Research Findings in Allergy-Immunology Unveiled

Investigators are presenting more than 380 abstracts on preliminary findings in the diagnosis and treatment of allergic diseases at the ACAAI Annual Meeting in Philadelphia, Nov. 9-15. Following are highlights of some key investigations on allergic rhinitis and ocular allergies.

ALLERGIC RHINITIS

?Patient Perspectives on the Symptoms of Allergic Rhinitis and the Effect of Allergic Rhinitis on Daily Living.? (Abstract #29: Nov. 12 at 2:00 p.m.) ? Michael S. Blaiss, M.D., Memphis, et al ? Allergic rhinitis (AR) is a chronic inflammatory disease of the upper airways affecting 10 percent to 25 percent of the world?s population. Of the 2,500 adults with AR who were surveyed by telephone interview, 40 percent reported that congestion was the most frequent symptom and was extremely bothersome. Post-nasal drip (28 percent), runny nose (26 percent) and red, itching eyes (23 percent) were also reported by patients as extremely bothersome symptoms. Approximately one third of patients with nasal allergies also suffered from asthma.

?Yuletide Allergy Symptoms.? (Abstract #P200: Nov. 11-12, Noon ? 1:00 p.m.) ? Michael Alexander, M.D., Niagara Falls, Canada, et al ? This investigation using completed questionnaires from four atopic subjects, and testing with airborne sampling and tree trunk tape lifts, demonstrates that patients with seasonal allergic rhinitis can experience symptoms caused by a Christmas tree in their homes. Christmas trees are a significant source of allergens, particularly mold. Airborne sampling revealed increased mold spores with the introduction of the tree, and a secondary burst of mold spores with the removal of the tree.

?3-Year Treatment of Children with Triamcinolone Acetonide Aqueous for Allergic Rhinitis Does Not Affect Statural Growth.? (Abstract #P217: Nov. 11-12, Noon ? 1:00 p.m.) ? David Skoner, M.D., Pittsburgh, Pa., et al ? Guidelines recommend intranasal corticosteroids for patients with allergic rhinitis (AR) but concerns remain as to possible adverse effects on growth. In an ongoing investigation, the 3-year results show that no statistical difference (at the 0.0005 level) was detected in the height of 19 children (aged 6.1 ? 14.0 years at entry) receiving triamcinolone acetonide aqueous treatment for allergic rhinitis.

?Impact of Congestion Associated with Allergic Rhinitis on Sleep, Daytime Somnolence and Fatigue, and Work and School Productivity.? (Abstract #P220: Nov. 11-12, Noon ? 1:00 p.m.) ? Donald.E. Stull, M.D., Bethesda, Md., et al ? Investigators report that symptoms associated with allergic rhinitis (AR) include impaired sleep resulting in day-time somnolence and fatigue, reduced productivity at work or school, and increased health care costs. This study explored the impact of congestion relative to the broader collection of AR symptoms. Authors conclude that nasal congestion alone has a significant, negative impact on patients? lives, accounting for most of the negative impact of AR symptoms on sleep adequacy. Congestion increases the likelihood of sleep problems, symptoms during sleep time, sleep disturbance, shortness of breath or headache, snoring, daytime somnolence and fatigue.

?Global Climatic Change and its Impact on Oak Pollen Season in the Midwestern US.? (Abstract #P278: Nov. 11-12, Noon ? 1:00 p.m.) ? Gregory G. Pendell, M.D., et al, Kansas City, Mo. ? Authors note that the last decades of the 20th century have been reported to be warmer than any comparable period in the past 1,000 years. This investigation, using a Burkhard spore trap operating from February to November during 1997 through 2006 in the urban core of Kansas City, shows that oak pollen season appears to begin a half day earlier each year. Authors conclude that the trend to an earlier oak pollen season in the Midwest should reach statistical significance in the next five years.

NON-ALLERGIC CONJUNCTIVITIS

?Non-allergic, Non-infectious Conjunctivitis. Potential for Urban Eye Syndrome?? (Abstract #P201: Nov. 11-12, Noon ? 1:00 p.m.) ? Bobby Lanier, M.D., Fort Worth, Texas ? Investigators determined by phone survey that almost 25 of 100 patients with non-allergic rhinitis also suffer from ocular symptoms. Itching was the most common symptom (91 percent) following by burning (82 percent), redness (73 percent) and dry eye (55 percent). Seasonality was the most common trigger (77 percent) followed closely by environmental (68 percent), chemicals (50 percent), pollution (36 percent) and animals (9 percent).

IMMUNOTHERAPY

?Safe and Effective Rapid Desensitization: A Cumulative Experience of 1,540 Patients.? (Abstract #20: Nov. 12 at 1:45 p.m.) ? William Smits, M.D., Fort Wayne, Ind., et al ? Conventional immunotherapy is effective in the treatment of allergic rhinitis, allergic asthma and chronic rhinosinusitus. Authors note that rapid desensitization (or rush immunotherapy) offers the advantages of rapid response, improved compliance and cost effectiveness, but safety continues to be a primary concern for this procedure. Investigators confirm in this study of 1,540 patients that maintenance immunotherapy can be reached quickly, safely and effectively under careful supervision, but caution must be exercised when using this procedure as anaphylaxis does occur.

?Sublingual Immunotherapy for Treatment of Poison Ivy Dermatitis.? (Abstract #P154: Nov. 11-12, Noon ? 1:00 p.m.) ? M.S. Morris and M. Learned, La Crosse, Wis. ? Each year 10 to 50 million Americans develop an allergic reaction after contact with poison ivy according to the investigators. Results of this preliminary retrospective chart review of 115 patients indicate that sublingual immunotherapy may be a viable treatment option for decreasing sensitivity for patients with poison ivy dermatitis. Authors note that this thereapy may allow patients who have occupation or hobbies which bring them into frequent contact with poison ivy to decrease the frequency and severity of outbreaks.

METAL ALLERGY

?Systemic Delayed Hypersensitivity (DH) to Cobalt (Co) after Metal Alloy Knee Arthroplasty.? (Abstract #P6: Nov. 11-12, Noon ? 1:00 p.m.) ? Frederick C. Cogen, M.D., Meadowbrook, Pa. ? Investigators note that joint arthroplasty with insertion of a metal alloy prosthesis is an increasing procedure in our aging population. Reporting on two cases and a cohort of 35 patients with failed knee replacements that had positive patch tests to cobalt, authors caution physicians to be aware of the entity of metal induced systemic delayed hypersensitivity following arthroplasty. They suggest patch testing may be useful in diagnosing DH in arthroplasty failures, and perhaps, in choosing the optimal implant for those with a history of DH to metals.

?Stainless Steel Allergy after the Nuss Procedure for Repair of Pectus Excavatum.? (Abstract #P195: Nov. 11-12, Noon ? 1:00 p.m.) ? Maripaz B. Morales, M.D., Suffolk, Va., et al ? This study evaluated metal allergy and its effects on the increasing use of implantable nickel and chromium bars for minimally invasive pectus excavatum repair treatment with the Nuss procedure in pediatric patients. Investigators conclude that allergy symptoms often are misdiagnosed as infection, but require different treatment. They suggest patients with a history of metal allergy or atopy be tested and a titanium bar be used for this procedure. Because the consequences of metal allergy may include the need to replace the bar, pediatric surgeons should be aware of this occurrence.

SKIN DISORDERS, SEMEN ALLERGY

?Prevalence of Thyroid Disease and Anti-thyroid Antibodies in Patients with Chronic Idiopathic Urticaria.? (Abstract #63: Nov. 13 at 2:30 p.m.) ? Yazan Said, M.D., Long Beach, Calif., and Harb Harfi, M.D., Riyadh, Saudia Arabia ? Investigators characterize chronic idiopathic urticaria/angiodema (CIU/A) as recurrent or persistent urticarial lesions and/or angioedema, lasting more than six weeks, and a debilitating disease with only supportive therapy. In this study of 165 CIU/A patients, they found an increased prevalence of thyroid disease and auto-antibodies, which may support the role of auto-immunity in its pathogenesis. Authors recommend testing for thyroid function and anti-thyroid antibodies in these patients since its treatment may help control CIU/A.

?Resurgence of Bedbug Bites Misdiagnosed as Allergic Skin Rashes in Inner-City Population.? (Abstract #P199: Nov. 11-12, Noon ? 1:00 p.m.) ? Sreenivasrao Amara, M.D., et al, Brooklyn, N.Y. ? There is an increase in reports of bites from bedbugs (Cimex lectularius), a nocturnal bloodsucking parasite, in the U.S. and worldwide. Investigators report six patients with multiple, cutaneous manifestations misdiagnosed as allergic reactions that were proven bedbug bites. They recommend health care professionals be alert to screen for bedbug bites in any patient with a new refractory rash.

?Seminal Plasma Protein Hypersensitivity: The First Case Report in a Puerto Rican Woman.? (Abstract #P32: Nov. 11-12, Noon ? 1:00 p.m.) ? Jennifer Collins, M.D., et al, New York, N.Y. ? Human seminal plasma protein hypersensitivity is a rare and often misdiagnosed phenomenon, with 80 cases existing in the medical literature including individuals from Europe, the United States, Australia, India, Japan, Israel and Korea, according to the authors. Authors note that, to their knowledge, this investigation is the first case report of seminal plasma protein hypersensitivity in a Puerto Rican female who underwent intravaginal desensitization.

About ACAAI

The American College of Allergy, Asthma and Immunology (ACAAI) is a professional medical organization headquartered in Arlington Heights, Ill., that promotes excellence in the practice of the subspecialty of allergy and immunology. The College, comprising more than 5,000 allergists-immunologists and related health care professionals, fosters a culture of collaboration and congeniality in which its members work together and with others toward the common goals of patient care, education, advocacy and research.


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