What is the safe FEV1 level on spirometry to start subcutaneous immunotherapy (SCIT) (allergy shots)?

What is the safe FEV1 level on spirometry to start subcutaneous immunotherapy (SCIT) (allergy shots)? At least 80% of predicted.

Dr Ledford explains below:

In the AAAAI’s survey of physician members on immunotherapy- and skin testing–induced fatal reactions and NFRs during the period of 1990-2001, 15 of the 17 fatalities occurred in patients with asthma, and in 9 patients not optimally controlled asthma was considered the susceptibility factor that contributed to the fatal outcome.The most severe NFR, respiratory failure, occurred exclusively in asthmatic patients, and 4 (57%) of 7 asthmatic patients had a baseline FEV1 of less than 70% of predicted value.

 In a prospective study of 125 asthmatic patients with mite allergy that used a 3-day rush immunotherapy protocol, FEV1 was identified as a predictor for systemic reactions. In this study 73.3% of the patients with an FEV1 of less than 80% of predicted value experienced an asthma reaction during rush immunotherapy, whereas only 12.6% of patients with an FEV1 of greater than 80% of predicted value had asthmatic reaction.The authors noted that if the patients with an FEV1 of less than 80% of predicted value had been excluded from the study, the systemic reaction rate would have been 19.7% instead of 36%. These studies suggest that labile asthma, severe asthma, or both is a risk factor for immunotherapy.

References:

https://www.aaaai.org/ask-the-expert/spirometry-immunotherapy

Currently available biologic therapies (biologics) for asthma

Anti-IgE therapy

- Omalizumab (Xolair). Adult dose: 150–375 mg SC every 2–4 weeks (based on patient’s weight and pre-treatment serum IgE level). Pediatric dose: Not indicated for children younger than 6 years. 75–375 mg SC every 2–4 weeks (based on patient’s weight and pre-treatment serum IgE level)

Anti-IL5 therapy

- Mepolizumab (Nucala), 100 mg SC every 4 weeks. Not indicated for children younger than 18 years.

- Benralizumab (Fasenra), 30 mg SC every 4 weeks for the first 3 doses, then every 8 weeks thereafter. Not indicated for children younger than 18 years.

- Reslizumab (Cinqair), 3 mg/kg IV every 4 weeks. Not indicated for children younger than 18 years.

References:

Asthma, Practical guide for allergy and immunology in Canada 2018 https://buff.ly/2CXsbwf

A series of excellent, updated, open-access articles on multiple allergy topics by Canadian allergists/immunologists

Here is the Practical guide for allergy and immunology in Canada 2018. This is a series of excellent, updated, open-access articles on multiple allergy topics by Canadian allergists/immunologists, released during #CSACI18 :

https://aacijournal.biomedcentral.com/articles/supplements/volume-14-supplement-2

Follow the latest updates from the CSACI annual meeting ongoing right now:

https://twitter.com/hashtag/csaci18?f=tweets&vertical=default&src=hash&lang=en

I was invited as a speaker during one of the CSACI meetings a few years ago and I can confirm from a personal experience that the CSACI members are a group of excellent and highly dedicated allergists/immunologists. They have an active Twitter presence as well.

Time for a paradigm shift in asthma guidelines: tools to monitor asthma across the lifespan

From JACI:

Here are some tools that may help achieve asthma control:

- assessment of lung function over time or defining trajectories of lung growth
- the Composite Asthma Severity Index score,
- a panel of useful biomarkers
- the Seasonal Asthma Exacerbation Prediction Index score
- rapidly advancing technology that includes adherence monitoring

Future guideline revisions should consider incorporating the following:

- follow spirometry over time to define trajectories of lung growth to assess risk for reduced lung growth and early decline
- asthma burden by using biomarkers to select and monitor therapy
- assessment of social determinants of health
- evaluation of risk for seasonal exacerbations
- consideration of electronic adherence monitoring for difficult-to-manage asthma

References:

Asthma across the lifespan: Time for a paradigm shift https://buff.ly/2MTjRCi

How to Read Food Labels if You Have Food Allergies



8 foods cause 90% of food allergies (click to enlarge the image). The likelihood of a negative oral food challenge is shown in relation to the respective values of skin prick test (SPT) and serum IgE (sIgE).

The Food Allergy Research & Education (FARE) has some helpful tips How to Read Food Labels if You Have Food Allergies:

The only way to prevent a food-allergy reaction is to avoid the problem food.

While all ingredients in a food are supposed to be listed in the ingredients list, the US law (FALCPA) only covers the eight most common allergens. These are milk, egg, peanut, tree nuts, soy, wheat, fish and crustacean shellfish.

For example, the law is different in Canada where the following allergens must be declared on all food labels (see the tweets below):

Egg
Milk
Wheat
Fish
Shellfish
Peanut
Tree nuts
Soy
Sesame
Mustard
Sulphites
(and gluten)

Note that molluscan shellfish—such as oysters, clams, mussels or scallops—are not required to be labeled as a major allergen.

The “May Contain” Statements does not mean much: You may also notice other precautionary language on food labels. These include statements such as “may contain,” “processed in facility that also processes” or “made on equipment with.” Such advisory labeling is voluntary for manufacturers. There are no laws governing it.

Precautionary allergen labeling ("may contain", etc.) is voluntary and unregulated in the U.S. and most other countries. Contact manufacturer and ask specific questions about food allergen content.

How to Read Food Labels if You Have Food Allergies

1. Familiarize yourself with your allergen and the foods it often appears in. Food allergens can appear in surprising places and go by less-common names. Knowing your allergen inside and out will improve your sleuthing skills.

2. If you are unsure whether a product could have come in contact with your allergen(s), call the manufacturer. Ask them about their ingredients and manufacturing practices.

3. If you encounter a product that doesn’t have an ingredients list, don’t buy it.

4. Be extra careful with imported products. Food labeling regulations vary by country. Imported items are supposed to follow FALCPA and other domestic food labeling laws, but occasionally they do not.

5. A child with a food allergy can start checking food labels as soon as he or she learns to read. Practice at home and when you’re shopping—with help from an adult.

For food allergen-specific instructions, see this PDF from FARE: https://buff.ly/2FzB108





References:

How to Read Food Labels | Food Allergy Research & Education https://buff.ly/2L4p0CZ