This summary was compiled from the tweets posted by the following allergists/immunologists who attended the 2012 annual meeting of the American Academy of Allergy Asthma and Immunology (AAAAI): Stuart Carr @allergydoc4kidz and Sakina Bajowala, M.D @allergistmommy. The tweets were labeled #AAAAI. The text was edited and modified by me.Stephen Durham compared SCIT vs SLIT:
IT should be combined with allergen avoidance, education, and pharmacotherapy (medications).
SCIT is clearly effective for AR, but the studies are very heterogeneous. There is a very similar treatment effect size for SCIT on allergic asthma.
Recent meta-analysis for SLIT showed moderate beneficial effect on AR, those were more homogeneous studies than SCIT. More large high quality SCIT/SLIT studies are still needed given the tremendous heterogeneity in existing trials.
SLIT is safer but perhaps slightly less effective than SCIT.
A large trial of grass tablet IT showed almost identical effects on symptoms and medication requirements to SCIT.
3-5 years of treatment with SCIT (grass and venom) gives 3-5 years of remission in AR. A recent study with grass SLIT showed a similar remission for 2 years after 3 years of SLIT. Allergen-specific IgG4 levels remain elevated, with persistent IgE blocking, for 2 years after grass SLIT.
Mechanisms of allergen-specific immunotherapy (click to enlarge the image). CD27 expression on allergen-specific T cells may be a new surrogate for successful allergen-specific immunotherapy (JACI, 2012).
Michael Blaiss presented on SLIT:
Only recently do we have double-blind placebo controlled studies for SLIT.
Why has it been so hard to get SLIT approved by the FDA?
SLIT studies are complicated by variability in pollen levels.
SLIT should not be considered a medication. It is more accurately described as a vaccine. The FDA has not made clear what would be required for approval. Will likely be a higher standard than for medications. Guess? P value <0.005.
Does SLIT work for multi-allergen treatment?
SLIT appears less effective. Are we saturating Langerhans cells, or are volumes too high?
Related: Sublingual Immunotherapy is Attracting Interest, Not Evidence - Medscape interviewed experts at 2012 #AAAAI http://goo.gl/arhcd
Kari Nadeau presented new insights in IT mechanisms:
Specific IgG4 level is a consistent marker of tolerance induction. Increased IL-10 production is also a consistent finding in studies of tolerance.
Anergy/clonal deletion appears to occur in cases of true tolerance induction, after a peak then a decline in specific IL-10+ Tregs.
Allergists achieved highest use of social media by any specialty
During the 2012 AAAAI meeting, the allergists achieved the highest use of social media by any specialty. There are more than 100 allergists on Twitter and 30 of them posted simultaneously from the annual meeting, broadcasting thousands of tweets tagged with #AAAAI. The annual AAAAI meeting was attended by approximately 5,000 people. In comparison, the 30 allergists on Twitter reached 250,000 people (measured by TweetReach.com on 03/04/2012).
This summary was compiled from some of the tweets posted by Stuart Carr @allergydoc4kidz and Sakina Bajowala, M.D @allergistmommy. I would strongly encourage you to post updates on Twitter from the CME conferences that you are planning to attend in the future. Here is how to do it: Twitter for Physicians: How to use Twitter to keep track of the latest news and scientific meetings, and share information with colleagues and patients.
Disclaimer: The text was edited, modified, and added to by me. This is one of a series of posts that will be published during the next few weeks.