George A. Sprecace M.D.,
J.D., F.A.C.P. and Allergy Associates of New
HIGHLIGHTS OF ABSTRACTS PRESENTED AT
MEETING, MARCH, 2009
- Mixed signals regarding the utility of
exhaled Nitric Oxide. Does not seem
ready for prime time yet.
- Subcutaneous IVIG seems to be a good
alternative to the IV route.
- In addition to inherited serum C1 esterase
inhibitor deficiency, an acquired form is described, especially in the
elderly with underlying diseases. Treatment
included anti-fibrinolytic agents and danazol.
- Here’s a dog-bites-man story: school
construction and conditions can be dangerous to student health.
- The skin-prick test was found more accurate
than Cap-Rast testing, requiring provocation testing for confirmation. I find such food testing rarely
necessary, especially considering the propensity for producing
generalized allergic reactions.
- Sublingual immunotherapy continues to have
its adherents, especially in Europe. I’m not one of them. Intradermal
skin testing and subcutaneous allergy immunotherapy continue to be the
- Reports continue to emerge regarding the use
of Omalizumab (Xolair) for the treatment of food allergy – off lable. Makes sense where anaphylaxis is involved.
- As we all know, boiling decreases the
allergenicity of milk.
- Several reports describe specific oral
tolerance induction to food allergies. Be
- Primatene Mist or other similar oral
epinephrine delivery system should be made available to all patients
subject to oral angioedema. PS It is a poor anti-asthmatic medication.
- Prompt and adequate Epinephrine dosing is
very important in reversing systemic allergic reactions and in avoiding
more serious and late-phase reactions. The
current Epi-pen needle length may be too short for plus-sized patients;
and one dose may not be enough. Thus, the
Epi-Pen Two Pac, better than the “Twin-Ject”.
- The incidence, or the discovery of,
Eosinophilic Esophagitis, appears to be increasing…estimated to be up
to 20% in GERD patients. Worth looking
for, at least in patients refractory to standard GERD treatment.
- Statins may be beneficial in the treatment
of serious Asthma, this relationship related to their anti-inflammatory
- Childhood obesity appears directly related
to the incidence of atopy and of asthma, probably through an
inflammatory mechanism. This may also have
a role in steroid resistance of some of these patients.
- Several studies describe the well-recognized
discordance in some patients between clinical evaluation of their
Asthma and pulmonary function test variations before and after
bronchodilator testing. Thus, the utility
of repeating PFT testing periodically, at least yearly – and more often
in patients on ICS therapy – to look for occult bronchospasm…and
consequent residual inflammation and possible remodeling.
This finding, despite the satisfactory clinical picture,
requires more aggressive anti-inflammatory treatment.
to #305/1,053. To be continued...)
<>HIGHLIGHTS….MAY, 2009 – PAGE 2
520/1,053). To be continued…
- As is the case with adults with
chronic bronchitis, children with chronic cough and wheezing have been
found to have their lower airways colonized with bacteria.
This lowers the threshold for the use of appropriate
antibiotics when they develop superimposed URI.
- Laryngopharyngeal reflux, a
distinct form of GERD, causes dysphonia, globus pharyngeus,
non-productive throat clearing, cough, dysphagia, and recurrent sore
throats. It is under-diagnosed and
undertreated, as is Obstructive Sleep Apnea…which can also cause these
conditions, and much more serious results.
- Homes with moldy walls
are also found to harbor dust mites. More
reasons to remediate.
- The role of endotoxins in immune
response is controvercial…although I have long considered them as the
mechanism for the clinical effectiveness of bacterial vaccines…once
widely used in clinical allergy practice. They
have been found to be present in many allergenic extracts.
And they may form the basis for the Hygiene Theory…and
future treatment…once more.
- A wide variety of prodromal
symptoms are reported to preceed, in nearly 50% of cases, episodes of
Hereditary Angioedema. (see # 377, 391).
- Evidence of thyroid autoimmunity is
commonly found (over 30%) in chronic urticaria. This
may be treatable with thyroid hormone.
- IgG anti-IgE autoantibodies have
been found in a variety of disease states, including rarely in chronic
urticaria. One of my patients was
diagnosed at Yale this year with this condition. She
declined immunosuppressive treatment and is so far doing well with
- Children with food allergies and
consequent food avoidances can have poorer health and poorer growth. Every effort should be made to eliminate these
food avoidances where possible. These
children also have a higher incidence of asthma.
- Sensitization to inhalant allergens
is common in children less than 3 years old with food allergies, atopic
dermatitis and a history of respiratory illnesses.
Most of these children can be treated with good
environmental control and reasonable medications.
- Allergy immunotherapy has been
found to “restore dendritic cell innate
immune function previously reported to be impaired at baseline in
- Allergic conjunctivitis is
under-diagnosed and under-treated. It may
or may not respond to a variety of available eye drops…and may at times
require steroid eye drops, which I leave to Eye MD’s to prescribe and
follow. It is also somewhat responsive to
nasal steroid spray use.
- Here is something that I have
suspected for many years: allergic patients seem to have a reduced
incidence of cancer. One abstract (#509)
reports that the documented use of antihistamines for over one year
“may be associated with decreased cancer risk”. ??
- Administered 100% CO2 was found to
inhibit mast cell degranulation and histamine release (# 516). Maybe “don’t inhale” is really a treatment.
- Here is an oldie and goodie: diesel
fumes worsen airway inflammation and promote airway infections…in
addition to promoting IgE. Have
cockroaches in urban environments been getting a bad rap?
<>HIGHLIGHTS….MAY, 2009 – PAGE 3
- “Cigarette smoke induces profound
disturbances in epithelial cell biology, such as inflammation and
- This is interesting, if confirmed:
long-term anti-IgE (Xolair) treatment was found to reduce IgE
production to normal non-atopic levels. The
related question is what happens when Xolair use is discontinued. This all has a bearing on its relative
effectiveness in desensitization vis a vis allergy immunotherapy (#583).
- If you want to do “original”
research, read the research done 40 to 70 years ago…and do it again. See #588, 612.
- Does obesity affect steroid
responsiveness? This study says “No”
- Probiotics may play a role in
reducing airway inflammation in children.
- One of the toxic molds, capable of
inducing a variety of systemic effects, is Stachybotrys Chartarum, a
“black mold”. #658 describes an assay for
- #668 describes a protocol for
graded dose administration of Flu vaccine in egg sensitive children.
- In one study, 50% of soy allergic
children outgrew their allergy to soy by age 8.
- Some women have severe uterine
cramping as part of an anaphylactic reaction. Inhaled
or injected terbutaline is useful in such cases.
- #720 describes the relative safety
of doing allergy testing on patients on beta- blockers.
- Epinephrine digital auto-injection
occurs and can produce severe digital ischemia, which may require
amputation. #723 describes the
effectiveness of hyperbaric oxygen in such patients.
- #912 describes desensitization for
Bactrim sensitivity, in both HIV + and – patients.
- Iodinated contrast media can
produce Type 4 delayed hypersensitivity reactions, delayed between 3-72
hours, according to this study (923).
- #943 notes that just 3 years of
venom immunotherapy (instead of the usually recommended 5 years) can
infer lasting immunity for up to 10 years. I
repeat the venom skin tests after three years. A
substantial reduction in reaction (ie. 100-fold) is usually found and
results in cessation of venom immunotherapy.
- The presence of allergic rhinitis
as a co-morbid condition in bronchial asthma can have a distinct effect
on asthma severity and control. It must
also be treated aggressively.
That’s all, folks…until next year.
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