FDA Adds Fasenra Indication for Severe Asthma in Children
TUESDAY, April 16, 2024 (HealthDay News) -- The U.S. Food and Drug Administration has approved an additional indication for Fasenra (benralizumab) as an add-on maintenance treatment for patients aged 6 to 11 years with severe asthma and an eosinophilic phenotype.
This indication was supported by evidence from the phase 3 TATE trial, as well as data from additional well-controlled trials in adult and adolescent populations. Results among children aged 6 to 11 years old show that Fasenra met the primary end points, demonstrating pharmacokinetics and pharmacodynamics with severe eosinophilic asthma. The safety and tolerability results were also consistent with the known profile.
The recommended dose for Fasenra is 30 mg for patients ages 6 years and older who weigh ≥35 kg, while a new 10-mg dose will be available for patients aged 6 to 11 years who weigh <35 kg. Fasenra is administered by subcutaneous injection every four weeks for the first three doses and then every eight weeks.
"We welcome additional treatment options for children living with severe asthma, a condition that remains complicated to manage, further helping to address the unmet need in this patient population and reducing the burden of disease for the broader asthma community," Lynda Mitchell, of the Allergy & Asthma Network, said in a statement.
Approval of this indication for Fasenra was granted to AstraZeneca.
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FDA Panel Recommends Approval of First Nasal Spray to Combat Severe Allergic Reactions
FRIDAY, May 12, 2023 (HealthDay News) -- Outside advisers for the U.S. Food and Drug Administration voted Thursday to recommend approval of Neffy, the first epinephrine nasal spray for severe allergic reactions.
Although most of the Pulmonary-Allergy Drugs Advisory Committee members supported the spray for adults (16:6) and children (17:5), key questions linger about whether more data are needed from its maker, ARS Pharmaceuticals, CBS News reported.
But Richard Lowenthal, cofounder, president, and CEO at ARS, said in a company statement following the vote, "We believe our clinical data from more than 600 individuals demonstrate Neffy's absorption-enhancing nasal spray technology is comparable to injectable products in delivering potentially lifesaving epinephrine, but with unique advantages of being small, needle-free, and conveniently sized."
Neffy delivers a 2-mg dose of epinephrine. Instead of large clinical trials, the drug company compared its product to already approved injectable epinephrine products, such as the EpiPen. It showed the results for Neffy were neither substantially higher or lower than injectable epinephrine.
"The effects of epinephrine on blood pressure and heart rate are surrogates for efficacy and are important in determining if someone is responding to treatment," Carlos Camargo, M.D., a professor of emergency medicine at Harvard Medical School in Boston, said in the company's news release. "With Neffy, blood pressure and heart rate are comparable to EpiPen with a single dose -- and with a second dose of Neffy, increases in systolic blood pressure were statistically higher, even better than revealed in the available data from EpiPen, which is crucial for patients requiring a second dose for a severe allergic reaction."
Epinephrine has been used since 1901 via injection. It was never put through the same approval process as drugs are now because it was on the market before the FDA existed, CBS News reported. That means the FDA does not have a lot of data it can use to compare Neffy's effectiveness in saving patients who are having a severe allergic reaction. As a result, it is not entirely clear whether the nasal spray will work as well as injectable epinephrine.
The FDA is expected to make its decision on whether to approve Neffy by the middle of this year. The company has said it could start selling the spray in late 2023. The drug is designed to work for patients who weight at least about 66 lb.
The company's research included a survey showing that people would be likely to use the spray 18 minutes earlier than an injectable medication, and as many as 35 percent more people would carry it with them.
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Modified Anaphylaxis Clinical Criteria Developed for Young Children
Newly developed modified anaphylaxis clinical criteria can improve identification of anaphylaxis among young children, according to a study published online May 20 in the Journal of Allergy and Clinic Immunology: In Practice.
Anna Handorf, M.D., from Mass General for Children in Boston, and colleagues examined age-specific signs and symptoms that more accurately identify anaphylaxis in young children in order to develop modified criteria for "likely anaphylaxis" to compare against the widely used 2006 National Institute of Allergy and Infectious Diseases/Food Allergy and Anaphylaxis Network (NIAID/FAAN) criteria. A total of 337 clinical encounters presenting to a pediatric emergency department with suspected allergic or anaphylactic reactions were reviewed. The study population comprised 33 percent infants (<12 months), 39 percent toddlers (age 12 to <36 months), and 29 percent children (≥36 months).
The researchers found that the modified criteria captured 98 percent of all patient encounters in the study, compared with 85 percent for the NIAID/FAAN criteria. Modified criteria had 22.8 and 10.3 percent improved performance among infants and toddlers, respectively, compared with NIAID/FAAN criteria.
"Utilization of modified criteria enhances identification of anaphylaxis in infants, and potentially toddlers," the authors write. "Our findings also support the need for improved training of health care professionals to recognize and manage anaphylaxis in infants and young children."
Two authors disclosed ties to the pharmaceutical industry.
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AAAAI: Black Children With Eczema More Likely to Have Asthma
MONDAY, Feb. 27, 2023 (HealthDay News) -- Black children with atopic dermatitis are more likely to have asthma than non-Hispanic White children, but they are less likely to be evaluated by an allergist, according to a study presented at the annual meeting of the American Academy of Allergy, Asthma & Immunology, held from Feb. 24 to 27 in San Antonio.
Ellen Daily, M.D., from Rush University Medical Center in Chicago, and colleagues explored real-world diagnosis patterns and factors associated with asthma risk in a large urban population of children aged 0 to 18 years diagnosed with atopic dermatitis. The risk for asthma diagnosis was examined in association with race, sex, age, body mass index (BMI), insurance, and area deprivation index (ADI).
The study population included 728 Black children and 246 non-Hispanic White children. The researchers found that Black children were significantly more likely than non-Hispanic White children to have an asthma diagnosis (31.2 versus 10.0 percent). This difference was impacted by three main variables: higher ADI, higher BMI, and older age at time of evaluation. Compared with non-Hispanic White children, Black children with asthma were less likely to see an allergist (46.7 versus 69 percent) and were more likely not to have prior inhalant allergy testing (odds ratio, 57.5).
"To minimize existing health care disparities, more research must be done to help us understand what factors underlie the observed differences in the diagnosis and management of atopic diseases, so that we can overcome existing barriers to providing equitable asthma care," a coauthor said in a statement.
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Indoor Allergens Worsen Respiratory Infections in Children With Asthma
Cockroach and mouse allergen exposure may predispose children with asthma to upper respiratory infections (URIs) and worse respiratory outcomes, according to a study published online Aug. 19 in the Journal of Allergy and Clinical Immunology.
Darlene Bhavnani, Ph.D., from the University of Texas at Austin, and colleagues examined associations between indoor allergens and: URI, URI + cold symptoms, URI + cold symptoms + pulmonary eosinophilic inflammation (fraction of exhaled nitric oxide ≥20 ppb), and URI + cold symptoms + reduced lung function (percent predicted forced expiratory volume in 1 second of <80 percent). The analysis included data from 90 participants in the Environmental Control as Add-on Therapy for Childhood Asthma study (192 observations).
The researchers found that 27 percent of observations were positive for URI. There were increased odds of a URI with cold symptoms with a doubling in cockroach allergen concentration (odds ratio [OR], 1.18; 95 percent confidence interval [CI], 0.99 to 1.40), as well as higher odds of a URI + cold symptoms + pulmonary eosinophilic inflammation (OR, 1.31; 95 percent CI, 1.10 to 1.57) and URI + cold symptoms + reduced lung function (OR, 1.45; 95 percent CI, 1.13 to 1.85). There were positive associations between mouse allergen concentrations and all outcomes. Among children sensitized to pest allergens, associations were suggestively stronger.
"These results could help explain why some children, especially those who live in underserved areas, have more trouble with their asthma than others," Bhavnani said in a statement.
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Oral Immunotherapy With Boiled Then Roasted Peanuts Feasible
WEDNESDAY, Jan. 11, 2023 (HealthDay News) -- Oral immunotherapy (OIT) using boiled followed by roasted peanuts is feasible and safe for treating children with peanut allergy, according to a study published online Jan. 11 in Clinical & Experimental Allergy.
Luke E. Grzeskowiak, Ph.D., from the College of Medicine and Public Health at Flinders University in Adelaide, Australia, and colleagues examined the efficacy and safety of OIT for treating peanut allergy in children using sequential doses of boiled peanuts followed by roasted peanuts. Seventy children aged 6 to 18 years with a positive history of peanut allergy underwent OIT involving sequential up-dosing with 12-hour boiled peanuts for 12 weeks, two-hour boiled peanuts for 20 weeks, and roasted peanuts for 20 weeks to a target maintenance dose of 12 peanuts/day.
The researchers found that desensitization was successfully induced in 56 participants (80 percent). Three participants withdrew due to treatment-related adverse events. Sixty-one percent of participants experienced treatment-related adverse events, for a rate of 6.58 per 1,000 OIT doses. Medication use was infrequent in association with treatment-related adverse events, with three participants (4 percent) reporting rescue epinephrine use (0.05 per 1,000 OIT doses).
"We demonstrate the safety and feasibility of a pragmatic outpatient clinic-based peanut OIT protocol utilizing reduced allergenicity boiled peanuts as an introductory step in successfully inducing desensitization in children aged 6 to 18 years with peanut allergy," the authors write.
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Peanut Oral Immunotherapy Yields Higher Rates of Tolerance in High-Threshold Allergy
For children with high-threshold peanut allergy, peanut oral immunotherapy (P-OIT) using home-measured peanut butter ingestion yields higher and sustained rates of peanut tolerance, according to a study published online Feb. 10 in NEJM Evidence.
Scott H. Sicherer, M.D., from the Icahn School of Medicine at Mount Sinai in New York City, and colleagues randomly assigned participants aged 4 to 14 years reacting to a challenge of 443 to 5,043 mg of peanut protein to P-OIT using home-measured peanut butter or peanut avoidance (38 and 35 participants, respectively). The primary end point was the difference in the proportion of participants tolerating a two-dose-level increase or 9,043 mg of peanut protein. For ingestion participants tolerating 9,043 mg, sustained unresponsiveness (tolerance off treatment) was tested after 16 weeks of ingestion followed by eight weeks of abstinence.
The researchers found 100 and 21.0 percent success for ingestion versus avoidance, respectively, in the primary analysis. All 32 treated and three of 30 avoiders tolerated 9,043 mg; sustained unresponsiveness occurred in 68.4 versus 8.6 percent of P-OIT and avoidance participants tolerating 9,043 mg in the intention-to-treat analysis. There were no dosing reactions greater than grade 1 severity and no reports of serious adverse events.
"In children 4 to 14 years of age who were allergic to peanut but could tolerate more than 143 mg of protein at baseline, that high-dose, store-bought, home-measured P-OIT was effective in raising their threshold to serving size amounts of peanut with a durable response off treatment for the majority," the authors write.
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ACAAI: 2013 to 2023 Saw Rise in Pediatric Psych Referrals Tied to Food Allergies
The number of pediatric psychology referrals for issues related to food allergy increased dramatically during the past decade, according to a study presented at the annual meeting of the American College of Allergy, Asthma & Immunology, held from Oct. 24 to 28 in Boston.
Andriana La Mantia, M.D., from the Nationwide Children's Hospital in Columbus, Ohio, and colleagues characterized the use of psychology services for food allergy-related anxiety in children. The analysis included outpatient pediatric psychology referrals at a tertiary care center between 2013 and 2023.
The researchers found that of the 250 patients (median age, 9.5 years), 88 percent were referred for food allergy-related concerns, with an average of 2.1 allergens per patient. More than half (53 percent) had prior documented anaphylaxis. More than two-thirds (69 percent) had food-related anxiety, and 12 percent had quality-of-life impairment prompting referrals. Six in 10 patients who received psychology referrals completed at least one appointment, with an average of 5.5 follow-up appointments attended during the subsequent year. During the study period, there was an 11-fold increase in food allergy-related anxiety referrals placed, with a single-year >50 percent increase in 2023 versus yearly referrals from 2018 to 2022.
"The number of pediatric psychology referrals for issues related to food allergy increased dramatically over the past decade," the authors write. "Expansion of these services will be important to meet the needs of our patients."
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American College of Allergy, Asthma & Immunology, Oct. 24-28
The annual meeting of the American College of Allergy, Asthma & Immunology was held from Oct. 24 to 28 in Boston, drawing attendees from around the world, including allergy and immunology specialists as well as other health care professionals. The conference featured presentations focusing on the latest advances in the prevention and treatment of asthma, food and medication allergies, and immune dysfunction.
In one study, Albert Wu, M.D., from New York City, and colleagues found that minorities are less likely to demonstrate vaccine hesitancy, even when taking into account age, gender, and language.
The authors collected vaccination history and demographic information from 338 new patients presenting to an outpatient allergy/immunology clinic between March 2023 and February 2024. White (37.2 percent), Hispanic (31.6 percent), Asian (18.9 percent), and Black (12.1 percent) ethnicities were included, with 80 percent speaking English as their primary language. The researchers found that minorities were less likely to demonstrate vaccine hesitancy. Age, gender, and language did not significantly affect likelihood for vaccine hesitancy. Mistrust of authority was among the most cited reasons by patients for vaccination hesitancy, including decreased confidence in the health care system and the government, as well as reservations regarding the safety and efficacy of vaccinations.
"Identifying target populations is a vital initial step in improving long-term vaccine acceptance. Our study found multiple patient characteristics differentially associated with increased vaccination hesitancy, including immunization history, age, and ethnicity," Wu said. "These characteristics could be used to identify patients more at risk for being vaccine-hesitant going forward to make vaccination campaigns more efficient. We can also improve upon current efforts to increase immunization rates by studying successful initiatives from the COVID pandemic."
In another study, David Stukus, M.D., of Nationwide Children's Hospital and The Ohio State University College of Medicine in Columbus, and colleagues report an 11-fold increase in the number of children referred to a psychologist for food allergy-related anxiety and decreased quality of life during a 10-year period.
In a retrospective chart review of outpatient pediatric psychology referrals between 2013 and 2023, the authors evaluated 250 patients, 88 percent of whom were were referred for food allergy-related concerns and 53 percent of whom had prior documented anaphylaxis. The researchers identified an 11-fold increase in the number of children referred for food allergy-related anxiety and decreased quality of life during a 10-year period. Many of these children were quite young, with a median age of 9 years.
"It is important to address anxiety with all children and caregivers who have food allergies and have services available when this impacts quality of life," Stukus said. "Comprehensive food allergy management should include assessment of anxiety and quality of life."
In a cross-sectional study, Nadia Makkoukdji, M.D., of the Jackson Health System in Miami, and colleagues found that food elimination diets are still commonly being used by parents of children with atopic dermatitis, with restrictive diets leading to malnutrition, emotional stress, and anxiety or depression, while also adding stress to parents.
The authors used a survey to assess parents' perceptions of the relationship between dietary choices and their child's atopic dermatitis. Participants in this study implemented elimination diets for varying durations, from one month to more than a year. Of those who followed elimination diets, 79 percent eventually reintroduced the suspected allergen, with no significant change in eczema severity. This finding was both statistically and clinically significant, with a P value < 0.001 as determined by a chi-square test.
In addition, the investigators found that 57 percent of parents altered their child's diet due to a belief that certain foods worsened their atopic dermatitis. Milk, tree nuts, seeds, peanuts, and eggs were the most commonly suspected triggers, aligning with well-known allergens globally. Again, dietary modifications did not lead to significant improvement in atopic dermatitis control, reflecting previous studies that showed limited efficacy for food elimination without confirmed food allergies.
"Our statistical analysis underscores the limited effectiveness of dietary restrictions as an eczema management strategy," Makkoukdji said. "These parental perceptions influence treatment decisions and highlight the need to follow guidelines from the American Academy of Allergy, Asthma & Immunology and American College of Allergy, Asthma & Immunology to optimize atopic dermatitis management."
ACAAI: ICS + Formoterol and ICS + SABA Better Than SABA Alone for Asthma
TUESDAY, Oct. 29, 2024 (HealthDay News) -- For patients with asthma, inhaled corticosteroids (ICS) combined with short-acting β agonists (SABA) and ICS combined with the long-acting β agonist formoterol are each associated with reduced asthma exacerbations compared with SABA alone, according to a study published online Oct. 28 in the Journal of the American Medical Association. The study was published to coincide with the annual meeting of the American College of Allergy, Asthma & Immunology, held from Oct. 24 to 28 in Boston.
ACAAI: 2013 to 2023 Saw Rise in Pediatric Psych Referrals Tied to Food Allergies
MONDAY, Oct. 28, 2024 (HealthDay News) -- The number of pediatric psychology referrals for issues related to food allergy increased dramatically during the past decade, according to a study presented at the annual meeting of the American College of Allergy, Asthma & Immunology, held from Oct. 24 to 28 in Boston.
ACAAI: Most Syphilis Patients With Penicillin Allergy Have Low Risk for Severe Allergy
FRIDAY, Oct. 25, 2024 (HealthDay News) -- Delabeling patients with syphilis who believe they are allergic to penicillin is safe, according to a study presented at the annual meeting of the American College of Allergy, Asthma & Immunology, held from Oct. 24 to 28 in Boston.
ACAAI: Many Anaphylaxis Protocols Are Incomplete, Outdated
FRIDAY, Oct. 25, 2024 (HealthDay News) -- Many anaphylaxis protocols are incomplete and/or outdated, and there is a need for patient education regarding treatment of anaphylaxis, according to two studies presented at the annual meeting of the American College of Allergy, Asthma & Immunology, held from Oct. 24 to 28 in Boston.
ACAAI: Gene-Editing Therapy Reduces Angioedema Attacks in Hereditary Angioedema
THURSDAY, Oct. 24, 2024 (HealthDay News) -- For adults with hereditary angioedema, the in vivo gene-editing therapy NTLA-2002, which is based on clustered regularly interspaced short palindromic repeats (CRISPR)-CRISPR-associated protein 9, administered as a single dose reduces angioedema attacks, according to a study published online Oct. 24 in the New England Journal of Medicine to coincide with the annual meeting of the American College of Allergy, Asthma & Immunology, held from Oct. 24 to 28 in Boston.
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CDC Reports on Prevalence of Seasonal and Food Allergies, Eczema
THURSDAY, Jan. 26, 2023 (HealthDay News) -- In two January data briefs published by the U.S. Centers for Disease Control and Prevention National Center for Health Statistics, data are presented regarding the prevalence of seasonal allergy, eczema, and food allergy among children and adults in 2021.
Benjamin Zablotsky, Ph.D., from the National Center for Health Statistics in Hyattsville, Maryland, and colleagues used data from the 2021 National Health Interview Survey (NHIS) to describe the percentage of children who had diagnosed seasonal allergy, eczema, or food allergy. The researchers found that 18.9, 10.8 and 5.8 percent had a seasonal allergy, eczema, and a food allergy, respectively, in 2021. The likelihood of having a seasonal allergy was higher for boys than girls (20.0 versus 17.7 percent). There was variation observed by age in the percentage of children with eczema (10.4, 12.1, and 9.8 percent in children aged 0 to 5, 6 to 11, and 12 to 17 years, respectively). The likelihood of having a food allergy was increased for non-Hispanic Black versus non-Hispanic White and Hispanic children.
Amanda E. Ng, M.P.H., and Peter Boersma, M.P.H., both from the National Center for Health Statistics, used 2021 NHIS data to describe the prevalence of seasonal allergy, eczema, or food allergy among adults. The researchers found that 25.7, 7.3, and 6.2 percent of adults had a seasonal allergy, eczema, and a food allergy, respectively, in 2021. Compared with Hispanic, non-Hispanic Black, and non-Hispanic Asian adults, the percentage of adults with a seasonal allergy was higher in non-Hispanic White adults. Women were more likely than men to have eczema (8.9 versus 5.7 percent). With increasing age, the prevalence of food allergy decreased.
"For all three allergies, women were more likely than men to have a diagnosed allergy," Ng and Boersma write.
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Most Families Exclude Food Allergens From Their Household
Most families choose to exclude food allergens from their households, and those that do report more food allergy (FA)-related concerns, according to a research letter published online Dec. 27 in JAMA Network Open.
Hana B. Ruran, from Boston Children's Hospital, and colleagues conducted a cross-sectional study to examine the proportion of households excluding allergens by specific FA and the association with FA-related psychosocial functioning. Overall, 919 surveys were completed by parents of a child with FA.
The researchers found that 63.8 percent of parents excluded at least one food from their home due to their children's FA. The most common allergies were peanut, tree nut, and egg (67.8, 65.5, and 44.0 percent, respectively). The foods most excluded from homes with FAs were peanut, tree nut, and sesame (62.4, 54.7, and 51.3 percent, respectively). Only 24.3 percent of homes with an egg allergy excluded egg from the home. Significant differences were seen in the proportion of those excluding sesame versus those excluding egg, milk, soy, and wheat. Worse mean FA-related quality-of-life scores for worry, anxiety, and self-efficacy were seen for parents who excluded food from the home because of their child's FA compared with parents who did not; these findings were consistent in child age subgroups. Compared with children from homes that did not exclude food-related allergens, children aged 8 to 17 years living in homes that excluded food allergens were more likely to have elevated generalized anxiety scores (30.4 versus 15.6 percent).
"Most families chose to exclude food allergens from their household and families engaging in this practice reported more FA-related psychosocial concerns than families who did not," the authors write.
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Expanded Use of Xolair to Treat Food Allergies Approved by the FDA
FRIDAY, Feb. 16, 2024 (HealthDay News) -- The U.S. Food and Drug Administration has expanded the use of the asthma drug Xolair (omalizumab) to help prevent anaphylactic reactions.
Xolair is an injected drug and is not meant as a substitute for EpiPens or other anaphylaxis rescue remedies, the agency stressed. Instead, "Xolair is intended for repeated use to reduce the risk of allergic reactions" that may occur with accidental exposure to multiple types of foods, the FDA explained in a news release.
Xolair was first approved in 2003 for the treatment of moderate-to-severe allergic asthma. It has also been approved to treat urticaria, as well as chronic rhinosinusitis with nasal polyps in certain patients.
"This newly approved use for Xolair will provide a treatment option to reduce the risk of harmful allergic reactions among certain patients with immunoglobulin E-mediated food allergies," Kelly Stone, M.D., said in the news release. She is associate director of the Division of Pulmonology, Allergy, and Critical Care in the FDA Center for Drug Evaluation and Research. "While it will not eliminate food allergies or allow patients to consume food allergens freely, its repeated use will help reduce the health impact if accidental exposure occurs."
Xolair's safety and effectiveness were tested in a trial of 168 babies, children, and adults. Participants were allergic to peanuts and at least two other foods, including milk, egg, wheat, cashew, hazelnut, or walnut, the FDA said. After receiving Xolair or a placebo for up to five months, "of those who received Xolair, 68 percent [75 of 110 subjects] were able to eat the single dose of peanut protein without moderate-to-severe allergic symptoms [e.g., whole body hives, persistent coughing, vomiting], compared to 6 percent [three of 55 subjects] who received placebo," the FDA said.
The study did not find any lessening of overall peanut allergy in people who received Xolair, however, so "continuation of strict allergen avoidance is still necessary, despite treatment with Xolair," the agency stressed. Similar results were found among people allergic to cashew, milk, or egg. In a minority of patients, anaphylaxis can occur after taking Xolair, so the FDA is including a boxed warning with the drug.
The expanded approval of Xolair was granted to Genentech.
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Global Prevalence of Eczema Estimated for Children, Teens
THURSDAY, Feb. 9, 2023 (HealthDay News) -- The global prevalence of eczema is 6.0 percent in children and has increased over time, according to a study published online Feb. 8 in Clinical & Experimental Allergy.
Sinéad Máire Langan, M.B.B.S., Ph.D., from the London School of Hygiene & Tropical Medicine, and colleagues examined eczema prevalence, severity, and lifetime prevalence in global centers participating in the Global Asthma Network (GAN) Phase I study (2015 to 2020), an international collaborative study arising from the International Study of Asthma and Allergies in Children (ISAAC).
GAN Phase I data were analyzed from 74,361 adolescents aged 13 to 14 years and 47,907 children aged 6 to 7 years. The researchers found that a median of 6 percent of children and adolescents had symptoms of current eczema, while symptoms of severe eczema were reported by 1.1 and 0.6 percent of adolescents and children, respectively. For adolescents and children, small overall 10-year increases in current eczema prevalence (0.98 and 1.21 percent, respectively) and in severe eczema (0.26 and 0.23 percent, respectively) were reported over 27 years after adjustment for world region and income; larger increases were seen in lifetime prevalence (2.71 and 3.91 percent for adolescents and children, respectively). Considerable variation was seen in 10-year change between centers, with evidence that region and income level explained some of this heterogeneity.
"Global research efforts are needed to address the burden related to eczema with continued international efforts to identify strategies to prevent the onset of eczema and to better manage the impact on individuals, their families, and health service," the authors write.
The GAN and ISAAC studies were partially funded by pharmaceutical companies.
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American Academy of Allergy, Asthma & Immunology, Feb. 24 to 27
The annual meeting of the American Academy of Allergy, Asthma & Immunology (AAAAI) was held from Feb. 24 to 27 in San Antonio and attracted 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 the fields of allergy, asthma, and immunology.
"The theme of the conference was 'optimizing patient care,'" David Khan, M.D., of the University of Texas Southwestern Medical Center in Dallas and president of the AAAAI, said in an interview with HealthDay. "As president, we get to have a little flavor of the conference, and one of my areas of interest is drug allergy, so there were certain sessions on drug allergy as well."
In one particular study, researchers described cases of COVID-19 mRNA vaccine-induced immunization stress-related response (ISRR), demonstrating that what appear to be allergies to a vaccine may be nonallergic manifestations. Muhammad Khalid, M.D., from the Laboratory of Allergic Diseases of the National Institute of Allergy and Infectious Diseases in Bethesda, Maryland, and colleagues evaluated patients who reported a history of allergic reactions to the Pfizer COVID-19 vaccine. In the small study of 16 patients, researchers randomly assigned patients to either a second dose of the vaccine or a placebo in a hospital intensive care unit setting.
"As it turned out, there were more people who had reactions to the placebo than the actual vaccine," Khan said. "In fact, almost all of them had some type of symptoms, and the typical symptoms that we saw were not really allergic but could be mimics of an allergic reaction."
Nonallergic manifestations were reported by nine patients after the second dose of the vaccine and 11 patients after receiving placebo. These included numbness, tingling, dizziness, throat tightness, dysphagia, and transient hypertension consistent with ISRR. Skin tests revealed that three of the 16 participants experienced an actual allergic reaction to their second Pfizer shot.
In a single center, retrospective study, Ellen D. Stephen, M.D., of the Rush University Medical Center in Chicago, and colleagues found that Black children with asthma and eczema are less likely to be evaluated by an allergist specialist and less likely to undergo environmental allergy testing than White children with asthma and eczema.
The authors performed a retrospective chart review of children aged 18 years or younger diagnosed with atopic dermatitis to determine if each child was diagnosed with asthma and if they were evaluated for asthma. After identifying 728 Black children and 246 non-Hispanic White children with atopic dermatitis, the researchers found that 31.2 percent of Black children were likely to have an asthma diagnosis, while 10 percent of White children were likely to have the same diagnosis. In addition, the investigators found that 47 percent of Black children were evaluated by an allergist, while 69 percent of White children were evaluated by an allergist.
"All children with asthma should ideally undergo allergist evaluation, including environmental allergy testing, as management of comorbid allergic rhinitis is known to be important in achieving optimal asthma control," Stephen said. "It is important, as part of the care plan for these patients, to consider allergist referral and to assess for socioeconomic barriers to accessing this specialty care that can be addressed by providers."
In another study, Elizabeth A. Kudlaty, M.D., of Northwestern University in Evanston, Illinois, and colleagues found that patients with asthma had higher rates of systemic corticosteroid prescriptions during the delta and omicron COVID-19 waves compared with the alpha wave; however, rates of antibiotic prescriptions were higher for the alpha compared with delta and omicron waves.
The authors evaluated how patients with asthma behaved during periods of the three different COVID-19 variants: alpha, delta, and omicron. Specifically, rates of systemic corticosteroid and antibiotic prescriptions for asthma patients diagnosed with COVID-19 were assessed in an effort to identify differences in the rates of prescriptions and provide insight into rates of upper and lower respiratory tract exacerbations. The authors examined health care utilization, mainly emergency room visits and hospitalizations, for patients with and without asthma during the three waves.
The researchers found that patients with asthma had higher rates of systemic corticosteroid prescriptions during the delta and omicron waves compared with the alpha wave. Furthermore, rates of antibiotic prescriptions were higher for the alpha wave compared with the delta and omicron waves, which may reflect prescribing patterns at the time.
"We also found that rates of emergency room visits and hospitalizations for COVID-19 in patients with asthma were lower during omicron compared to delta and alpha," Kudlaty said. "This is reassuring as it suggests that even though rates of steroid prescriptions were higher during omicron compared to alpha, asthma patients did not seem to be hospitalized at greater rates."
Ami Shah, M.D., of the Ichan School of Medicine at Mount Sinai in New York City, and colleagues found that sesame oral desensitization using crushed sesame seeds and tahini can be a safe and effective way to achieve sustained unresponsiveness to sesame.
The authors performed a retrospective chart review of 86 pediatric patients undergoing oral desensitization to sesame. They found that 61 (71 percent) reached a daily dose of 1 teaspoon of tahini/sesame paste (approximately 2,000 crushed sesame seeds). At the time of data analysis, 14 of those patients were able to ingest three times their daily amount (1 tablespoon of tahini, approximately 6,000 crushed sesame seeds) after ingesting their daily dose for at least six months. All 14 of these patients (100 percent) were also able to tolerate the 1 tablespoon of tahini after cessation of ingestion of their daily dose for four weeks (i.e., achieve sustained unresponsiveness). About 30 percent of patients experienced treatment-related adverse reactions, of which the majority were mild.
"Allergists should consider sesame oral immunotherapy as a treatment option for their pediatric patients with sesame allergy," Shah said.
AAAAI: EMR Alert Effective for Reducing Food Allergy Panel Testing
MONDAY, Feb. 27, 2023 (HealthDay News) -- An electronic medical record (EMR) alert is effective for reducing food allergy panel ordering among pediatric and adult patients, according to a study presented at the annual meeting of the American Academy of Allergy, Asthma & Immunology, held from Feb. 24 to 27 in San Antonio.
AAAAI: Black Children With Eczema More Likely to Have Asthma
MONDAY, Feb. 27, 2023 (HealthDay News) -- Black children with atopic dermatitis are more likely to have asthma than non-Hispanic White children, but they are less likely to be evaluated by an allergist, according to a study presented at the annual meeting of the American Academy of Allergy, Asthma & Immunology, held from Feb. 24 to 27 in San Antonio.
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