Allergy Notes

Cetirizine Eye Drops for Allergic Conjunctivitis - Zerviate 1 drop twice daily

2017-06-10T09:49:00.000-04:00

The US Food and Drug Administration (FDA) approved the first topical ocular formulation of the antihistamine cetirizine for the treatment of ocular itching associated with allergic conjunctivitis.
The efficacy of cetirizine ophthalmic solution 0.24% (Zerviate) was shown in 3 clinical trials.

Patients had less ocular itching within 15 minutes and the effect persisted for 8 hours after treatment.

In PR-focused wording, the company quotes cetirizine "world-wide exposure representing more than 300 million patient-years".

The recommended dose of Zerviate is one drop in each affected eye twice daily, 8 hours apart.

The most commonly reported adverse reactions were ocular hyperemia (redness), instillation site pain, and reduction in visual acuity, which occurred in roughly 1% to 7% of patients.

Treatment options for allergic conjunctivitis (eye drops) (click here for larger image).

References:

FDA Clears Cetirizine Eye Drops for Allergic Conjunctivitis http://buff.ly/2swY4Sp

Histaminergic Angioedema

2017-06-09T09:34:00.000-04:00

Angioedema is frequently categorized into:

- histamine-mediated disease
- bradykinin-mediated disease

It is critical to determine the underlying mediator of symptoms as it directs treatment.

Histaminergic angioedema is the most frequent cause of angioedema. It is classified as:

- acute (lasting less than 6 weeks)
- chronic (symptoms for longer than 6 weeks)

It is further classified into angioedema presenting with or without urticaria.

Mast cells and basophils are central to the underlying pathophysiology of histamine-mediated angioedema.

The underlying treatments of histamine-mediated angioedema are:

- antihistamines
- corticosteroids
- epinephrine

References:

Histaminergic Angioedema http://buff.ly/2ryJ5dn

Acquired C1 Inhibitor Deficiency (C1-INH-AAE)

2017-06-08T09:28:00.000-04:00

Acquired angioedema due to C1-INH deficiency (C1-INH-AAE) can occur when there are acquired (not inherited) deficiencies of C1-INH.

A quantitative or functional C1-INH deficiency with negative family history and low C1q is diagnostic of C1-INH-AAE.

The most common conditions associated with C1-INH-AAE are:

- autoimmunity
- B-cell lymphoproliferative disorders

A diagnosis of C1-INH-AAE can precede a diagnosis of lymphoproliferative disease and confers an increased risk for developing non-Hodgkin lymphoma.

Treatment focuses on symptom control with:

- therapies that regulate bradykinin activity (C1-INH concentrate, icatibant, ecallantide, tranexamic acid, androgens)
- treatment of any underlying conditions

References:

Acquired C1 Inhibitor Deficiency http://buff.ly/2sx8r8B

Acute Management of Hereditary Angioedema Attacks (HAE)

2017-06-07T09:26:00.000-04:00

Several treatment modalities have become available for management of acute hereditary angioedema (HAE) attacks in the last 15 years. Preferred contemporary use of the treatments is “on demand,” because control remains with the patient and delays in treatment access avoided.

Four treatments are available:

— plasma-derived C1 inhibitor concentrate
- recombinant C1 inhibitor concentrate
- ecallantide
- icatibant

References:

Acute Management of Hereditary Angioedema Attacks http://buff.ly/2ryJDzV

The Burden of Chronic Urticaria Is Substantial

2017-06-06T09:21:00.000-04:00

Hives are raised, itchy, red bumps (welts) on the surface of the skin. They can be caused by an allergic reaction to food, drugs, or other causes. Urticaria affects up to 20% of people at some point in their lives.

Chronic spontaneous urticaria (CSU) can be debilitating, difficult to treat, and frustrating for patients and physicians.

This international observational study included 600 adult patients with CSU whose symptoms persisted for longer than 12 months despite treatment.

Almost 50% of patients had moderate-to-severe disease activity as reported by Urticaria Activity Score.

CSU markedly interfered with sleep and daily activities.

Angioedema in the previous 12 months was reported by 66% of enrolled patients and significantly affected health-related quality of life (HRQoL).

More than 20% of patients reported more than 1 hour per week of missed work; productivity impairment was 27%.

CSU has considerable humanistic and economic impacts. Patients with greater disease activity and with angioedema experience greater HRQoL impairments.

Urticaria (hives): what is the cause? (click to enlarge the image).

Chronic Urticaria Treatment Options in 6 Steps (click to enlarge the image). En Español.

Laboratory Diagnosis of Chronic Urticaria (click to enlarge the image).

Anti-FceR1 autoantibodies in chronic autoimmune urticaria: IgG against FceRI (receptor for IgE) (click to enlarge the image).

References:

The Burden of Chronic Spontaneous Urticaria Is Substantial: Real‐World Evidence From ASSURE‐CSU http://buff.ly/2swQJ5d

Related reading

CIU & You - Patient support website about Chronic Idiopathic Urticaria, sponsored by the makers of Xolair http://buff.ly/1zypqKg
Urticaria and angioedema. Allergy, Asthma & Clinical Immunology 2011, 7(Suppl 1):S9.
Blog articles from AllergyNotes
Questions to ask if a patient has a suspected episode of anaphylaxis

Image source: Urticaria, Wikipedia, public domain.

How do air-conditioners cause "sinus congestion"?

2017-06-05T08:14:00.000-04:00

There are several reasons:

- Change in temperature and humidity. Walking into a cold, dry room can trigger a runny nose. This is similar to how walking outside on a cold winter day can also cause runny nose (vasomotor rhinitis). The cold air may trigger nervous system reflexes in the nose that cause glands in the nasal membranes to produce mucus. This may be more common in people with allergies. However, changes in temperature and humidity should trigger only brief congestion.

- Allergens and pollutants/irritants get trapped in AC filter. People with allergies might develop congestion because small particles like pollen, mold spores, pollutants and dust mites can get trapped by air-conditioning filters. Pollutants and bacteria wouldn’t cause an allergic reaction but could irritate the nose via VOCs (nonallergic rhinitis).

The key is to change AC filters regularly.

References:

Can Air-Conditioners Cause Sinus Congestion? http://buff.ly/2rjbjsb

Non-allergic rhinitis (NAR) occurs in absence endonasal infection and sensitization to inhalant allergens

2017-05-08T09:03:00.000-04:00

A significant number of patients suffering from persistent rhinitis are defined as non-allergic non-infectious rhinitis (NANIR) patients, often denominated in short as having non-allergic rhinitis (NAR).

NAR is defined as a symptomatic inflammation of the nasal mucosa with the presence of minimal 2 nasal symptoms like nasal obstruction, rhinorrhoea, sneezing, and/or itchy nose, without clinical evidence of endonasal infection and without systemic signs of sensitization to inhalant allergens (i.e., no allergy).

Symptoms of NAR may have a wide range of severity, and be either continuously present and/or induced by exposure to unspecific triggers, also called nasal hyperresponsiveness (NHR). NHR represents a clinical feature of both AR and NAR patients.

NAR involves different subgroups:

- drug-induced rhinitis
- (non-allergic) occupational rhinitis
- hormonal rhinitis (including pregnancy rhinitis)
- gustatory rhinitis
- senile rhinitis
- idiopathic rhinitis (IR)

NAR should be distinguished from those rhinitis patients with an allergic reaction confined to the nasal mucosa, also called ‘entopy’ or local allergic rhinitis (LAR).

References:

Non‐Allergic Rhinitis: Position paper of the European Academy of Allergology and Clinical Immunology http://buff.ly/2pHUXbA

Japanese guidelines for allergic diseases 2017 - free, open access funded by Japanese Society of Allergology

2017-05-01T09:51:00.000-04:00

The Japanese Society of Allergology offers a set of review articles in the journal Allergology International (AI) Vol. 66, Issue 2, covering the Japanese Guidelines for Allergic Diseases 2017. This issue will be of great help to both clinical and basic investigators working in this field:

http://www.sciencedirect.com/science/journal/13238930/66/2

Japanese guidelines for adult asthma 2017 http://www.sciencedirect.com/science/article/pii/S1323893016301745

Japanese guidelines for childhood asthma 2017 http://www.sciencedirect.com/science/article/pii/S1323893016301678

Japanese guidelines for allergic rhinitis 2017 http://www.sciencedirect.com/science/article/pii/S1323893016301654

Japanese guidelines for allergic conjunctival diseases 2017 http://www.sciencedirect.com/science/article/pii/S1323893016301733

Japanese guidelines for atopic dermatitis 2017 http://www.sciencedirect.com/science/article/pii/S1323893016301721

Japanese guidelines for food allergy 2017 http://www.sciencedirect.com/science/article/pii/S1323893017300059

Japanese guidelines for occupational allergic diseases 2017 http://www.sciencedirect.com/science/article/pii/S1323893016301964

References:

Japanese guidelines for allergic diseases 2017 - free, open access funded by Japanese Society of Allergology http://buff.ly/2ppoOnD

Chronic urticaria -- “Agony of Hives” -- is the focus of World Allergy Week 2017 (2-8 April)

2017-03-13T07:30:00.000-04:00

Understanding Chronic Urticaria Is the Focus of World Allergy Week 2017: World Allergy Organization says there is hope for the “Agony of Hives”.

From World Allergy Organization (WAO) press release (Milwaukee, WI. March 9, 2017):

WAO, together with its member societies around the world, will host World Allergy Week from April 2-8, 2017. The theme and educational focus will be: The Agony of Hives – What to do when hives and swelling will not go away.

Chronic urticaria is defined as episodic or daily hives lasting for at least six weeks and impairing quality of life. To date there is no cure for the disease and suffering can last several years. “Too many people with chronic urticaria give up hope when the symptoms don’t go away,” said Paul Greenberger, MD, of Northwestern University in Chicago. “But there is hope for controlling chronic urticaria with the aid of the allergist.”

During World Allergy Week 2017 experts will provide information to physicians and the general public about the importance of the role of the allergist in diagnosing and managing the disease. “There are multiple options available for treating chronic urticaria,” said Mario Sánchez Borges, MD, of Centro Médico Docente – La Trinidad, in Caracas, Venezuela, and President of the World Allergy Organization. “Allergists have the necessary expertise in the diagnosis and treatment of chronic urticaria including knowledge about medication options. They also are able to teach patients about the condition, which is important in improving quality of life.”

Up to 1.8% of the population currently has chronic urticaria. More research on the global prevalence of the disease is needed. World Allergy Week 2017 organizers plan to draw attention to this and other future needs regarding chronic urticaria.

“The World Allergy Organization has 97 member societies around the world and many of them will participate along with us in World Allergy Week 2017,” said Dr Sánchez Borges. “They will hold workshops for physicians, patient education events and other activities that will help to increase awareness of the disease itself and share information about how to get relief from symptoms that can often seem unbearable.”

Recently, a highly effective biologic therapy (anti-IgE therapy) has become available for chronic urticaria. Experts will discuss the disease and approaches to patient care during a webinar to be held on April 4.

For more information about World Allergy Week 2017 and chronic urticaria, visit: www.worldallergyweek.org. To find a member society of the World Allergy Organization in your country or region, visit: http://www.worldallergy.org/about-wao/member-societies.

Urticaria (hives): what is the cause? (click to enlarge the image).

Chronic Urticaria Treatment Options in 6 Steps (click to enlarge the image). En Español.

Laboratory Diagnosis of Chronic Urticaria (click to enlarge the image).

Anti-FceR1 autoantibodies in chronic autoimmune urticaria: IgG against FceRI (receptor for IgE) (click to enlarge the image).

References

Greenberger PA. Chronic urticaria: new management options. World Allergy Organ J. 2014; 7:31
http://waojournal.biomedcentral.com/articles/10.1186/1939-4551-7-31

Kocatürk E, Maurer M, Metz M, Grattan C. Looking forward to new targeted treatments for chronic spontaneous urticaria. Clin Transl Allergy 2017, 7:1.
https://ctajournal.biomedcentral.com/articles/10.1186/s13601-016-0139-2

Maurer M, Church MK, Goncalo M, Sussman G, Sanchez Borges M. Management and treatment of chronic urticaria. J Eur Acad Dermatol Venereol. 2015; 29(Suppl3): 16-32.
http://onlinelibrary.wiley.com/doi/10.1111/jdv.13198/full

Maurer M, Rosén K, Hsieh HJ, Saini S, Grattan C et al. Omalizumab for the treatment of chronic idiopathic or spontaneous urticaria. N Engl J Med. 2013 Mar 7;368(10):924-35
http://www.nejm.org/doi/full/10.1056/NEJMoa1215372

Sanchez Borges M, Asero R, Ansotegui IJ, Baiardini I, Bernstein JA et al. Diagnosis and treatment of urticaria and angioedema, a worldwide perspective. World Allergy Organ J. 2012; 5:125
http://waojournal.biomedcentral.com/articles/10.1097/WOX.0b013e3182758d6c

Zuberbier T, Aberer W, Asero R, Bindslev-Jensen C, Brzoza Z et al. The EAACI/GA²LEN/EDF/WAO Guideline for the definition, classification, diagnosis and management of Urticaria. The 2013 revision and update. Allergy 2014:69; 868-887
http://onlinelibrary.wiley.com/doi/10.1111/all.12313/full

Image source: Urticaria, Wikipedia, public domain.

Should you stop steroid eye drops before a skin patch test for contact dermatitis?

2017-03-10T09:49:00.001-05:00

No, is the simple answer.

Avoid using test sites to which topical glucocorticoids, antihistamines, immunosuppressants, or immunomodulators are applied. The use of topical steroids or immunosuppressants at or near potential test sites should be avoided from at least one week prior to patch testing through the conclusion of patch testing.

Oral steroids may cause false-negative results of patch testing.

The effect of concomitant systemic antihistamine administration on the performance of patch testing is
unknown. The current recommendation from AAAAI is not stop oral antihistamines.

Topical steroids, antihistamines and other immunosuppressants (e.g., tacrolimus) may be used on non-test areas, but should be avoided on potential patch test areas prior to and during testing.

Simple instructions: Preparing for the Test

- Your skin should be clear for 2 weeks before the test if possible.
- Avoid exposing your back to the sun for 1 week before the testing.
- Stop these medicines for 1 week before your appointment: topical steroids to the back

- Stop these medicines for 3-5 days before the test: Oral corticosteroids and Non-steroid anti-inflammatories (NSAIDs)

- Do not apply any ointments, creams or lotions to the back 4 hours before the appointment.

Contact Dermatitis - An Approach to Treatment (click to enlarge the image).

References:

T.R.U.E. TEST Quick Reference Guide http://buff.ly/2mr7tZO
Allergy Patch Skin Testing http://buff.ly/2mtm7kM

AAAAI Tweetup! Meet the allergists who are updating Twitter with the latest allergy news from the #AAAAI17 meeting

2017-03-03T08:12:00.002-05:00

Here is the list of the allergists who are planning to use Twitter to post updates from the #AAAAI17 meeting. The list is open for edit, please feel free to add your own info. It shows the availability of the allergists by date and if they are planning to attend the Tweetup (a meeting of people who use Twitter or are following the tweets). If interested in a real life meeting Tweetup during the #AAAAI17, sign up in the spreadsheet above. This will be the Sixth Annual Tweetup during AAAAI! We started in 2012.

Here is the Tweetup info - come meet us for a chat at:

#AAAAI17 Tweetup
Saturday, March 4, 2017: 2:30 PM-3:30 PM
Atlanta Marriott Marquis, Atrium Level, Room A702

This is a free, informal event, no ticket required. Suggested topics: how to tweet? why to tweet? who to follow? research projects using social media, Twitter for patient education, etc.

The Tweetup will be hosted by Dr. Matthew Bowdish @MatthewBowdish and Dr. Alexei Gonzalez @docalergias

For tweeps attending the @aaaai_org mtg, we're having a Tweet-Up, Sat, Mar 4, 2:30-3:30, Marriott Marquis, Atrium Level, Rm A702 #aaaai17
— Matthew Bowdish MD (@MatthewBowdish) March 1, 2017

Hey Dr Bowdish, will see you at the tweet-up https://t.co/K2jHHKWrdC
— Dr Alexei Gonzalez (@docalergias) March 3, 2017

And to sweeten the deal, we're going to raffle off a surprise gift for those who come to the Tweet-Up #aaaai17
— Matthew Bowdish MD (@MatthewBowdish) March 1, 2017

If you can stop by the Tweet-Up on Saturday, Marriott Atrium Rm A702, pls do. If you see me, pls stop me and say hello. #aaaai17
— Matthew Bowdish MD (@MatthewBowdish) March 1, 2017

The hashtag for the meeting is #AAAAI17

The hashtag for the 2017 annual meeting of the American Academy of Allergy, Asthma and Immunology (AAAAI) is #AAAAI17

Type #AAAAI17 in Twitter Search box to find all recent updates from #AAAAI17: https://twitter.com/search

You can also find info about the #AAAAI6 hashtag on the website of Symplur:
http://www.symplur.com/healthcare-hashtags/aaaai17/

How to use Twitter to post updates from #AAAAI17 meeting

See examples of best practice by @MatthewBowdish and @DrAnneEllis posted here: http://allergynotes.blogspot.com/search/label/AAAAI (tweets were summarized in a series of blog posts by me). For example, the tweets from 2012 AAAAI meeting reached more than 250,000 people.

I would strongly encourage you to post updates on Twitter from the CME conferences that you are planning to attend in the future. Here is how to do it: Twitter for Physicians: How to use Twitter to keep track of the latest news and scientific meetings, and share information with colleagues and patients.

WAO TV Social Media Guide for Allergists

Here is WAO TV Social Media Guide for Allergists: http://bit.ly/1iL88OD

Dr Stukus: How to use Twitter to engage patients

Dr Bowdish: Best practices for Twitter use by allergists

Dr Bowdish: How to use Twitter during a scientific conference: AAAAI, ACAAI, etc.

Dr Ramirez: How allergists can use Facebook for patient education

References:

The impact of social media on a major international emergency medicine conference -- Neill et al. -- Emergency Medicine Journal http://bit.ly/Ywhstq

PLOS ONE: Tweeting the Meeting: An In-Depth Analysis of Twitter Activity at Kidney Week 2011 http://buff.ly/XmisPw

Tweeting the Meeting: Investigating Twitter Activity At the 2012 AAAAI Conference http://bit.ly/XyugQP - Disclaimer: I am one of the authors.

How to share up to 4 photos in a single Tweet buff.ly/1vTBSh1 - Great for conference posters - see example buff.ly/1vTC13L

How to Make the Most of A National Scientific Conference http://buff.ly/1vTEnzH

Drug allergy - Twitter summary from #ACAAI16 meeting

2017-02-27T07:30:00.000-05:00

Anaphylaxis - Twitter summary from #ACAAI16 meeting

2017-02-26T07:30:00.000-05:00

Asthma - Twitter summary from #ACAAI16 meeting

2017-02-25T07:00:00.000-05:00

Annual literature review - Twitter summary from #ACAAI16 meeting

2017-02-24T07:30:00.000-05:00

This is a Twitter summary from #ACAAI16 meeting. The post is a part of series. See the rest here: http://allergynotes.blogspot.com/search/label/#ACAAI16

Several allergists did a great job posting updates on Twitter from the 2016 meeting of ACAAI, the hashtag was #ACAAI16. I used the website Symplur to review the tweets:

@docalergias @drsilge

http://www.symplur.com/healthcare-hashtags/acaai16/

Presentation handouts are available from the ACAAI website: http://annualmeeting.acaai.org/session_presentations.cfm

TYRO3 is a new molecule identified in asthma regulation - negative regulator of Th2 type asthma https://t.co/n8Io4NE37F

At lit review. Topics may fly by too quickly for decent tweets, so pics may be coming. Happy that Dr. Grayson is pointing out the significant potential conflicts of interest of authors in lit review. Need open data.

Asthma may be divided into clusters: Th2-high, Th17-high, and Th2/Th17 -low. https://t.co/BhXpUzJmz5

Treating only Th2 driven asthma or Th17 driven may just push asthma to other phenotype. https://t.co/3r63qvXwBA

There seems to be a correlation between atopic wheezers and microbiome. In mice fecal transplant attenuated this. https://t.co/wWGVDneUOK

Manipulation of the GI microbiota might be helpful in asthma control with a small window of opportunity - the first 3 months of life https://t.co/W4MGr7bDI1

Diet and microbe induced pTregs may be needed to fully drive tolerance to food allergy https://t.co/9k9STCIrBh

The role of PLA2 provides a therapeutic target that could potentially reduce inflammation in AD https://t.co/uMXQ2TtFX9

In recent news: Removal of live attenuated influenza vaccine due only 3% effectiveness https://t.co/wvTz5Y0YBV -- efficacy was repoted as high as 98% prior to the latest study.

Current recommendations for flu vaccine in egg-allergic pts: get it, but if egg allergic symptoms that are more than hives get in MD's office. Don't go to a pharmacy, etc.

Recommendations on influenza vaccination in severe egg allergic patients in this slide: https://t.co/2pAgpOrXxS

Hand, foot and mouth disease is common in children but may also present in adults. May be confused with HSP https://t.co/UzBaiiMVbt

Recent outbreak of mumps in adults at U of Illinois raises question of need for 3rd dose of MMR. https://t.co/zP9rGdTI1a

Bacteroides dominant profile was associated with a higher likelihood of bronchiolitis in infants https://t.co/QRyftHtAIk

Another correlation study on gut microbiome and bronchiolitis. Causation unknown. https://t.co/dyEjilAh20

Exposure to respiratory viruses is not protective in atopic disease. "Old friends" (archaic microorganisms we co-evolved with) may be.

Early ART in HIV-infected individuals dramatically reduced infection rate in partners regardless of pt's CD4 count. https://t.co/jveJu0Bjik

Zika virus can be spread male to male, male to female, female to male sexual contact. For those who lived the plodding pace of research on early HIV years, the pace of research findings on Zika is a sharp contrast.

Risk of death increased 11-fold for patients with non-infectious complications in CVID https://t.co/bwFV6hgvqh

Lentivirus as a vector for gene therapy in WAS with promising early results in a pilot trial. Newer generation vector lentivirus for PID without inducing leukemia https://t.co/GGj39B8Gvj

@dryesimdem: Incidence of SCID (severe combined immunodeficiency) is 1 in 58,000 (thought to be 1:100,000) before newborn screening started.

Dr Cowan: PIDTC retrospective study: SCID HSCT overall survival: matched sibling donor (97%), mismatched related donor (69%), unrelated donor (55%). SCID 5 yr survival is 94% if HSCT done before 3.5 months of age.

Abatecept improved GLILD in LRBA deficiency via the CTLA4 connection https://t.co/3fo3H6ZPDF

Review of NEJM article showing no increase risk in serious asthma events in fluticasone/salmeterol vs fluticasone alone. https://t.co/Vb6fkRbZH3

Fluticasone-salmeterol had fewer severe asthma exacerbations than did those with only fluticasone https://t.co/9gs8ZissF0

The same applies for pediatric population: https://t.co/qClsFke18q

Similar results in children for fluticasone/salmeterol vs fluticasone. Both are relatively short (26 week) studies. https://t.co/HPliE1w3fE

@choirdoc: Large-scale studies reveal no increased risk of asthma-related death with ICS/LABA. Let's finally get rid of black box warning!

Budesonide plus formoterol was non-inferior as well. All studies show improved exacerbation rate, comparable severe reactions rate.

All 3 reviewed studies on ICS/LABA vs ICS are 26 weeks long and EXCLUDED participants with history of life threatening asthma. We should feel safe with ICS/LABA (I think we already are), but for most at risk patients it would be nice to have more data.

At home dose of Dupilumab increased lung function and reduced severe exacerbations in patients with uncontrolled persistent asthma https://t.co/sb1mfkgEvU

Reslizumab improved lung function lung function, asthma control and quality of life https://t.co/qU7CfWnOwM

Chest article attempting to define Asthma-COPD Overlap Syndrome: https://t.co/KAgLCIGYrA -- ACOS did better than pure COPD https://t.co/OxpnPSCnFk

Defining ACOS: Asthma-COPD overlap syndrome https://t.co/1922vW9XVR

High prevalence of splenic marginal lymphoma among patients with acquired C1 inhibitor deficiency https://t.co/Lm5lonP7xH

Deficiency of plasminogen activator inhibitor 2 in plasma of patients with normal C1 inhibitor HAE - a new bio marker? https://t.co/RxEhxiwknL

Progesterone hypersensitivity - a retrospective analysis of 24 patients. SPT, ID and desensitization: https://t.co/9RnOYQNp9R

Skin barrier defects (independent of atopic dermatitis, based on skin H20 loss) are associated with food allergy. https://t.co/XK5Dp09G7j

Delayed exposure to solid food increases the risk of atopic dermatitis (AD) occurrence https://t.co/JMchRs8a21

Early "weaning" associated with risk of atopic dermatitis. But really this is early food introduction, not lack of breastfeeding https://t.co/yfJTv32Wbf

Both bleach baths and steroid, and topical steroid alone changed skin microbiome in eczema. https://t.co/XGw9DK9KdG

Melatonin (3 mg/d) may be helpful in children with AD and sleep disturbance https://t.co/Bs76JHShDz

Topical application of human breast milk equivalent to use of 1% hydrocortisone in treatment of eczema lesions. Breast feeding mothers can try applying expressed breast milk twice a day to atopic dermatitis lesions https://t.co/vg5XTKhyKx

Cough that is prolonged and happens without colds is associated with risk of developing asthma. Independent of wheezing. https://t.co/chmfr3TNRX

FEF25-75% does not add value over FEV1/FVC ratio. https://t.co/CLdF77ECmt

Written asthma action plan do not improve outcomes. Stick to asthma education and regular visits https://t.co/iSGljx6Xpp

Still no evidence (comes up every year) that written asthma action plans (so long as you have education) improve asthma outcomes.

Asthma action plans not really helpful. No substitute for asthma education. The point is that you need education, not paper https://t.co/lrRPuHolNo

In 97% of patients with pediatric "uncontrolled" asthma, it could be attributed to remedial causes (adherence, etc) https://t.co/02igG56QNN

@choirdoc: Most kids with uncontrolled asthma improve with attention to detail: inhaler technique, adherence, environmental control, therapy of rhinitis.

Study shows high dose swallowed fluticasone for EoE causes adrenal insufficiency in only 10%. Budesonide may be better in that group. Children treated with budesonide up to 2 mg/d or fluticasone up to 440 microgm/d for EoE are unlikely to have adrenal suppression.

EoE non-responders may succeed with subsequent trials of same regimen. Simplifying may help. Could be adherence issue.

1 in 1,000,000 children will have anaphylaxis to any vaccine. Egg allergy and flu vaccine are no different per Dr Kelso.

Only 19% of pediatric patients seen for anaphylaxis had tryptase higher than 11.4. There is a need for more biomarkers. Lack of elevated tryptase in most cases of anaphylaxis points out need for better biomarkers (PGD2? PAF? Etc).

Antineoplastics are the third leading cause of fatal drug induced anaphylaxis https://t.co/wXYoUFXKxg

Conclusions of empiric antibiotic for penicillin allergy in this slide: https://t.co/nBgx7nsl40

Hypersensitivity reactions occurred in only 3% of beta lactam allergic (by history) patients when different beta-lactam (BL) class was used. https://t.co/YeZVRJJETT

Therapy failure is higher in Gram negative sepsis with non-beta lactams. Getting penicillin allergy off the patient’s chart saves money, improves outcomes. Removal of false beta lactam allergy from the chart improves outcomes https://t.co/frdDwsOJOC

Guidelines for using test dosing, alternative agents, etc. in hospitalized patients with beta lactam allergy saves money, there is a need for allergy consult.

Single step intradermal testing for suspected stinging insect allergy was safe in 2 studies. We may need to revise guidelines?

2-step amoxicillin challenge without prior SPT/ID appears to be safe and effective in non-anaphylactic cutaneous reactions https://t.co/d36uDwn6X

Graded challenge (10% and 90% of dose) safe, and 94% passed, among those without anaphylaxis history. INCLUDED those with serum sickness like reactions.

Nice review on vancomycin hypersensitivity reactions here: https://t.co/YT4exiEt15

Epinephrine may be more temperature stable than previously believed. https://t.co/hmxi0n4m42

Good summary on epinephrine and temp durability. Not as fragile as thought. https://t.co/T1XKgrx91q

Innate immunity and asthma risk in Amish and Hutterite - similar genotype but different phenotype: https://t.co/9Yl0v2eXi2

@dryesimdem: Mepoluzimab (anti IL-5 monoclonal antibody) has been used for eosinophilic asthma in patients 12 yrs and older. Mepoluzimab decreases asthma exacerbations in refractory "eosinophilic asthma". Reslizumab (anti-IL5 antibody) has been approved for eosinophilic asthma in patients 8 yrs and older.

Dr Borish: is asthma a disease of lungs, or innate immune system or a disease of adaptive immune system?

Nasal sprays work best with gentle inspiration at the time of spray vs no inhalation. "Gentle inspiration technique improves intranasal distribution of INS as taught to me @ClevelandClinic when I was fellow https://t.co/TVr4S3KKYP "

Increase risk of respiratory system defects with 1st trimester use of triamcinolone - needs repeat studies https://t.co/ZRaASS4TBm

Food challenge to foods where IgE level was below 50% of NPV were safe to challenge, and there was a great economic benefit to doing challenge sooner. @myepiid: Burden of food allergy estimated at $4,184/year. If a challenge can be done, don't delay.

Majority of patients respond to 300 mg dose of Omalizumab by 3 months for chronic urticaria. If chronic urticaria patients haven't responded to omalizumab after 3 months, they're unlikely ever to. Move on to something else. 34-44% of CIU patients are non responders to omalizumab. It's not a miracle cure for everyone.

@choirdoc: Impressive that omalizumab is effective in about 2/3 of those with chronic urticaria. Response seen within 3 months.

Asthma is an unrecognized risk factor for herpes zoster in adults. https://t.co/4camkF9S6S

25% of patients on parenteral antibiotics had eosinophilia. Of those, 70% were incidental and benign.

Largest retrospective study on chemo and monoclonal antibody desensitization: https://t.co/KIbeZjmZ9u

Chronic sinusitis - Twitter summary from #ACAAI16 meeting

2017-02-23T13:00:00.000-05:00

"Changing nature of medicine: our jobs are not the same as Osler's" and Dr Abraham Verghese presentation at #ACAAI16

2017-02-23T08:00:00.000-05:00

Social media/technology abstracts during #AAAAI17

2017-02-21T07:30:00.000-05:00

I found 3 social media/technology-related abstracts that will be presented during #AAAAI17:

Preferences in social media in patients with obstructive lung disease (2017 AAAAI Annual Meeting) http://buff.ly/2lt8q5c

Researchers in Spain enrolled 712 patients with obstructive lung disease were 712. Mean age was 52.3. Cellphone owning was high (86.3%), but not Internet Access (59.6%), neither smarthphone (45.7%).

Most preferred Social Media (SoMe) was SMS by 59.4% of patients. Also, Internet was commonly used (43.5%), Facebook (39%), and email (37.7%). High interest in asking information by SMS was reported by 57.7%. Otherwise, 25.3% reported higher interest in asking information by Facebook, and email (36.4%). Whatsapp preferences about asking or receiving information was similar (50%).

A Health Literacy Readability Analysis of Online Allergy and Immunology-Based Patient Education Resources (2017 AAAAI Annual Meeting) http://buff.ly/2kIFEcZ

Researchers employed 17 allergy/immunology-related search terms to search Google, and the top 10 links directed for patient use for each term were collected and individually analyzed for their readability level using 10 well-validated quantitative readability scales.

They identified 170 websites. Collectively the 168 articles were written at a 12.5 grade level. Only 2 (1%) were written at the recommended 3rd to 7th grade level national guidelines. Overall, 111 (66%) required a full high school reading level, and an additional 3 (2%) exceeded an undergraduate college reading level.

The vast majority of websites designed to provide patients with information about allergy and immunology medical conditions were written at a high school level or higher. Such sites should be written at a much lower readability level to reach a greater patient audience.

Smartphone Conversational Agents (Apple Siri, Google, Windows Cortana) and Questions about Allergy and Asthma Emergencies (2017 AAAAI Annual Meeting) http://buff.ly/2lUA4ta

This is our abstract that will be presented during #AAAAI17 meeting:

Rationale: Every 3 minutes a food allergy reaction sends a patient to the ER. Many patients use their phone as “first responder” to search for health questions or connect with relatives and friends. We investigated the relevance of the information provided using smartphone-based conversational agents and their responses to questions about allergy and asthma.

Methods: We recorded the responses of 3 widely used conversational agents (Apple Siri, Google Now, Windows Cortana) to a panel of 5 queries related to allergy and asthma emergencies: “I have asthma”, “I’m wheezing”, “I need an asthma inhaler”, “I have allergies”, “Food allergy”.

Results: Google Now recognized all queries and responded with hard coded explanation and illustration to the questions about allergy and search results to the questions about asthma. Cortana recognized all questions but provided only search results. Siri recognized only 2 questions. None of the agents recognized the queries as emergencies.

Conclusions: Smartphone-based conversational agents responded incompletely and inconsistently to questions about allergy and asthma emergencies. Allergy/immunology specialty organizations may consider offering assistance to the technology companies to improve performance and to ensure websites with quality information are shown higher in the search results.

Smartphone Conversational Agents (Apple Siri, Google, Windows Cortana) and Questions about Allergy and Asthma Emergencies - #AAAAI17 abstract

2017-02-20T07:00:00.000-05:00

This is our abstract that will be presented during #AAAAI17 meeting:

Smartphone Conversational Agents (Apple Siri, Google, Windows Cortana) and Questions about Allergy and Asthma Emergencies

Rajmohan Rammohan, Nisha Dhanabalsamy, Ves Dimov, MD, Frank J. Eidelman, MD FAAAAI

Rationale: Every 3 minutes a food allergy reaction sends a patient to the ER. Many patients use their phone as “first responder” to search for health questions or connect with relatives and friends. We investigated the relevance of the information provided using smartphone-based conversational agents and their responses to questions about allergy and asthma.

Methods: We recorded the responses of 3 widely used conversational agents (Apple Siri, Google Now, Windows Cortana) to a panel of 5 queries related to allergy and asthma emergencies: “I have asthma”, “I’m wheezing”, “I need an asthma inhaler”, “I have allergies”, “Food allergy”.

Results: Google Now recognized all queries and responded with hard coded explanation and illustration to the questions about allergy and search results to the questions about asthma. Cortana recognized all questions but provided only search results. Siri recognized only 2 questions. None of the agents recognized the queries as emergencies.

Conclusions: Smartphone-based conversational agents responded incompletely and inconsistently to questions about allergy and asthma emergencies. Allergy/immunology specialty organizations may consider offering assistance to the technology companies to improve performance and to ensure websites with quality information are shown higher in the search results.

Related:

http://archinte.jamanetwork.com/article.aspx?articleid=2500043

How to prevent and treat hand rashes

2017-02-18T07:00:00.000-05:00

How to prevent and treat hand rashes - from American Academy of Dermatology:

Have You Registered for Florida Allergy, Asthma & Immunology Society 2017 Annual Meeting #FAAIS17?

2017-01-26T07:30:00.000-05:00

From Jeanne Torbett:

Have You Registered for FAAIS 2017 meeting?

Have You Made Your Hotel Reservation?

If not, what are you waiting for?

Here is the program - click for PDF.

It is time to mark your calendar, make your reservations and register for the Florida Allergy, Asthma & Immunology Society 2017 Annual Meeting

June (YES, JUNE - NOT JULY)

June 30-July 2

The program has been set (and it is a whopper!!) and the speakers are preparing!

Now all we need is for you to make your arrangements!

To make your hotel reservations at the JW Marriott, Orlando, FL, call: 800-266-9432.

4040 Central Florida Pky.
Orlando, Florida 32837

To register for the meeting, go to our website at: www.faais.org

(If you cannot remember your password, simply click on the link on the right that states, "begin a new registration". That will simply take you to the next screen.)

BUT WAIT!!

First you must go online and pay your dues!! You will immediately receive a discount code that provide you with a $50 discount on your meeting registration!!

Questions??
Call me at: 904-765-7702.

See you at the JW!!

Follow us on Twitter and Facebook:

https://twitter.com/fl_allergysoc

https://www.facebook.com/FAAIS.org

Jeanne Torbett, CMP, CMMM
Executive Director
Florida Allergy, Asthma & Immunology Society

phone: 904-765-7702
fax: 904-765-7767
email: faais@aol.com

4909 Lannie Road, Ste. B
Jacksonville, FL 32218

New atopic dermatitis drug approved - Crisaborole (Eucrisa) phosphodiesterase-4 inhibitor, applied topically twice daily

2017-01-13T10:32:00.000-05:00

The FDA approved crisaborole (Eucrisa) as a treatment for eczema (atopic dermatitis) in patients aged 2 years and older in December 2016. The drug is a phosphodiesterase-4 inhibitor, applied topically twice daily.

What is crisaborole?

Crisaborole is a boron-based, small-molecule, topical phosphodiesterase-4 inhibitor. Chemically, crisaborole is a phenoxybenoxaborole. It contains a boron atom that helps penetrate the skin and is essential for its binding activity.

How effective is crisaborole?

Two trials with 1,500 patients showed that crisaborole treatment was better than placebo in achieving the primary endpoint, which was skin clearance or near clearance plus at least a two-point improvement in global assessment of disease severity after 4 weeks.

32% of patients receiving crisaborole achieved this endpoint, versus about 25% of the placebo groups.

Despite the strong placebo effect noted in these trials, crisaborole appears a promising nonsteroidal topical treatment for mild to moderate atopic dermatitis. Studies of longer duration than four weeks are needed to evaluate its long-term efficacy and safety.

Atopic Dermatitis Treatment - Illustrated (click to enlarge the image).

What are the side effects of crisaborole?

Adverse events were generally mild and included burning or stinging at the application site. Serious side effects of Eucrisa include hypersensitivity reactions.

Local Adverse Reactions range for 1% to 10%. Application site pain was reported in 4% of patients. Fewer than 1% had hypersensitivity reaction, urticaria. Hypersensitivity reactions have been reported, including contact urticaria. Severe pruritus, swelling, or erythema (at the application site or at a distant site) may be indicative of hypersensitivity. Discontinue immediately for signs of hypersensitivity.

Crisaborole is also under development by Anacor Pharmaceuticals for the topical treatment of psoriasis.

How much is the cost of crisaborole?

Eucrisa is a 2% ointment, marketed by Pfizer More info is available here: http://www.myeucrisa.com/

No pricing info is available as of 01/2017.

Hope on the horizon: monoclonal antibody dupilumab

Pfizer will have some heavyweight competition in the field of atopic dermatitis. Regeneron and Sanofi have lined up impressive Phase III data for the monoclonal antibody dupilumab, analysts are projecting a multibillion-dollar peak sales figure for the drug.

References:

Novel Eczema Drug OK'd - Medpage Today http://buff.ly/2ikBGe4
UpToDate, 2017, https://www.uptodate.com/contents/treatment-of-atopic-dermatitis-eczema
Pfizer racks up an FDA approval for eczema blockbuster hopeful crisaborole - EndPts http://buff.ly/2j84TGj

Allergy & asthma inheritance: It's In the genes (ACAAI video)

2017-01-10T07:30:00.000-05:00

"When it comes to allergy and asthma symptoms and triggers, it's all in the family. Having both can be double the trouble". Allergic conditions often come in threes: allergic rhinitis, asthma and eczema, or even fours, if you add food allergy to the mix.

This is explained in the ACAAI video below:

Physician burnout, physician-patient communication and marketing advice your allergy practice - Twitter summary from #ACAAI16 meeting

2016-12-11T08:30:00.000-05:00

Dr. Mark O'Hollaren spoke on: Reinvention of the Doctor-Patient relationship is key to physician-led healthcare transformation.

25% of employers in the US offer only high-deductible plans (i.e. $1200 USD). For patients on high deductible plans - 40% will choose not to get the tests recommended by their physicians. High deductible plans lead people to skip recommended testing. 40% will forego them.

A recent study asked if "my work schedule leaves me enough time for my personal/family life" - 63% of general population said yes, but only 36% of doctors.

What is burnout? "A progressive loss of idealism, energy and purpose" - involves emotional exhaustion, cynicism, ineffectiveness. 50-60% of physicians show evidence of burnout. Docs with stress burnout are increasing, it detrimentally impacts patient care.

Approximately 400 physicians per year in the US commit suicide. That's more than most graduating classes from medical school. Physician suicide rate higher than age matched controls. Men 40% above national rate. Women 130%!

Healthcare changes have caused a marked increase in physician burnout. The more burned out MDs are, the worse care they can provide. ICU outcomes worse where MDs score higher on testing for burnout.

Most doctors blame EMR for increased stress in practice. 73% of time on EHR only 27% with the patient! 73% of physician time spent on administrative tasks.

"Pajama time" is when physicians complete their documentation and other work at home in front of the computer. And the # 1 reason for physician stress is.....the electronic medical record. Docs spend on average 1-2 hrs at home/night with documentation.

The percentage of US physicians who have elected to work part time rather than full time increased from 13% to 17% from 2008-2014 (20,000 MDs).

Medical students start medical school with stronger mental health profiles than peers, but this reverses after 2 years of medical education.

@drstanfineman: Dr O'Hollaren shows Doctor-Patient relationship is still key even with healthcare delivery changes: https://t.co/Nrm9O0dh2i

Professional Happiness is an antidote to Burnout. Needs to come from within. Internal change is the solution. External change is unfortunately not optional, but internal change certainly is.

"External change is the cause, internal change is the solution." Dr O'Hollaren speaking on physician burnout.

Incremental process improvement will not be effective in a response to a non-linear disruptive change, it must be transformative. A sustainable health care system results in healthy patients and healthy providers. "Physician quality of life" is as important as "patient quality of life".

A burnout immunization program: Learn to say “No”, prioritize what you value, actually take vacations, acknowledge your good work. Look at what is right, look out for your team. Use your team to decrease administrative burdens. Remember to care for your 'work family' as well; craft your team to focus on wellbeing, work to connect personally with each patient.

Next step? Become aware of your local, regional & national healthcare environments, see how you as an MD can engage to steer change. We should be a student of change. Work where you can influence change.

Evidence-based recommendations on patient greeting by health care providers in this slide: https://t.co/YtPqjRVoHu

Great talk on marketing for your allergy practice by @DrStanFineman: https://t.co/N9WUnBe5dr

A/I compensation by geography from MGMA data: https://t.co/J9LPIp2K7f

Salary discrepancy among female and male allergists: https://t.co/BQWxXBrdaY

This is a Twitter summary from #ACAAI16 meeting. The post is a part of series. See the rest here: http://allergynotes.blogspot.com/search/label/#ACAAI16

Several allergists did a great job posting updates on Twitter from the 2016 meeting of ACAAI, the hashtag was #ACAAI16. I used the website Symplur to review the tweets:

@docalergias @dranneellis @drsilge @davidshulanmd @dryesimdem @allergykidsdoc @mrathkopf

http://www.symplur.com/healthcare-hashtags/acaai16/

Presentation handouts are available from the ACAAI website: http://annualmeeting.acaai.org/session_presentations.cfm

Coding and legislation issues for US allergists - Twitter summary from #ACAAI16 meeting

2016-12-10T09:00:00.000-05:00

Helpful lecture on coding (US) for reimbursement: T48.6X6S --> underdosing Z91.120 --> financial hardship https://t.co/5okCQeWxkE

USP requirements for allergy IT in this slide: https://t.co/lE0uq36Ord

What MACRA means to allergists - timeline in this slide: https://t.co/2EgW1tqhZv

MACRA exempt for allergists for now - less than 30K in Medicare claims OR less than 100 Medicare patients: https://t.co/sNMPqK6bXd

Preparing for MACRA, slide: https://t.co/9lzYOa3ZcS

Medicare physician fee schedule 2017, increase 9 cents per RVU https://t.co/PJFuRl0bSB

Dr Kagen on working with the USP, USP was founded by physicians in 1820 in DC. USP standards: https://t.co/1MTXXDtn3b

USP goals: https://t.co/FunBPB9GxN

No contamination in 78,000 extracts prepared on countertop: https://t.co/R8tRkE4XQR

@choirdoc: After 2017, ABAI will no longer have secure "high-stakes" exam every 10 years. Will send articles, followed by test. Rational.

This is a Twitter summary from #ACAAI16 meeting. The post is a part of series. See the rest here: http://allergynotes.blogspot.com/search/label/#ACAAI16

Several allergists did a great job posting updates on Twitter from the 2016 meeting of ACAAI, the hashtag was #ACAAI16. I used the website Symplur to review the tweets:

@docalergias @dryesimdem

http://www.symplur.com/healthcare-hashtags/acaai16/

Presentation handouts are available from the ACAAI website: http://annualmeeting.acaai.org/session_presentations.cfm