What separates Allergists from other specialists: atopy and immunotherapy - Twitter summary from #ACAAI16 meeting
Dr. Hal Nelson presented on What separates Allergists from other specialists?
Allergists are not defined by an organ system. Rather we focus on 'atopy'. Coca and Cooke described Atopy in 1922 - strong hereditary component, clustering of eczema, rhinitis and asthma with positive SPT.
Pollen sensitization a risk factor for allergic rhinitis. Not so for asthma. Perennial allergen sensitization to HDM, animals is important.
House dust mite avoidance can actually reduce bronchial hyperresponsiveness (classic Davos study - moved the kids to HDM free zone) .
Because of differences of impact of seasonal vs perennial allergen sensitization, allergists become armchair Aerobiologists.
Intradermal skin testing is 1000x more sensitive than skin prick testing - is it clinically relevant though? A study showed that with positive intradermal tests (if SPT was negative) were no different than negative tests and lower/upper respiratory symptoms.
Requirements for effective immunotherapy: adequate doses of relevant allergen; attention to cross-reactivity; maintain extract potency.
SCIT effective doses established for ragweed, grass, dust mites, cat, dog, birch and Alternaria mold - of note, dog extract was changed. The RCT that established the effective dose of ragweed allergen to put in an SCIT treatment set was published in 1965!
SLIT is effective and FDA approved SLIT-T, SLIT drops are not FDA approved.
Dr. Michael Nelson presented on Allergen Immunotherapy: Current Best Practices.
Immunotherapy has been around for over 100 year now - a treatment doesn't last that long if it doesn't work.
Starting AIT - should we consider starting earlier to allow for prevention of new sensitizations, new asthma? Knowing that AIT needs to be given for at least 3-5 years to allow for disease modification means selecting the right patient to start.
Best practice is to have a trial off immunotherapy after 5 years - yes, some will recur but many will not, not a reason to do lifelong AIT.
@choirdoc: Biggest surprise in my career was learning how resistant many patients are to stopping IT.
The Payne and Nelson study of AIT prescriptions within DOD database showed only a 50% refill in AIT after 1st year of therapy.
Early and complete patient education leads to enhanced patient selection and adherence - route, procedures, AEs, duration, adherence importance.
The AIT practice parameter published in JACI 2011 shows probable effective doses for both standardized and nonstandardized US extracts.
We need to separate extracts with proteolytic enzyme activities from other extracts. Don't mix molds with pollens - need 2 vials.
This is a Twitter summary from #ACAAI16 meeting. The post is a part of series. See the rest here: http://allergynotes.blogspot.com/search/label/#ACAAI16
Several allergists did a great job posting updates on Twitter from the 2016 meeting of ACAAI, the hashtag was #ACAAI16. I used the website Symplur to review the tweets:
Presentation handouts are available from the ACAAI website: http://annualmeeting.acaai.org/session_presentations.cfm