. Unlike the LABAs salmeterol and formoterol, however, vilanterol is not approved for use as a single agent. Vilanterol (as part of the combination product) would be the first new LABA approved for asthma in 15 years.

The FDA usually follows the recommendations of its advisory panels; a decision is expected by April 30. Panelists had no disclosures.

[email protected]

GAITHERSBURG, MD.– A Food and Drug Administration advisory panel supported approval of a fluticasone and vilanterol combination to treat asthma in adults – but the majority voted against approval for adolescents, citing a need for more safety and effectiveness data in that younger population.

GlaxoSmithKline has proposed that two fixed-dose combinations, 100 mcg or 200 mcg of the inhaled corticosteroid (ICS) fluticasone with 25 mcg of the long-acting beta-agonist (LABA) vilanterol in a dry powder inhaler, be approved for maintenance treatment of asthma in patients age 12 years and older, administered once per day.

The FDA approved the 100 mcg/25 mcg dose in 2013 to treat chronic obstructive pulmonary disease; GSK markets it as Breo Ellipta. To earn an asthma indication, the company submitted data from four studies, including a large safety study that addressed safety concerns associated with LABAs in the treatment of asthma.

At the March 19 joint meeting of the FDA’s Pulmonary-Allergy Drugs Advisory Committee and Drug Safety and Risk Management Advisory Committee, the panels voted 16-4 that the efficacy and safety data supported the approval of both proposed doses in adults.

Many panelists noted the benefit of having a once-daily inhaled treatment to treat asthma, which could improve compliance. Most agreed that the efficacy data in adults provided a substantial amount of evidence that the two doses had a “clinically meaningful benefit” in adults, with beneficial effects on lung function and exacerbation rates.

But the panelists voted 19-1 that the data did not support approval in adolescents, aged 12-17 years. Members expressed uncertainty about safety in that age group, which was studied in the same trials as adults.

In addition, study data indicated that the combination’s beneficial effects were no better than fluticasone alone, panelists said. They also noted a numerical imbalance in hospitalizations among adolescents in a large safety study, and they pointed to the availability of other treatments for that age group.

Panelists voting no also said the efficacy results in adolescents were inconsistent, with “no clear trends in the positive direction,” as one panelist noted. Furthermore, there was no evidence that the combination of fluticasone and vilanterol at either dose was more effective than the ICS alone on forced expiratory volume in 1 second or asthma exacerbations.

Panelists also cautioned that the positive results in adults, who made up the majority of patients enrolled in the studies, could not be extrapolated to adolescents. Thus, there was a need for a separate safety and efficacy study in adolescents.

“At least in the adults, it offers something, perhaps the additional benefit of better compliance,” said the panel chair, Dr. Erik Swenson, professor of medicine and physiology, pulmonary and critical care medicine, University of Washington, Seattle. The combination also was superior at both doses at improving lung function and reducing exacerbations.

But among patients age 12-17 years, “there seems to be no obvious superiority and possibly inferiority against just fluticasone alone,” Dr. Swenson said.

Considering that results of large, ongoing LABA safety trials may soon become available, “I don’t feel comfortable adding a new LABA to the mix right now,” said Dr. Judith Kramer, professor emerita of medicine, Duke University, Durham, N.C., who voted against approval both for pediatric and adult patients.

Because it is taken once a day, the combination’s main advantage would be adherence, Dr. Kramer added. But “it’s not adding any major new therapeutic benefit, and there is the safety concern in the adolescents, and there may well be off-label use.”

Given longstanding concerns about serious asthma-related events associated with LABAs – particularly in pediatric and black patients – the FDA has required manufacturers to conduct postmarketing safety studies evaluating the risks of LABAs when added to an ICS.

Those studies include a GSK study of more than 11,000 patients aged 12 years and older evaluating the safety of Advair, a combination of fluticasone and the LABA salmeterol. Results from that study could be available in early 2016.

For the fluticasone-vilanterol asthma indication, GSK submitted the results of two 12-week and one 24-week lung function studies, enrolling a total of about 2,200 patients whose mean age was 44 years (about 8% were aged 12-17 years).

Another study evaluated the time to first asthma exacerbation in more than 2,000 patients, which included almost 300 patients aged 12-17 years. In that study, the risk of asthma exacerbations was reduced by about 20% among those on the combination, compared with those on fluticasone alone. There were no intubations or deaths from asthma exacerbations.

But in a subgroup analysis of patients aged 12-17 years, conducted by the FDA, the risk of asthma exacerbations was higher among those treated with fluticasone-vilanterol, compared with patients 18 years and older.

In addition, an FDA meta-analysis of asthma-related serious adverse events in the four studies found a numerical imbalance in hospitalizations among adolescents: four hospitalizations among those on the combination drug, but none on fluticasone alone.

If approved, fluticasone-vilanterol would be the first once-daily inhaled ICS/LABA combination treatment for asthma. Fluticasone (100 mcg and 200 mcg) is approved for treating asthma. Unlike the LABAs salmeterol and formoterol, however, vilanterol is not approved for use as a single agent. Vilanterol (as part of the combination product) would be the first new LABA approved for asthma in 15 years.

The FDA usually follows the recommendations of its advisory panels; a decision is expected by April 30. Panelists had no disclosures.

[email protected]

GAITHERSBURG, MD.– A Food and Drug Administration advisory panel supported approval of a fluticasone and vilanterol combination to treat asthma in adults – but the majority voted against approval for adolescents, citing a need for more safety and effectiveness data in that younger population.

GlaxoSmithKline has proposed that two fixed-dose combinations, 100 mcg or 200 mcg of the inhaled corticosteroid (ICS) fluticasone with 25 mcg of the long-acting beta-agonist (LABA) vilanterol in a dry powder inhaler, be approved for maintenance treatment of asthma in patients age 12 years and older, administered once per day.

The FDA approved the 100 mcg/25 mcg dose in 2013 to treat chronic obstructive pulmonary disease; GSK markets it as Breo Ellipta. To earn an asthma indication, the company submitted data from four studies, including a large safety study that addressed safety concerns associated with LABAs in the treatment of asthma.

At the March 19 joint meeting of the FDA’s Pulmonary-Allergy Drugs Advisory Committee and Drug Safety and Risk Management Advisory Committee, the panels voted 16-4 that the efficacy and safety data supported the approval of both proposed doses in adults.

Many panelists noted the benefit of having a once-daily inhaled treatment to treat asthma, which could improve compliance. Most agreed that the efficacy data in adults provided a substantial amount of evidence that the two doses had a “clinically meaningful benefit” in adults, with beneficial effects on lung function and exacerbation rates.

But the panelists voted 19-1 that the data did not support approval in adolescents, aged 12-17 years. Members expressed uncertainty about safety in that age group, which was studied in the same trials as adults.

In addition, study data indicated that the combination’s beneficial effects were no better than fluticasone alone, panelists said. They also noted a numerical imbalance in hospitalizations among adolescents in a large safety study, and they pointed to the availability of other treatments for that age group.

Panelists voting no also said the efficacy results in adolescents were inconsistent, with “no clear trends in the positive direction,” as one panelist noted. Furthermore, there was no evidence that the combination of fluticasone and vilanterol at either dose was more effective than the ICS alone on forced expiratory volume in 1 second or asthma exacerbations.

Panelists also cautioned that the positive results in adults, who made up the majority of patients enrolled in the studies, could not be extrapolated to adolescents. Thus, there was a need for a separate safety and efficacy study in adolescents.

“At least in the adults, it offers something, perhaps the additional benefit of better compliance,” said the panel chair, Dr. Erik Swenson, professor of medicine and physiology, pulmonary and critical care medicine, University of Washington, Seattle. The combination also was superior at both doses at improving lung function and reducing exacerbations.

But among patients age 12-17 years, “there seems to be no obvious superiority and possibly inferiority against just fluticasone alone,” Dr. Swenson said.

Considering that results of large, ongoing LABA safety trials may soon become available, “I don’t feel comfortable adding a new LABA to the mix right now,” said Dr. Judith Kramer, professor emerita of medicine, Duke University, Durham, N.C., who voted against approval both for pediatric and adult patients.

Because it is taken once a day, the combination’s main advantage would be adherence, Dr. Kramer added. But “it’s not adding any major new therapeutic benefit, and there is the safety concern in the adolescents, and there may well be off-label use.”

Given longstanding concerns about serious asthma-related events associated with LABAs – particularly in pediatric and black patients – the FDA has required manufacturers to conduct postmarketing safety studies evaluating the risks of LABAs when added to an ICS.

Those studies include a GSK study of more than 11,000 patients aged 12 years and older evaluating the safety of Advair, a combination of fluticasone and the LABA salmeterol. Results from that study could be available in early 2016.

For the fluticasone-vilanterol asthma indication, GSK submitted the results of two 12-week and one 24-week lung function studies, enrolling a total of about 2,200 patients whose mean age was 44 years (about 8% were aged 12-17 years).

Another study evaluated the time to first asthma exacerbation in more than 2,000 patients, which included almost 300 patients aged 12-17 years. In that study, the risk of asthma exacerbations was reduced by about 20% among those on the combination, compared with those on fluticasone alone. There were no intubations or deaths from asthma exacerbations.

But in a subgroup analysis of patients aged 12-17 years, conducted by the FDA, the risk of asthma exacerbations was higher among those treated with fluticasone-vilanterol, compared with patients 18 years and older.

In addition, an FDA meta-analysis of asthma-related serious adverse events in the four studies found a numerical imbalance in hospitalizations among adolescents: four hospitalizations among those on the combination drug, but none on fluticasone alone.

If approved, fluticasone-vilanterol would be the first once-daily inhaled ICS/LABA combination treatment for asthma. Fluticasone (100 mcg and 200 mcg) is approved for treating asthma. Unlike the LABAs salmeterol and formoterol, however, vilanterol is not approved for use as a single agent. Vilanterol (as part of the combination product) would be the first new LABA approved for asthma in 15 years.

The FDA usually follows the recommendations of its advisory panels; a decision is expected by April 30. Panelists had no disclosures.

[email protected]

HOUSTON – The higher prevalence of chronic urticaria in patients with self-reported penicillin allergy suggests that these patients may be confusing one condition with the other, according to a late-breaking study presented at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

A retrospective chart review of 1,419 patients with self-reported penicillin allergy revealed that 175 patients (12.3%) had a diagnosis of chronic urticaria, a significantly higher percentage than the typical prevalence range of 0.5%-5% that has been reported in the general population.

“Patients are potentially mistakenly attributing symptoms of chronic urticaria to a penicillin allergy,” explained study author Dr. Susanna G. Silverman of the University of Pennsylvania, Philadelphia.

The study included patients at the University of Pennsylvania’s allergy and immunology clinic who self-reported penicillin allergy from June 2007 to August 2014. Patients were identified as having penicillin allergy if penicillin, amoxicillin, amoxicillin-clavulanate, or piperacillin-tazobactam were present on the allergy list of their medical records.

Dr. Silverman then identified all patients from that group who also received a diagnosis of urticaria – a total of 343 patients – then narrowed the list to those who were diagnosed with chronic urticaria or the presence of urticaria for at least 6 weeks.

Of the 175 patients who had chronic urticaria, all were between the ages of 20 years and 92 years; 84% were female, and 53% were white.

“We think it’s important for physicians to think about this and to ask patients about symptoms of chronic urticaria when they report penicillin allergy,” Dr. Silverman noted, “to better determine what is truly penicillin allergy versus simply chronic urticaria symptoms.”

Dr. Silverman did not report any financial disclosures.

[email protected]

HOUSTON – The higher prevalence of chronic urticaria in patients with self-reported penicillin allergy suggests that these patients may be confusing one condition with the other, according to a late-breaking study presented at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

A retrospective chart review of 1,419 patients with self-reported penicillin allergy revealed that 175 patients (12.3%) had a diagnosis of chronic urticaria, a significantly higher percentage than the typical prevalence range of 0.5%-5% that has been reported in the general population.

“Patients are potentially mistakenly attributing symptoms of chronic urticaria to a penicillin allergy,” explained study author Dr. Susanna G. Silverman of the University of Pennsylvania, Philadelphia.

The study included patients at the University of Pennsylvania’s allergy and immunology clinic who self-reported penicillin allergy from June 2007 to August 2014. Patients were identified as having penicillin allergy if penicillin, amoxicillin, amoxicillin-clavulanate, or piperacillin-tazobactam were present on the allergy list of their medical records.

Dr. Silverman then identified all patients from that group who also received a diagnosis of urticaria – a total of 343 patients – then narrowed the list to those who were diagnosed with chronic urticaria or the presence of urticaria for at least 6 weeks.

Of the 175 patients who had chronic urticaria, all were between the ages of 20 years and 92 years; 84% were female, and 53% were white.

“We think it’s important for physicians to think about this and to ask patients about symptoms of chronic urticaria when they report penicillin allergy,” Dr. Silverman noted, “to better determine what is truly penicillin allergy versus simply chronic urticaria symptoms.”

Dr. Silverman did not report any financial disclosures.

[email protected]

HOUSTON – The higher prevalence of chronic urticaria in patients with self-reported penicillin allergy suggests that these patients may be confusing one condition with the other, according to a late-breaking study presented at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

A retrospective chart review of 1,419 patients with self-reported penicillin allergy revealed that 175 patients (12.3%) had a diagnosis of chronic urticaria, a significantly higher percentage than the typical prevalence range of 0.5%-5% that has been reported in the general population.

“Patients are potentially mistakenly attributing symptoms of chronic urticaria to a penicillin allergy,” explained study author Dr. Susanna G. Silverman of the University of Pennsylvania, Philadelphia.

The study included patients at the University of Pennsylvania’s allergy and immunology clinic who self-reported penicillin allergy from June 2007 to August 2014. Patients were identified as having penicillin allergy if penicillin, amoxicillin, amoxicillin-clavulanate, or piperacillin-tazobactam were present on the allergy list of their medical records.

Dr. Silverman then identified all patients from that group who also received a diagnosis of urticaria – a total of 343 patients – then narrowed the list to those who were diagnosed with chronic urticaria or the presence of urticaria for at least 6 weeks.

Of the 175 patients who had chronic urticaria, all were between the ages of 20 years and 92 years; 84% were female, and 53% were white.

“We think it’s important for physicians to think about this and to ask patients about symptoms of chronic urticaria when they report penicillin allergy,” Dr. Silverman noted, “to better determine what is truly penicillin allergy versus simply chronic urticaria symptoms.”

Dr. Silverman did not report any financial disclosures.

[email protected]

HOUSTON– Dr. Megan S. Motosue of the Mayo Clinic in Rochester, Minn., discusses the value of penicillin skin testing as a potent tool for improving inpatient antibiotic stewardship. By routinely performing penicillin skin testing using standard methods in a consecutive series of inpatients with a self-reported history of penicillin allergy, roughly 80% were found to not in fact be allergic. And this information changed their physicians’ behavior: prior to testing, vancomycin was the most commonly used antibiotic in the inpatients, but its use was reduced by more than half based upon the skin test results, with a commensurate increase in prescriptions for semi-synthetic penicillins.

HOUSTON– Dr. Megan S. Motosue of the Mayo Clinic in Rochester, Minn., discusses the value of penicillin skin testing as a potent tool for improving inpatient antibiotic stewardship. By routinely performing penicillin skin testing using standard methods in a consecutive series of inpatients with a self-reported history of penicillin allergy, roughly 80% were found to not in fact be allergic. And this information changed their physicians’ behavior: prior to testing, vancomycin was the most commonly used antibiotic in the inpatients, but its use was reduced by more than half based upon the skin test results, with a commensurate increase in prescriptions for semi-synthetic penicillins.

HOUSTON– Dr. Megan S. Motosue of the Mayo Clinic in Rochester, Minn., discusses the value of penicillin skin testing as a potent tool for improving inpatient antibiotic stewardship. By routinely performing penicillin skin testing using standard methods in a consecutive series of inpatients with a self-reported history of penicillin allergy, roughly 80% were found to not in fact be allergic. And this information changed their physicians’ behavior: prior to testing, vancomycin was the most commonly used antibiotic in the inpatients, but its use was reduced by more than half based upon the skin test results, with a commensurate increase in prescriptions for semi-synthetic penicillins.