American Academy of Allergy, Asthma & Immunology, Feb. 22-25

The American Academy of Allergy, Asthma & Immunology

The annual meeting of the American Academy of Allergy, Asthma & Immunology was held from Feb. 22 to 25 in San Francisco and attracted more than 5,000 participants from around the world, including clinicians, academicians, allied health professionals, and others interested in allergic and immunologic disease. The conference highlighted recent advances in allergy, asthma, and immunology.

In one study, Ruchi S. Gupta, M.D., M.P.H., of Northwestern University in Chicago, and colleagues found that both children and adults with sesame allergy report severe sesame-allergic reaction symptomatology, epinephrine autoinjector use, and food allergy-related emergency department visits at comparable rates to patients with the other top eight food allergies.

"Over one million U.S. children and adults have a reported sesame allergy with a history of convincing immunoglobulin E-mediated reaction symptoms and/or a physician-diagnosed sesame allergy," Gupta said. "These estimates are based on the largest, most comprehensive study of the U.S. population-level burden of sesame allergy to date (approximately 80,000 participants). These data suggest that in the United States, sesame allergies may be comparably prevalent and serious as other allergies for which allergen labeling is currently required by the U.S. Food and Drug Administration (i.e., pine nut, macadamia nut)."

Gupta notes that physicians should be aware that sesame allergy is frequently comorbid with other major food allergies -- particularly peanut allergy (which affects one in two sesame-allergic patients) and tree nut allergies (which affect one in three sesame-allergic patients).

"Also, approximately one in four adults with a sesame allergy reported their first reaction during adulthood, so physicians should be aware that these allergies can develop among patients of all ages," Gupta said. "Our data also suggest that sesame allergies are likely to affect U.S. children and adults of all races/ethnicities, income strata, sexes, and geographic regions."

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In another study, Edwin Kim, M.D., of the University of North Carolina at Chapel Hill, and colleagues found that egg oral immunotherapy (OIT) has the potential to allow for the introduction of dietary egg, which is maintained even five years after completing OIT.

"In our study, after up to four years of egg OIT, subjects fell into four groups: sustained unresponsiveness (SU), desensitized, nondesensitized, and placebo. SU meant [that they could] could eat 10 g of egg (7 g = one whole egg) on treatment and again even after stopping treatment for four to six weeks," Kim explained.

According to Kim, desensitized meant eating 10 g on treatment but not being able to do this after stopping treatment. Nondesensitized meant likely eating more egg than when fully allergic but not being able to eat the whole 10 g.

"Kids who got SU after treatment seemed to be able to eat both concentrated forms of egg and baked forms of egg [and] eat it much more often and in larger quantities per sitting than the others," Kim said.

The investigators also found that children who were desensitized and nondesensitized were more variable in the types of egg they could consume, although most could eat baked eggs. They mostly ate egg less frequently and in lesser amounts. Symptoms with baked eggs were not common in any groups, but symptoms with concentrated forms of egg were more common in the desensitized and nondesensitized groups compared with the SU groups.

"Egg OIT could be an option for patients who can't tolerate baked egg naturally to allow for the introduction of egg into the diet with its associated improvements in quality of life, nutrition, and potential for speeding up natural resolution of egg allergy," Kim said.

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Nandinee Patel, M.D., of Imperial College London, and colleagues assessed the use of boiled peanuts to induce desensitization in children with peanut allergy. Specifically, the investigators evaluated whether peanuts, prepared by parents at home, could be as effective and safe to induce desensitization.

"We recruited 47 children, aged 8 to 16 years, with peanut allergy; 32 children started oral immunotherapy immediately (treatment group) with a daily dose of boiled peanut before switching to roasted peanut from supermarkets around halfway into the study," Patel said. "Fifteen children were randomized to a control group, which was standard management (peanut avoidance group)."

At the beginning of the study, the majority of participants reacted to less than half a peanut kernel. After one year of treatment, 75 percent of patients in the treatment group returned for reassessment, all of whom were now able to tolerate 1.4 g of peanut protein (approximately six to eight peanuts) without developing an objective allergic reaction. Fifty-eight percent could eat more than 20 peanuts without reacting. Less than 11 percent of doses caused an allergic reaction during the year, and half of these reactions were very transient and mild in nature.

"There were 19 episodes of anaphylaxis occurring in 10 patients. Given this, we would not recommend oral immunotherapy being performed without stringent safeguards by experienced health care personnel," Patel said. "This study paves the way for the development of an effective, safe, and potentially far cheaper alternative method of delivering OIT. We hope this may increase the affordability and accessibility of OIT in the future to improve patient care."

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Roshni Naik, M.D., of the Mount Sinai Health System in New York City, and colleagues found that a substantial proportion of adults with chronic opioid dependence receiving care in the emergency department, hospital, and ambulatory surgery have concurrent asthma.

The investigators performed a cross-sectional data analysis of ICD-9 and ICD-10 coding of opioid dependence from discharge billing among adults treated at Kings County Hospital Center in the setting of inpatient admission, emergency department visit, and ambulatory surgery between 2013 and 2017. There were 1,966 patients included in the study, with ages ranging from 18 to 79 years.

"The overall prevalence of asthma in patients with opioid dependence was 17.2 percent, which is higher than the 8.3 percent for the national prevalence of adults with asthma in 2016. The prevalence of asthma patients with opioid dependence among women was 25 percent compared to the national prevalence rate of adult asthma among women of 9.7 percent," Naik said. "These findings suggest that women with opioid dependence are disproportionately affected by asthma. The reasons for the disproportionate increase are not readily apparent, but studies have shown that women are more likely than men to report chronic pain conditions and therefore be prescribed more opioid medication for pain compared to men."

According to Naik, this study is limited by its focus on chronic opioid dependence among adults treated in a large, inner city, minority-serving hospital, and this population is disproportionately at risk for morbidity and mortality from asthma.

"Furthermore, the acute care focus limits the findings, as asthma among outpatient chronic opioid patients is understudied, and therefore it is difficult to estimate the overall prevalence of asthma among chronic opioid users," Naik added.

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AAAAI: Small Amounts of Dietary Peanuts Beneficial After Immunotherapy

THURSDAY, Feb. 28, 2019 (HealthDay News) -- Most individuals who complete peanut immunotherapy trials continue peanut consumption with few reports of reactions, according to a study presented at the annual meeting of the American Academy of Allergy, Asthma & Immunology, held from Feb. 22 to 25 in San Francisco.

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AAAAI: Egg Oral Immunotherapy Shows Sustained Benefit in Children

WEDNESDAY, Feb. 27, 2019 (HealthDay News) -- Egg-allergic children who undergo egg oral immunotherapy and achieve sustained unresponsiveness eat more egg and have fewer symptoms five years later, according to a study presented at the annual meeting of the American Academy of Allergy, Asthma & Immunology, held from Feb. 22 to 25 in San Francisco.

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AAAAI: Exclusive Breastfeeding Not Linked to Eczema Risk

MONDAY, Feb. 25, 2019 (HealthDay News) -- Exclusive breastfeeding is not associated with the odds of general eczema diagnosis, but exclusive breastfeeding for three months or longer is associated with reduced odds of continued eczema at age 6, according to a study presented at the annual meeting of the American Academy of Allergy, Asthma & Immunology, held from Feb. 22 to 25 in San Francisco.

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