Allergic rhinitis - a Twitter summary from the 2011 ACAAI meeting

This summary was compiled from the tweets posted by some of the allergists who attended the 2011 ACAAI meeting. The tweets were labeled #ACAAI. The text was edited and modified by me.

Allergic rhinitis (AR) and bronchial hyperresponsiveness

Many AR patients have diminished FEF 25-75%, a volume lower than 70% of predicted may be a risk factor for subsequent asthma development (Am J Rhinol Allergy. 2011). 40% of patients with allergic rhinitis have bronchial hyper-responsiveness.

Local allergic rhinitis (non-allergic rhinitis with local IgE production)

Local allergic rhinitis means that the patient is symptomatic to nasal allergen challenge but they have a negative SPT/IgE measurement. There is a debate rewarding the best approach to diagnosis and management (JACI 2011).

Pepper spray (capsacain)

Pepper spray (capsacain) in NAR. The nasal and sinus symptoms improved in 53 seconds but how can a pepper spray have a proper placebo to test a true difference? (Annals of Allergy, Asthma & Immunology, 2011).

Various nasal steroids

There is no evidence for differences in effectiveness of the various nasal steroids. There is a role for patient preference though.

New "dry" nose sprays

There were multiple abstracts at the ACAAI meeting about HFA containing aerosol nasal treatments, with both beclomethasone and ciclesonide being used.

Existing nose sprays deliver the product in large droplets that feel uncomfortably wet to many patients. Complaints that the liquid drips out of their noses or down into their throats are common. The new "dry" formulations are intended to fix these aspects of intranasal steroid sprays. The new ciclesonide and beclamethasone sprays are driven by hydrofluoroalkanes (HFA), the propellant now used in metered-dose asthma inhalers (MedPage Today report from the ACAAI meeting).

Allergy to pets

A practice parameter for "Furry Animals" is coming in 2012.

90% of homes have measurable allergen to cats and dogs. Fewer than 50% of cat-allergic individuals report direct cat exposure (at home or elsewhere) (JACI, 2012). There is a 9-fold risk of back to school asthma for cat allergic children when attending school where there are many cat owners.

Hypoallergenic cat breeds (genetically bred to have no Fel d1) still produce Fel d2 (20% of cat-allergic patients are allergic to this).

There is a possible link between Can f5 (dog allergen) and human seminal fluid allergy.

Cat and mold particle sizes are much smaller, so there is need better filtration vs. dust mite or pollen particles. Also, the smaller sizes makes it easier to get further into the lungs. There is no conclusive evidence that duct cleaning will result in improved allergy symptoms.

Carpeted floors get 100-fold more cat allergen than polished floors.

Skin-prick testing for cat allergy has 100% sensitivity and 93.5% specificity - intradermal testing did not add value (

Chronic sinusitis

For chronic inflammatory rhinosinusitis, some experts recommend Pulmicort respules 500 mcg or 1000 mcg in Pediatric Sinus Rinse BID.

This summary was compiled from some of the tweets posted by Dr. David Fischer @IgECPD4, Robert Silge, MD, @DrSilge, Danny Ramirez, MD @allergysa, and a few others. The tweets were labeled #ACAAI and they reached more than 10,000 people. I would strongly encourage you to post updates on Twitter from the CME conferences that you are planning to attend in the future. Disclaimer: The text was edited, modified, and added to by me.

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