What's new in allergy and immunology from UpToDate

35% of UpToDate topics are updated every four months. The editors select a small number of the most important updates and share them via "What's new" page. I selected the brief excerpts below from What's new in allergy and immunology:

Epinephrine autoinjectors

New epinephrine autoinjectors are available and some of these differ significantly. Doctors should write the specific name of the drug intended to be dispensed on the prescription rather than generic "epinephrine autoinjector." They should provide patient education that is specific to that product to avoid confusion.

Montelukast versus inhaled glucocorticoids in asthma

Children with mild-to-moderate persistent asthma who were treated with inhaled glucocorticoids had better pulmonary function and asthma control (eg, fewer asthma exacerbations requiring systemic glucocorticoids, less albuterol use, and lower symptom scores) than those treated with montelukast.

Step-up therapy in asthma

Options for step-up therapy include:

- increasing the dose of inhaled glucocorticoid
- adding a long-acting beta agonist (LABA)
- adding a leukotriene receptor antagonist (LTRA)

Step-up strategies can be used serially if the initial approach does not improve asthma control. Potential issues with long-term use of LABAs should be considered when choosing step-up therapy, especially in children younger than 12 years.

Food allergen avoidance

A survey of products with milk advisory labeling (eg, "may contain...", "processed in a facility with...", "manufactured on shared equipment with...") found that these items had a much higher frequency of contamination (42 percent) than products with peanut advisory labeling (7 percent).

Natural history of soy allergy

Earlier studies suggested that soy allergy is typically outgrown in the preschool-age years. However, a new study found that only 50 percent of children had outgrown soy allergy by seven years of age.

Formula selection in high risk infants

Infants who were fed partially hydrolyzed formula (pHF) had a lower risk of atopic dermatitis (AD) than those fed cow's milk (CM) formula. This was particularly true in those infants at high risk because of family history of atopic disease.

Venom immunotherapy


The majority of patients are protected from a repeat systemic reaction to a challenge sting within one week of reaching a maintenance dose of 100 micrograms of venom. Challenge sting: to bee or not to bee? Sting challenges don't add much to current diagnostic testing & increase risk http://goo.gl/F50dX

Montelukast and immunotherapy

The administration of montelukast during subcutaneous immunotherapy (SCIT) may reduce the clinical and immunologic efficacy of SCIT. Induction of regulatory T cells, one of proposed therapeutic mechanisms of SCIT, was diminished in the group receiving montelukast.

References:
What's new in allergy and immunology. UpToDate.

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