AnaphylaxisFrom @MatthewBowdish:
Dr. Lieberman: Treatment of anaphylaxis: epi, epi, epi, then other modalities.
At 30 min po intake Benadryl, only 16% drug is 'active'. Just because someone w/ anaphylaxis gets better w/ Benadryl, doesn't mean the Benadryl successfully treated the condition.
Hypotension tended to be more common in anaphylaxis pts over 65.
Two complications of epi in these 54 'elderly' pts (age >50y) - one chest pain and one NSTEMI. Lieberman: shouldn't worry abt tx anaphylaxis in ASCVD pts with epinephrine. Epi doesn't restrict coronary blood flow.
About 60% pts given epipen on discharge from ER/inpatient. About a third had allergist follow-up.
@ACAAI: ACAAI President says peanut-free zones in schools & airlines unnecessary; allergists help acute sufferers deal: http://bit.ly/9rSqnp
Immunotherapy
Advances in immunotherapy
From @MatthewBowdish:
Dr. Finegold: Immunotherapy first became available clinically in 1911. What will the next century of immunotherapy involve?
Dr. Casale: intranasal toll-like receptor-8 agonist increased IL10, IL-12 and IFNg (VRXP-B103 study) with symptom score improvement in AR.
A newer form of CpG is still under development after the Cretticos product never panned out. Cytos CpG data of recent asthma study showing dec in steroids, maintained FEV1 and improvement in symptoms scores.
SLIT
Contrary to popular belief, anaphylaxis does occur in SLIT. More common: oral pruritus, angioedema, mucosal ulceration, etc.
Some ENTs in CO are doing SLIT, but they've called our clinic on three occasions with pts having systemic rxns. Are these rxns for the ENTs problem with standardization? multi-sensitized pts? inappropriate pt selection?
Other issues with SLIT in US: effective dose not known, risk factors in US pts not known and relative values are hard to know.
Dr. Canonica is suggesting that some of the less than impressive evidence for SLIT may be related to patient non-compliance. SLIT is not without risk, although thought to be more safe than traditional subcutaneous IT (SCIT)
Most allergistis not using SLIT because of lack of FDA approval. Estimated that only 5-6% allergists in US providing SLIT, with most using multiple allergens and taking cash w/o billing insurance. Billing insurance for SLIT might even be considered fraud.
Immunodeficiency
Dr. Steihm: transient hypogammaglobulinemia of infancy can persist past infancy...up to ages 5-6.
Dr. Orange: for every 121 mg/dL increase in IgG trough (not dose), there is a subsequent 27% decrease in pneumonia incidence (new meta analysis).
Poster sessions
From @MatthewBowdish:
Another reason why I'm in the best specialty: poster session has everything from tangerine seed anaphylaxis to hairy cell leukemia. Perhaps the most peculiar poster at the ACAAI meeting today - Urticaria to bologna.
Dr. Finegold: Immunotherapy first became available clinically in 1911. What will the next century of immunotherapy involve?
Dr. Casale: intranasal toll-like receptor-8 agonist increased IL10, IL-12 and IFNg (VRXP-B103 study) with symptom score improvement in AR.
A newer form of CpG is still under development after the Cretticos product never panned out. Cytos CpG data of recent asthma study showing dec in steroids, maintained FEV1 and improvement in symptoms scores.
SLIT
Contrary to popular belief, anaphylaxis does occur in SLIT. More common: oral pruritus, angioedema, mucosal ulceration, etc.
Some ENTs in CO are doing SLIT, but they've called our clinic on three occasions with pts having systemic rxns. Are these rxns for the ENTs problem with standardization? multi-sensitized pts? inappropriate pt selection?
Other issues with SLIT in US: effective dose not known, risk factors in US pts not known and relative values are hard to know.
Dr. Canonica is suggesting that some of the less than impressive evidence for SLIT may be related to patient non-compliance. SLIT is not without risk, although thought to be more safe than traditional subcutaneous IT (SCIT)
Most allergistis not using SLIT because of lack of FDA approval. Estimated that only 5-6% allergists in US providing SLIT, with most using multiple allergens and taking cash w/o billing insurance. Billing insurance for SLIT might even be considered fraud.
Immunodeficiency
Dr. Steihm: transient hypogammaglobulinemia of infancy can persist past infancy...up to ages 5-6.
Dr. Orange: for every 121 mg/dL increase in IgG trough (not dose), there is a subsequent 27% decrease in pneumonia incidence (new meta analysis).
Poster sessions
From @MatthewBowdish:
Another reason why I'm in the best specialty: poster session has everything from tangerine seed anaphylaxis to hairy cell leukemia. Perhaps the most peculiar poster at the ACAAI meeting today - Urticaria to bologna.
Related:
I do have a slight clarification to my tweet on Jordan Orange's talk on IgG replacement and pneumonia. The tweet I posted isn't correct. I should have written that for every 121mg/dL increase in IgG trough (not dose), there is a subsequent 27% decrease in pneumonia incidence. Sorry for any confusion.
ReplyDeleteImpact of trough IgG on pneumonia incidence in primary immunodeficiency: A meta-analysis of clinical studies.
Orange JS, Grossman WJ, Navickis RJ, Wilkes MM.
Clin Immunol. 2010 Oct;137(1):21-30.
http://www.ncbi.nlm.nih.gov/pubmed/20675197