HIGHLIGHTS OF ABSTRACTS PRESENTED

AT THE MEETING OF THE

AMERICAN ACADEMY OF ALLERGY, ASTHMA, AND IMMUNOLOGY, MARCH 14-18, 2008

(Published in the Feb. 2008 volume, JACI)
 

1. Dexamethasone (Decadron) is mentioned in Abstract #3.  This oral and injectible corticosteroid is important as the only such medication (since Celestone – Betamethasone – became unavailable for oral use) which is effective in patients who have become unresponsive (“steroid resistant”) to prednisone and methylprednisolone.  It is especially useful in some of our asthmatic patients. 
2. The measurement of exhaled Nitric Oxide is finally approaching clinical availability in the evaluation of inflammation in bronchial asthma and chronic bronchitis – asthma variant.  It compares well with other measures of inflammation.  See Abstracts # 123, 292, 605, 612.
3. Abstract 20 notes a positive correlation found between early onset asthma and adult respiratory status. 
4. The subject of generalized reactions to allergy immunotherapy injections, although real, is often presented in overwrought fashion.  Abstract # 101 suggests pretreatment with anti-histamines…which I discourage as giving a possibly false sense of security.  Strict adherence to safe protocol results in very rare reactions.  Such reactions are discussed in Abstracts #481 and 549.
5. Allergic reactions to foods are the subject of numerous abstracts: a) most reactions in children occur in school, not in buses - #106; b) RAST, puncture-prick, intradermal and patch testing are discussed in #400; c) casein-containing chalk may be the reason for increased asthma in milk-allergic children in school - #714; d) one can be allergic to goat and sheep milk without being allergic to cow’s milk - #716; e) the issue of histamine in wine is discussed in #’s 746, 908, and 910; f) cross-reactions between peanut (a legume) and nuts…in addition to the problem of manufacturing proximity…are discussed in #936; g) desentization for milk allergy is discussed in #’s 962 and 982; h) oral desensitization to peanut and milk is discussed in #’s 530,531.
6. There is an increased risk of invasive pneumococcal disease in the presence of allergic disorders - #122.
7. The  “Atopic March” is alive and well: a) atopic dermatitis is often the firstr step, and its clearing may not alter the march to other allergic manifestations - #126; b) the use of probiotics in infancy seems to lower the occurrence of allergies - #129; c) the potential of Rituximab (anti-CD-20) is discussed in #138; d) exclusive breast feeding for four or more months is protective - #144.
8. Omalizumab (Xolair) is the topic of several abstracts: a) possible use in insulin allergy - #150; b) in hyper-IgE Syndrome - #341; c) has no effect on T-cell responses - #446; d) reasons to discontinue - #537; e) improves quality of life in asthma - #592; f) is being used in patients with IgE over the currently stipulated maximum of 700 - #845.  This approach to dealing with the underlying cause of atopic allergies (IgE) continues to be a distant second to properly evaluated and implemented allergy immunotherapy.  But at least, finally, asthmatic patients of Pulmonologists are getting some attention to this basic matter. 
9. Eosinophilic Esophagitis has been re-discovered: a) diagnosis is by biopsy, and correlates well with presenting symptoms = #;s 169, 177; b) dysphagia is a common presenting symptom, often secondary to major motor disturbance of small muscle function - #’s 271,273; c) it may present in various ways - #285; d) these patients should be tested for food sensitivities - #’s 399,400,402.
10. Concomitant use of nasal decongestants and nasal steroids is discussed in #215.  I discourage this.
11. Systemic reactions to percutaneous skin testing reportedly occurs in 3.5% of patients, for which the prompt administration of epinephrine is useful - #223.
12. Subcutaneous IG is a more convenient and also effective mode of administration, as compared with  IVIG - #230.
13. SSRI anti-depressants do not affect histamine wheal size – 234.
14. Long-term use of inhaled nasal steroid (over 3-4 years) appears safe in children and adolescents - #235.
15. Wheezing Rhinovirus infection in early childhood predisposed to later asthma - #’s 240,561.
16. Known for many years, diesel exhaust exposure has both early and late effects, and increases the likelihood of asthma (think school buses!) - #’s 252,253.
17. Abstract # 262 discusses protocols for desensitization to retuximab and other chemical agents. 
18. Sublingual desensitization is experiencing a revival of interest, although I don’t believe it is yet ready for prime time – #’s267, 370, 493. 
19. Allergy Immunotherapy is very useful in children, although I find it rarely necessary below the age of 5 years - #289.
20. Genetics in Asthma occurrence and progression are discussed in #297.
21. Positive ANA is correlated with lack of proper control in asthma - #298.
22. The use of pulmonary function testing, which I find very useful in determining adequacy of actual – vs clinical – control – is discussed in #311.
23. Immunodeficiency: a) this should include isolated IgA deficiency - #331; b) CVID is associated with recurrent purulent infections and reduced lung function - #339; c) a new IVIG (Privigen) is discussed in #’s 634,635.
24. Peanut Sensitivity; a) efforts at rush desensitization (not recommended by me), #’s 370,371,375,528,529,532; b) “may outgrow”, #567; c) associated with increased risk of other food sensitivities, especially if the reactivity is severe - #’s932, 976.
25. Hereditary Angioneurotic Edema can be treated with replacement of C1-esterase inhibitor (#380) and by use of fresh frozen plasma (#383).
26. Chronic Urticaria:  a) when associated with autoimmune disease (#396), and b) may be treated with (Xolair), with which I have no experience (#’s 566, 872). 
27. A form of Lactobacillus, another probiotic, may be useful in decreasing the asthma response - #’s 470,714.
28. Therapy of asthma: a) remember Cardiac Asthma - #621; b) there is too much use of ICS /LABA therapy vs ICS mono-therapy, leading to increased mortality…a point with which I agree, given the propensity for the development of tolerance to excessive use of beta adrenergic therapy - #’s 551, 596; c) early screening and diagnosis is vital to effective asthma control - #609; d) s-Tryptase in induced sputum is correlated with increase in eosinophiles and with increased severity of asthma - #806; e) HSCRP may be a useful marker for persistent inflammation in asthma, although it does not correlate with exhaled Nitric Oxide of local eosinophile count - #760; f) staphylococcal enterotoxins may play a role in asthma severity - #765.
29. As we have learned more pointedly in recent years Vitamin D plays an important role in many metabolic functions in addition to bone health.  This is all the more important given the fact that many if not most people are deficient in this vitamin. Abstracts # 555 and 752 note that low levels in patients with bronchial asthma contribute to increased exacerbations and to problems with bone health.
30. The existence of a “naso-ocular reflex” prompts the use of nasal inhaled steroids for ocular symptoms - #582.
31. “Broncho-thermoplasty” is being studied as a possible treatment for asthma.  But its long-term effects remain unknown - #590.
32. Inhaled Corticosteroids: a) no growth retardation in children younger than six years, but growth must still be monitored - #602; b) concentrated usage (2X, 4X) during exacerbations reduces symptoms and reduces need for oral steroids - #842; c) indications for reducing or eliminating ICS are discussed in # 844.
33. Aspirin Sensitivity: a) # 613 describes bronchial and oral challenge tests; b) NSAID reactivity is becoming increasingly common - #727; c) aspirin desensitization is described in # 737; d) extra-respiratory reactions are discussed in #747.
34. Regarding Pneumovax, pre-immunization antibody level reduces response, but does not eliminate it.
35. Sarcoidosis: those patients with elevated IgE are improved on Xolair - #668, probably reflecting combined disease with bronchial asthma.
36. Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis are very serious systemic diseases, usually caused by drug reactions, especially anti-epileptic medications - #’s 724,733,743.
37. For Penicillin testing, both major and minor determinant materials may be available from Kaiser-Permanente in California - #740.
38. Abstract #750 suggests reasons for an OPD Allergy consultation.  Tell that especially to the pediatricians.
39. Myelitis with atopic diathesis may be caused by infection with Toxicara - #782
40. Cross-reaction among latex, tobacco and other related species is described in # 857.
41. According to #’s 923 and 925, egg-allergic patients can tolerate influenza vaccine without ill effect, even when given in a single dose.  (?).