New developments in A/I - Annual literature review - Twitter summary from #ACAAI 2013 meeting

This Twitter summary from the 2013 meeting of the American College of Allergy, Asthma & Immunology (#ACAAI) was based on tweets by the following allergists/immunologists:

Robert Rogers ‏@choirdoc
Andrew Nickels ‏@AndrewNickelsMD
Dr. Dave Stukus ‏@AllergyKidsDoc
Robert Silge, MD ‏@DrSilge

Most probiotics contain milk protein; many don't list it as ingredient. "Low-dust" chalk contains casein; can induce asthma in milk-allergic students.

Parents who "clean" pacifier by sucking it markedly reduce risk of asthma and eczema in their kids.

Yet another study confirms that all dogs produce airborne dander, so there is no "hypoallergenic" dog. Sorry, breeders.

Face-down position for 20 min twice a day for 6 weeks shows a marked benefit in resolution of sinusitis. “Logical. Brilliant”, says one of the allergists attending the meeting.

High fast food diet related to higher incidence of all atopic disease; high fruit diet reduces risk of atopic disease

Dupilumab, monoclonal ab to IL4 receptor, reduced exacerbation in asthmatic with eosinophilia.

Impulse oscillometry is an effort independent method to measure airway resistance. However, the cost is $50,000 for the device.

Allergic rhinitis

Panel discussion on SAR feels that FDA is going to push more drugs OTC, largely to shift costs to patients. Nasal steroids are just the start. Fluticasone is OTC basically everywhere else in the world. What % of the time does a patient come to the allergist already on fluticasone? Pretty often. We’re not going to lose a ton of patients to OTC INS.

Patients don't always understand the burden of allergic rhinitis & impact on quality of life, especially poor sleep = fatigue. Poor control of allergic rhinitis = missed school/work, decreased activities - overall grumpiness! Allergic rhinitis is an 'itis' = inflammation. Most effective therapy are intranasal steroid sprays, especially for congestion.

Angioedema

Aliskiren (direct renin inhibitor) has Hazard Ratio of 8.84 for serious angioedema.

HAE deaths occur more often in undiagnosed disease. It presents most often in the morning hours with angioedema with HAE.

HAE should be treated early to avoid fatal laryngeal edema. Robert Rogers ‏@choirdoc: HAE patient discussed sense of guilt of needing to use such an expensive medication. I never considered that aspect.

Progestin therapy for patient with no allergic angioedema maybe of benefit at low doses. More studies are needed to understand effects and ADEs.

Urticaria

Xolair is shown to be effective in chronic urticaria. However, length of therapy with CIU is still unclear.