Annual Literature Review (#ACAAI19 Twitter summary)

Robert Rogers @choirdoc: Always inspired to see so many colleagues willing to sacrifice $ and time away from family/practices to keep up to date on current research, so that they can provide the best care of patients with allergic disease. Literature Review #ACAAI19

Dr. Dave Stukus @AllergyKidsDoc: 500 attendees...9 hours of literature review - it’s journal club on steroids! Friday is off and running at #ACAAI19 - many look forward to this annual event & hearing from experts to get a year’s worth of journal articles in one day!

Dr Alexei Gonzalez @alexeigonzmd: Antibodies blocking Galectin-10 (which makes up Charcot-Leyden crystals) reversed asthma effects in a mouse model.

Epithelial stem cells may harbor memory of allergies though IL-4/IL-13 exposure which may add to the persistence of CRSwNP.

Modulation of intestinal microbiome (clostridial species) might be a potential therapy for food allergy. Food allergy individuals have reduced IgA but increased IgE binding to fecal bacteria.

Robert Rogers @choirdoc: It's not crazy to think that we might be able to treat patients with food allergy using bacteria (fecal transplants, probiotics).

Dr Alexei Gonzalez @alexeigonzmd: LIBERTY NP SINUS-24 and 52 trials: Dupimulab In CRSwNP reduced polyp size, improve symptoms, Th2 biomarkers and sinus CT scans; reduced oral steroid use and need for sinus surgery; 7 cases of conjunctivitis (AE).

AERD: Diagnostic aspirin challenge should be considered with suspected AERD prior to ESS to increase diagnostic accuracy; Ur LTE4 may not be reliable after surgery .

Around 65% of patients with Evans syndrome (AHA+ITP) will have damaging mutations in genes that cause Primary Immunodeficiency.

If you have a patient with “CVID” and high IgE and/or multiple ST-positives: re-think the diagnosis!

PID: Pre-post pneumococcal tigers in patients to evaluate for possible Ab deficiency, you MUST send both samples to the same lab.

Appears that SCIG may be useful in decreasing serious infections and possibly mortality in patients with multiple myeloma.

Using strict criteria (AEC higher than 300, eNO higher than 50), only 2% of adult patients were candidates for IL-5 monoclonal therapy.

Poorly controlled asthma is frequent in #pregnancy; 19% have severe asthma based on a recent US population based study.

E-cigarettes were more effective for smoking cessation than nicotine-replacement therapy; however those patients continue to smoke E-cigarettes.

Dr. Ellis @DrAnneEllis: Joining the AM Literature Review session - First up for the last of the AM is Dr. Mark Riedl - Update on Skin Diseases, Urticaria, Angioedema and other Skin Disorders.

Autoimmune CSU should be considered an immunologically distinct subtype of CSU - these patients may respond less well to omalizumab and more so to cyclosporine - problem is the tests not commercially available (e.g. ASST, basophil activation).

2 patients developed SAE to dapsone- 1 case of DRESS syndrome and 1 case of methemoglobinemia.

Hofman et al reporting a "High occurrence of antihistamine resistance in patients with recurrent idiopathic angioedema" - Clin Transl Allergy 2019 July 12.

64% of patients with recurrent idiopathic angioedema responded to prophylactic antihistamines, 31% no change, 5% actually worsened.

Updates in hereditary angioedema - Riedl presenting the Phase 3 pivotal trial of lanadelumab for prophylaxis in HAE showing obviously positive results. Lanadelumab reduced HAE attack rates - 0.5 per month compared with 2 per month in the placebo group.

Other prophylactic studies of HAE - plasma derived C1 inhibitor given SC at 40-60 IU/Kg shown to be effective in reducing attack rates as well. The 60 IU/kg dose was the one ultimately approved by the FDA.

AVON longitudinal study of children with atopic dermatitis and their children - almost 14,000 mother/child pairs - high prevalence of night time awakenings and early morning awakenings in young children - as they get older issues with falling asleep.

Dr. Kelso now presenting Pediatric Allergy Updates -starting with a study of cold-induced urticaria in children. 18.6% of the children in one case series of cold-induced urticaria experienced cold-induced anaphylaxis - swimming was trigger in vast majority (77%), others included being in a cold hospital room or receiving an infusion of cold saline/med!

Summary lessons -children with cold urticaria can have anaphylaxis and should be counseled to avoid swimming alone or in cold water.

Wool alcohols, surfactant, bichromate and fragrance mix were common causes of allergic contact dermatitis in children with atopic dermatitis.

Glue and Borax are both perfectly capable of causing allergic contact and irritant dermatitis - ask about slime making habits in children with hand dermatitis!

Maya Gharfeh MD @MayaGharfeh Persistent hand dermatitis in teens? Ask about slime!

Dr. Ellis @DrAnneEllis: Some milk allergic children can tolerate yogurt in a study by Keskin - 34 patients with OFC proven cow's milk allergy; 50% were able to tolerate yogurt with no reaction.

54% of children with peanut allergy avoid all tree nuts. Regardless of negative skin tests to same. Main reason fear of cross-contamination.

Esophageal brushings via NG tube may be a way to monitor EoE without repeat endoscopies.

Tim Trojan @OkieAllergy: Difficult to control atopic dermatitis may owe to occult contact dermatitis (75% in study). Contact derm agents found were often used to treat the atopic dermatitis

Only 12% of stinging insect anaphylaxis patients get a referral to an Allergist from the ED. Another take is you have an 88% chance of not getting standard of care on discharge.

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