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American College of Allergy, Asthma & Immunology, Nov. 6-11, 2008

American College of Allergy, Asthma & Immunology Annual Scientific Meeting

The American College of Allergy, Asthma & Immunology Annual Scientific Meeting took place Nov. 6-11 in Seattle and attracted about 4,000 attendees, including 1,800 physicians. Topics included barriers to asthma care, unresolved issues with sublingual immunotherapy, and promising new treatments for hereditary angioedema.

"The key theme of this year's meeting was 'Adapting to Change,'" said ACAAI officer Stanley M. Fineman, M.D., of the Atlanta Allergy and Asthma Clinic. "If affects the whole gamut of conditions we treat."

One of the meeting's best-attended sessions addressed the multiple barriers that prevent patients from receiving appropriate asthma care. "These include a lack of access, delay in diagnosis, and patient adherence to prescribed medications," Fineman said. "We may have the best tools in the world, but if patients don't utilize them, they don't get help."

Fineman added, "African-Americans, Hispanics and other minorities are especially likely to face barriers to asthma care. They tend not be seen by allergy specialists, and often receive incorrect diagnoses and treatments."

"These delays can have a deleterious effect on outcomes including fatalities, increasing days with symptoms, and resulting in a rapid decline in lung function," Phillip L. Lieberman, M.D., of the University of Tennessee Health Science Center in Memphis, said in a statement.

The session also addressed lifestyle factors associated with poor asthma outcomes. These included obesity, fast-food consumption, current smoking, and language differences and cultural beliefs that often prevent minorities and immigrants from receiving and adhering to appropriate asthma regimens.

"Current smoking has been associated with increased severity of asthma, worse asthma-specific quality of life, worse mental health status, and a greater risk of hospitalization for asthma," Michael Blaiss, M.D., of the University of Tennessee Health Center in Memphis, said in a statement. "Smoking is also associated with poor asthma control, and new evidence suggests that smoking reduces the benefits of inhaled corticosteroids. Exposure to passive smoke at home may delay recovery from an acute attack."

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A number of discussions addressed the effectiveness, appropriate use, dosage, and safety of sublingual immunotherapy. "Some of these early studies show that it's not quite as effective as we would like, and also show that there's some risk," Fineman said. "There are patients who have had severe reactions. So our specialty is not recommending the general use of sublingual immunotherapy at this time."

One of the major drawbacks of sublingual therapy is that it hasn't been shown to be effective with more than one non-cross reacting allergen. It also hasn't been shown to be as effective as conventional subcutaneous immunotherapy.

"Although 35 percent of studies show at least a 30 percent reduction in some symptoms of rhinitis and use of medications with sublingual immunotherapy, some 40 percent of studies result in no reduction in symptoms and the need for medications," Paul A. Greenberger, M.D., of Northwestern University in Chicago, said in a statement. "Can we recommend such a treatment when it isn't impressive as compared with subcutaneous immunotherapy? For poly-sensitized patients, we can't vouch for safety, patient satisfaction, or lack of benefits a patient would have getting care here in the office. The indications may increase if there are FDA approved products, CPT codes and appropriate reimbursement and satisfied patients."

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"There were several studies about potential new therapies for hereditary angioedema, some of which have just been approved and some of which are pending approval," Fineman said. "It will give patients new options for treatment that will probably be superior to what they've had before."

During one session, Bruce Zuraw, M.D., of the University of California San Diego, and colleagues presented the results of an open-label trial of a nanofiltered C-1 esterase inhibitor (Cinryze), which was recently approved for the prevention of hereditary angioedema attacks. In their multi-center trial, Zuraw and colleagues treated 447 attacks in 82 patients and found that 95 percent of patients who received a 1,000-unit intravenous injection of Cinryze achieved significant symptom relief within fours.

Robyn J. Levy, M.D., of the Family Allergy and Asthma Center in Atlanta, and colleagues presented the results of a phase III study of an investigational kallikrein inhibitor -- DX-88 (Ecallantide) -- involving 96 patients with hereditary angioedema. They found that 66.7 percent of patients receiving Ecallantide achieved symptom improvement lasting at least four hours compared to 38.3 percent of placebo-treated patients.

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