Allergy and Immunology News of the Day

Health News of the Day is a daily summary made from the selected links I post on Twitter. It is in a bullet points format with links to the original sources which include 350 RSS feeds that produce about 2,500 items per day.

• Epinephrine Auto-Injector Needle Length May Be Too Short for Intramuscular Delivery. EpiPen Needle May Be Too Short for Intramuscular Delivery in 12% of Children who weighed less than 30 kg. EpiPen Needle May Be Too Short for Intramuscular Delivery in 30% of Children who weighed more than 30 kg http://bit.ly/118TGN
  
  
• Guidelines and experts agree that adrenaline (epinephrine) is the first line treatment for anaphylaxis. Antihistamines should never be given alone or instead of adrenaline in anaphylaxis. In anaphylaxis, antihistamines should be considered only after adrenaline administration and with caution. http://bit.ly/wgkp0
  
  
• Fluticasone Nose Spray Useful as Acute and Long-Term Therapy for Nasal Polyposis http://bit.ly/7nZ75
  
  
• VideoMD.com Search Results For "Allergy" http://bit.ly/szIlC
  
  
• Allergist Matthew Greenhawt, MD is on Twitter @FoodAllergyMD http://bit.ly/ekMCt

Medical news tweets are not research articles - they are 140-character messages - please always go to the original source/links, etc. The inclusion of a Twitter update (tweet) does not represent endorsement or agreement of any kind. Tweets and links do not represent endorsement, approval or support.

Image source: OpenClipArt.org, public domain.

Allergy and Immunology News of the Day

Health News of the Day is a daily summary made from the selected links I post on Twitter. It is in a bullet points format with links to the original sources which include 350 RSS feeds that produce about 2,500 items per day.

• Western Lifestyle Increases Prevalence of Atopic Diseases from 0% to 6% on a Small Papua New Guinean Island http://bit.ly/rIlYF
  
  
• New Point-of-Care Device, ImmunoCAP Rapid could identify 95% of the patients with allergies http://bit.ly/pB7FM
  
  
• Prevalence of food allergy in children with atopic dermatitis: egg (16-39%) , cow's milk (35.13%), peanut (25%) http://bit.ly/Q1tyC
  
  
• Serum and sputum eosinophilic inflammatory markers are associated with poor asthma control. http://bit.ly/vBvHK
  
  
• 10 Surprising Food Allergy Dangers Parents Should Watch For - San Fernando Valley Sun http://bit.ly/1ydKm

Image source: OpenClipArt.org, public domain.

FDA is reviewing possible heart risks with asthma drug Xolair (omalizumab)

What is Xolair (omalizumab)?

Omalizumab (Xolair) is a monoclonal IgG antibody that selectively binds to human immunoglobulin E (IgE) used mainly in asthma to reduce allergic hypersensitivity. Its main drawbacks have been anaphylaxis risk in 1 to 2 patients per 1,000 and cost ($10,000 to $30,000 a year). The drug is used by 30,000 to 35,000 patients, representing less than one half of 1 percent of the eligible patient population.

What happened?

The U.S. Food and Drug Administration is conducting a safety review of Xolair (omalizumab), a drug used to treat adults and adolescents with moderate-to-severe persistent asthma.

Reviewers are looking for a possible association between patients who use Xolair and an increased risk of heart attack, abnormal heart rhythm, heart failure, and stroke. The possible association has been identified based on interim results from an ongoing study of Xolair known as Evaluating the Clinical Effectiveness and Long-Term Safety in Patients with Moderate to Severe Asthma (EXCELS). The study is being conducted by the manufacturer, San Francisco-based Genentech Inc.

The FDA has not made any conclusions about these data yet. Genentech spokeswoman Tara Cooper also said limitations in the existing data "preclude a definitive association with Xolair use.

The FDA says results are from observational study, not a randomized trial and is not advising asthma patients who use Xolair to stop.

What to do?

Dr. Tom Casale, the executive vice president of the American Academy of Allergy, Asthma & Immunology (and chairman of the department I work at), said in a CNN interview he "will recommend that his patients who are on the drug remain on it. These are the patients that are more likely to have (emergency room) visits, hospitalizations and more problems with their asthma." Still, he said, he would like to see the data that the FDA regulators have seen.

References:
FDA Reviewing Preliminary Safety Information on Asthma Drug Xolair. FDA.
U.S. reviewing possible heart risks with asthma drug. Reuters.
FDA scrutinizing safety of asthma drug Xolair. CNN.
Image source: Wikipedia, public domain.

Related:
When to Use Xolair (Omalizumab) in Asthma?
Use of omalizumab (Xolair) anti-IgE therapy beyond asthma
Anaphylactic Reaction to Omalizumab (Xolair) in a Patient with Severe Asthma
Is Xolair cost-effective in severe asthma?
Does omalizumab (Xolair) cause bleeding or thrombocytopenia?
Joint Task Force Report on Omalizumab-associated Anaphylaxis

Asian ladybug has become a prominent cause of seasonal inhalant allergy in endemic areas

The exotic Asian lady beetle, Harmonia axyridis, has become a prominent cause of seasonal inhalant allergy.

The Asian ladybug was introduced into the U.S. environment as an agricultural pest-control predator 20 years ago to control plant lice (aphids).


Asian Ladybug. Image source: Wikipedia, Creative Commons Attribution ShareAlike 2.5, Bruce Marlin, http://www.cirrusimage.com/beetles_multicolored_Asian_ladybird.htm


Aphids (plant lice). Image source: Wikipedia, GNU Free Documentation License.

It was anticipated that the insects would not survive the winter but they did by invading houses. Asian ladybugs may cause seasonal indoor symptoms - chronic cough, rhinitis, and asthma.

Ladybug allergy prevalence in endemic areas has been reported as high as 10%.

Ladybug hemolymph is the primary source of allergens - Har a 1 and Har a 2. 'Reflex bleeding' from tibiofemoral joints (for communication and during alarm) disperses these allergens.

Ladybug skin testing should be routine in endemic areas. SCIT may be effective but a commercial extract is needed.

Control measures:

- treatment of the outside of a house with pyrethroid before the cold weather
- move to a tightly-built house or into an urban area

References:
Seasonal inhalant insect allergy: Harmonia axyridis ladybug. Goetz, David W. Current Opinion in Allergy and Clinical Immunology: August 2009 - Volume 9 - Issue 4 - p 329-333.
Indoor Allergen Avoidance

Allergy and Immunology News of the Day

Health News of the Day is a daily summary made from the selected links I post on Twitter. It is in a bullet points format with links to the original sources which include 350 RSS feeds that produce about 2,500 items per day.

• Allergen advisory labels: warnings included "may contain" (38%), "shared equipment" (33%), and "within plant" (29%). Nonspecific terms, such as "natural flavors" and "spices," were found on 65% of products. Many product labels have ambiguities that present challenges to consumers with food allergy. http://bit.ly/SMNxg
  
  
• Afamelanotide, a photoprotective drug, granted Orphan Medicinal Product for treatment of Solar Urticaria in Europe. Afamelanotide was approved in 2008 for treatment of erythropoietic protoporphyria (EPP). Solar urticaria affects approximately 3 per 100,000 people, as little as 5 minutes of sun exposure can cause hives http://is.gd/1xetz
  
  
• Travel Tips Checklist for Patients with Allergy And Asthma from ACAAI http://bit.ly/yPEfF
  
  
• Link between innate and adaptive immune system: Toll-like receptor 7 and 9 defects in common variable immunodeficiency http://bit.ly/2ZUSm
  
  
• Increased urinary leukotriene E(4) excretion in obstructive sleep apnea due to obesity and hypoxia http://bit.ly/pcog4
  
  
• The abstract submission site is now open for the 2010 AAAAI Annual Meeting, deadline is September 2, 2009 http://bit.ly/FUyrp
  
  
• SpringerImages (biomedical) can be used for almost all noncommercial purposes, presentations, etc. http://bit.ly/9dZMh & http://bit.ly/cgHRJ

Image source: OpenClipArt.org, public domain.

Allergy and Immunology Trivia

Thucydides (Athens, 5th century BC) first mentioned immunity to an infection that he called "plague" http://is.gd/1qgAQ


Bust of Thucydides residing in the Royal Ontario Museum, Toronto. Image source: Wikipedia, public domain.

Who was the boy who received the first vaccine by Edward Jenner in 1796? James Phipps http://is.gd/1qgRs


1802 caricature of Jenner vaccinating patients who feared it would make them sprout cowlike appendages. Image source: Wikipedia, public domain.

When does adaptive immunity (antibodies, T and B lymphocytes) appear in evolution? Vertebrates. http://is.gd/1qhK9

What species has the most immunoglobulin types? Homo sapiens (human) has 9 immunoglobulin types: IgG (1-4), IgA (1-2), IgM, IgE, IgD (GAMED)

What is the first immunoglobulin to appear in evolution? IgM, in jawed vertebrates. http://is.gd/1qhK9

Discoverer of phagocytosis, Mechnikov, made 2 unsuccessful suicide attempts (1875, 1880), then won the Nobel prize in 1908 http://is.gd/1qiLo


Ilya Ilyich Mechnikov, Nobel Prize in Medicine (1908). Image source: Wikipedia, public domain.

Combination of loratadine/montelukast relieves congestion similarly to pseudoephedrine in allergic rhinitis

The most common and bothersome symptom of allergic rhinitis (AR) is nasal congestion.

This study assessed efficacy and safety of a once-daily tablet containing 10 mg of loratadine, an antihistamine, and 10 mg of montelukast, a leukotriene antagonist versus placebo and pseudoephedrine (PSE; 240 mg once-daily).

In a multicenter, double-blind, double-dummy, randomized study, 1095 subjects with documented history of seasonal AR and positive skin-prick test to a prevailing aeroallergen were treated for 15 days.

There were no significant differences between L/M and PSE for any efficacy analysis.

Subjects treated with L/M experienced a similar incidence of adverse events versus placebo and a lower incidence of adverse events (dizziness, insomnia, jitteriness, nausea, and dry mouth) versus PSE.

Nasal decongestant activity of L/M was similar to that of PSE and better tolerated than PSE.

The authors concluded that L/M offers a safe and efficacious alternative to PSE for the treatment of nasal congestion in AR.


Medications for Allergic Rhinitis.

References:
Efficacy and safety of fixed-dose loratadine/montelukast in seasonal allergic rhinitis: Effects on nasal congestion. Prenner, Bruce; Anolik, Robert; Danzig, Melvyn; Yao, Ruji. Allergy and Asthma Proceedings, Volume 30, Number 3, May/June 2009 , pp. 263-269(7).
Allergic Rhinitis: A Short Review
Mind Maps: Allergic Rhinitis
Mnemonics: Allergic Rhinitis
Image source: Wikipedia, a Creative Commons license.

Olopatadine nasal spray may be as effective as fluticasone for allergic rhinitis

The efficacy of nasal antihistamines (NAHs) for allergic rhinitis (AR) is comparable with or better than second-generation oral antihistamines. NAHs have a faster onset of action and greater effect on congestion.

Limited data suggest that NAHs may be equivalent to intranasal corticosteroids at reducing congestion.


Olopatadine. Image source: Wikipedia, public domain.


Fluticasone propionate, Flonase (US and Canada) Flixonase (EU and Brazil). Image source: Wikipedia, public domain.

The efficacy of olopatadine 0.6% nasal spray (2 sprays/nostril b.i.d.) was compared with fluticasone 50 microg nasal spray (2 sprays/nostril q.d.) in a double-blind, randomized trial of 130 patients.

Both treatments reduced nasal and ocular symptoms throughout the 2-week study period.

The nasal symptom score decreased by 45.4% for patients treated with olopatadine and by 47.4% for those treated with fluticasone.

No significant between-treatment differences were determined for for congestion, runny nose, sneezing, itchy nose, and ocular symptoms. But olopatadine had a faster onset of action for reducing all symptoms.

The authors concluded that both olopatadine and fluticasone nasal sprays reduced nasal and ocular SAR symptoms with a faster and greater onset of action with olopatadine.


Medications for Allergic Rhinitis.

References:
Comparison of olopatadine 0.6% nasal spray versus fluticasone propionate 50 μg in the treatment of seasonal allergic rhinitis. Kaliner, Michael A.; Storms, William; Tilles, Stephen; Spector, Sheldon; Tan, Ricardo; LaForce, Craig; Lanier, Bobby Q.; Chipps, Bradley. Allergy and Asthma Proceedings, Volume 30, Number 3, May/June 2009 , pp. 255-262(8).
Allergic Rhinitis: A Short Review
Mind Maps: Allergic Rhinitis
Mnemonics: Allergic Rhinitis

Allergy and Immunology News of the Day

Health News of the Day is a daily summary made from the selected links I post on Twitter. It is in a bullet points format with links to the original sources which include 350 RSS feeds that produce about 2,500 items per day.

• How does exercise cause asthma attacks? Dehydration of the airways results in release of mediators. http://bit.ly/FXUaF
  
  
• Filaggrin gene defects increase the risk of developing allergic sensitisation, atopic eczema, and allergic rhinitis. Filaggrin gene defects are present in up to one in 10 western Europeans and North Americans http://bit.ly/S1r5b
  
  
• Company offers temporary tattoos to identify an allergy as in "I have a peanut allergy" http://tottoos.org and http://bit.ly/V8bIH -- "Medical Tottoos used to quickly identify severe allergies" - for example, "Allergic to Tree Nuts" http://bit.ly/hquhH
  
  
• Meaning of positive skin tests to foods? - a detailed answer by AAAAI Ask the Expert http://bit.ly/1wL91 -- If you want to find the answer to your allergy-related questions, search AAAAI Ask the Expert (bottom of the page) http://bit.ly/3PMFmN

Image source: OpenClipArt.org, public domain.

Contrary to popular belief, strawberry allergy is uncommon

Contrary to popular belief and the posts on some non-medical blogs, strawberry allergy is not common.

The largest specialty book, Middleton's Allergy (7th edition, 2008), does not even mention it on any of its 1924 pages. You can search for yourself another textbook - Allergy and Asthma: Practical Diagnosis and Management by Lange on Google Books - still no mention. In fact, AAAAI lists "Fresh Strawberry Sorbet" as Food Allergy-Free Recipe: http://l.pr/a4x1

Strawberry allergy is reported but not commonly. Only few cases of patients with adverse reactions to strawberry are listed in literature: http://bit.ly/grLe1

No strawberry allergen has been identified until 2004 when evidence about Bet v 1 emerged: http://bit.ly/gDbHO

No clinical reactivity was found in 66% of positive skin prick tests and 63% of positive specific IgE determinations to Rosaceae fruits: http://bit.ly/41XM8U. The species of Fragaria (strawberries) belongs to the family Rosaceae.

The double blind placebo controlled food challenge test remains the gold standard for exclusion test in suspected strawberry allergy.


Food challenges, mind map diagram.


Mind map of food allergy.


Eight top allergens account for 90 percent of all food allergies. The 8 top allergens can be remembered by the mnemonic TEMPS WFS:

Tree nuts (almonds, cashews, walnuts)
Egg white (not egg yolk)
Milk
Peanuts
Shellfish (crab, lobster, shrimp)
Wheat
Fish (bass, cod, flounder)
Soy

Diagnostic algorithm for food allergy: SAD Child:

1. Symptoms: close relation between specific food intake and symptoms, often affect 2 or more organs
2. Allergy testing: skin prick testing or ImmunoCAP.
3. Diagnostic diet: restricted diet leads to symptoms disappearance or significant reduction
4. Challenge - oral food challenge.

References: Clinical review: ABC of allergies, Food allergy. BMJ 1998;316:1299, figure.

References:
Food Allergy: A Short Review
Food Allergen Avoidance
Food Challenges
Mind Maps: Food Allergy
Mnemonics: Food Allergy
Image source: Fragaria × ananassa 'Gariguette,' a cultivar grown in southern France. Wikipedia, David Monniaux, GNU Free Documentation License.