American Academy of Allergy, Asthma & Immunology, Feb. 26-Mar. 2, 2010
The annual meeting of the American Academy of Allergy, Asthma & Immunology took place Feb. 26 to March 2 in New Orleans, and attracted nearly 5,000 attendees from around the world. Highlights included studies suggesting there may be effective treatments for children with food allergies and urban children with asthma, along with sessions devoted to personalized medicine and immune tolerance in allergies.
Several studies showed that oral immunotherapy may be a safe and effective therapy for allergies to peanut, egg and milk. "Peanut allergy is a huge and growing problem," said program co-chair, R. Stokes Peebles, M.D., of Vanderbilt University in Nashville. "Reactions can be life-threatening. These studies show that oral immunotherapy can protect against inadvertent peanut ingestion, which is a huge advance."
In one study, researchers from Duke, Johns Hopkins, Mount Sinai, National Jewish, and the University of Arkansas randomly assigned 55 egg-allergic children to receive either egg white solid oral immunotherapy or placebo. After conducting an oral food challenge, they found that 21 of the 40 children in the immunotherapy group passed compared to none of the 15 children in the placebo group.
"This is the first multi-center trial of oral egg immunotherapy in which they were able to induce clinical desensitization," Peebles said. "But it took 44 weeks."
"Some of the most exciting research in allergy today focuses on possible treatments for patients with severe food allergy," one of the study's authors, Robert A. Wood, M.D., of the Johns Hopkins University Medical Center in Baltimore, said in a statement. "This important study on the use of oral immunotherapy for children with egg allergy provides further evidence that a real treatment for food allergy will soon be possible."
In a related study, researchers from clinics in Dallas and El Paso, Texas, performed office-based oral desensitization in 50 food-allergic patients with anaphylactic sensitivity. Of these, 28 became tolerant of their allergic food, including seven with egg allergy, five with milk allergy, and 16 with peanut allergy. However, 14 patients developed significant reactions requiring epinephrine treatment, three of whom subsequently dropped out of the study.
"Although significant reactions occur frequently, careful, office-based, oral food desensitization appears safe and effective for many patients," the authors conclude.
Researchers from Northwestern University, the University of Illinois, and Boston University performed a candidate-gene study of 931 children, and identified multiple genetic polymorphisms that may be associated with food sensitization. For example, they found that rs2072915 in the RXRB gene and rs2071351 in the HLA-DPB1 gene were strongly associated with sensitization to peanut.
One of the meeting's highlights was a symposium presentation by William W. Busse, M.D., of the University of Wisconsin in Madison, showing that the anti-IgE drug omalizumab may be an effective treatment for inner-city children with uncontrolled asthma. "I think this may translate into changes in clinical care and provide some new information about the role of IgE in these urban environments," said program co-chair, James E. Gern, M.D., also of the University of Wisconsin in Madison.
Gern noted that the findings were too preliminary for presentation as an abstract or published study, but called them "exciting." "The key findings were that omalizumab significantly improved asthma control in inner-city children who were already receiving standard therapy," he said. "They had a 25-percent reduction in days with asthma symptoms, and there was a 30-percent reduction in the number of patients who had asthma exacerbations."
In addition, omalizumab appeared to blunt the seasonal pattern of exacerbations, which are more common in the spring and fall, Gern said.
Another asthma study, presented by researchers from Columbia University in New York City, showed that increased roadway density may be associated with an increased risk of asthma and cough in urban children. For example, they found that a 0.36 km (interquartile range) increase in the length of highways and a 2.3 km increase in trucking route density were associated with a significantly increased probability of cough within the previous year (12 and 14 percent, respectively).
The presidential plenary session was devoted to one of the meeting's major themes: personalized medicine. "Hopefully in the next 10 years we'll be able to tailor our medication prescribing toward individuals rather than population groups because many of the medications we use are ineffective in large segments of the population," Peebles said. "It would be nice to determine in advance which people are going to have good responses and which ones are going to have side effects."
"Another major theme was immune tolerance and trying to develop tolerance to allergies -- not only foods but also aeroallergens," Peebles added. He cited a plenary presentation by U.K. researcher, Stephen Durham, M.D., of the Royal Brompton Hospital in London, showing that the cytokine profile to a specific allergen is a "positive predictor of a benefit" in patients receiving immunotherapy to that allergen.
A study presented by researchers from the National Institutes of Health in Bethesda, Md., looked at immune responses in 141 helminth-infected patients and 165 uninfected controls. Compared to controls, they found that infected patients had significantly increased levels of IgE to house dust mite and cockroach.
"Our data reveal that there is strong structural similarity between major aeroallergens and immunogenic helminth proteins, suggesting that the relationship between atopy and helminths may occur at the epitope level," the authors conclude.
AAAAI: Step-Up Therapy for Children With Asthma Studied
TUESDAY, March 2 (HealthDay News) -- Although many children with uncontrolled asthma have a differential response to step-up therapy, many respond better to one approach than others, emphasizing the need to consistently monitor and appropriately adjust asthma therapy prior to further step-up, according to a study published online March 2 in the New England Journal of Medicine to coincide with a presentation at the annual meeting of the American Academy of Allergy, Asthma & Immunology, held from Feb. 28 to March 2 in New Orleans.
AAAAI: Adult Asthma Found to Be Increasing in Many States
TUESDAY, March 2 (HealthDay News) -- Since 2000, the prevalence of adult asthma has significantly increased in more than one-third of U.S. states, according to research presented at the annual meeting of the American Academy of Allergy, Asthma & Immunology, held from Feb. 28 to March 2 in New Orleans.
AAAAI: Climate Change Linked to Increased Allergies
MONDAY, March 1 (HealthDay News) -- In Italy, climate changes over the past quarter-century may have increased the pollen load of some allergenic species and therefore the rates of allergic sensitization to those species, according to research presented at the annual meeting of the American Academy of Allergy, Asthma & Immunology, held from Feb. 28 to March 2 in New Orleans.
AAAAI: Studies Find Peanut Immunotherapy Promising
MONDAY, March 1 (HealthDay News) -- In peanut-allergic children, peanut oral immunotherapy may be an effective treatment, according to research presented at the annual meeting of the American Academy of Allergy, Asthma & Immunology, held from Feb. 28 to March 2 in New Orleans.
AAAAI: Maternal Exposures Linked to Children's Asthma
MONDAY, March 1 (HealthDay News) -- Maternal exposure to high amounts of the chemical bisphenol A or the nutrient folate may be associated with an increased risk of asthma in offspring, according to research presented at the annual meeting of the American Academy of Allergy, Asthma & Immunology, held from Feb. 28 to March 2 in New Orleans.