Research Findings on Anaphylaxis and Food, Insect Allergy 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 anaphylaxis, food allergy and insect allergy.

ANAPHYLAXIS

?Patient Education and Awareness about the Use of Epinephrine Auto-injectors (AIs). (Abstract #P301: Nov. 11-12, Noon ? 1:00 p.m.) ? Myron Zitt, M.D., North Babylon, N.Y. ? Anaphylaxis is described as an acute, usually unanticipated, life-threatening reaction, which is most often immunologically induced. The effective early management of anaphylaxis depends on patients and caregivers being educated about proper epinephrine auto-injector (AI) use, the potential need for two doses of epinephrine and available AI devices. A survey of 59 patients and caregivers showed that 51 percent did not receive any training with their first AI prescription, and awareness about the potential need for two doses of epinephrine to reverse an anaphylactic reaction was low.

FOOD ALLERGY

?Survey of Physicians? Approach to Food Allergy: Part II. Allergens, Diagnosis, Treatment and Prevention.? (Abstract #11: Nov. 12 at 1:30 p.m.) ? Sami Bahna, M.D., Shreveport, La., et al ? A 2-page questionnaire was mailed to 3,000 ACAAI members and 4,000 non-allergists comprised of 1000 each of internists, family practitioners, pediatricians and otolaryngologists to determine differences in their approach to food allergy. Authors conclude that there are marked variations between allergists and non-allergists in the reported causes, methods of diagnosis, treatment and prevention of food allergy. More non-allergists than allergists utilize unproved methods of diagnosis and treatment. This study was supported by the ACAAI and submitted on behalf of the Adverse Reactions to Food Committee.

?Respiratory Symptoms are a Marker of Persistent Cow?s Milk Allergy in Children.? (Abstract #13: Nov. 12 at 2:00 p.m.) ? Alessandro Fiocchi, M.D., et al, Milan, Italy ? Cow?s milk allergy (CMA) has been described to remit in the vast majority of cases. Investigators assessed whether clinical factors impact the natural history of CMA in a population of 153 children confirmed with CMA who were followed up from diagnosis until onset of tolerance or continued disease. The results indicate that high sensitization to CM proteins and severity of symptoms are predictive of duration of the condition. Investigators conclude that the presence of asthma is a marker of long-lasting CMA, as the presence of food allergy is predictive of severe asthma.

?Oral Desensitization in Children with Immunoglobulin E-mediated Cow?s Milk Allergy: Follow-up at 4 Years and 8 Months.? (Abstract #P130: Nov. 11-12, Noon ? 1:00 p.m.) ? Paolo Meglio, et al, Rome, Italy ? Authors note that the treatment for food allergy to avoid the offending item is difficult in the case of common foods, and when there is a risk of severe reaction due to inadvertent ingestation. Investigators conducted a follow-up study of the long-term effectiveness and safety of oral cow?s milk (CM) desensitization of 21 children, concluding that oral food desensitization seems to be a promising method to treat food allergy to some common foods. The protocol offers the advantage that it can be performed at home and is quite safe. Authors note that the methodology needs standardization, and in some children clinical tolerance may not be definitive.

?Presentation of Failure to Thrive in Children with Food Allergies.? (Abstract #P144: Nov. 11-12, Noon ? 1:00 p.m.) ? Mary Beth Preston, et al, Milwaukee, Wis. ? Investigators review two cases of children who presented with failure to thrive due to excessive dietary restrictions and the subsequent impact of a focused nutritional therapeutic intervention. Authors conclude that elimination diets prescribed to the child diagnosed with food allergy may result in failure to thrive and other severe nutritional deficiencies. Intensive nutritional assessment and management should be included following the institution of restrictive allergen free diets.

INSECT REACTIONS

?Prevalence of Sensitization to Imported Fire Ant (IFA) in Children Living in an IFA-endemic Region. Clemmens von Pirquet Award. (Abstract #41: Nov. 13 at 1:00 pm) ? Megan E. Partridge, M.D., Augusta, Ga., et al ? An estimated 30 percent of individuals living in an imported fire ant (IFA) endemic region are stung by IFA annually. Over half of the children in this study were sensitized to fire ant venom by 2-5 years of age, with the prevalence increasing to approximately 65 percent of older children. Authors conclude that based on their data on the prevalence of fire ant sensitization, approximately 1,119,426 children under the age of 15 years who live in the state of Georgia, a fire ant endemic region, will be sensitized to fire ant.

?Hymenoptera Reactions Presenting to a Pediatric Inner-City Emergency Department.? (Abstract #42: Nov. 13 at 1:15 p.m.) ? Nalini Packianathan, M.D., et al, Buffalo, N.Y.
Hymenoptera stings, comprising those from sawflies, wasps, bees and ants, are common and often times life-threatening. Investigators in this 5-year study determined that epinephrine when indicated, was not prescribed on discharge for a third of pediatric patients treated in the Emergency Department (ED). Only one patient with a systemic reaction and none with multiple stings had recommendations for allergy follow-up on discharge from the ED. A significantly greater incidence of systemic reactions were observed in whites as compared to African Americans (12 percent vs. 3 percent).

?Prevalence of Lady Beetle Allergy.? (Abstract #P274: Nov. 11-12, Noon ? 1:00 p.m.) ? Jeremy Drelich, M.D., and Katherine R. May, M.D., Cumberland, Md. ? Asian lady beetles (Harmonia axyridis), which have become household nuisances since their introduction into the United States in the latter half of the twentieth century, have been identified as triggers for allergic rhinoconjunctivitis and asthma. Investigators found that 20 percent (90/456) of all patients tested for allergies in their practice were allergic to lady beetle. Authors conclude that skin test reactivity to the Asian lady beetle in rural Western Maryland is common and about as prevalent as cockroach and birch allergy and more common that Alternaria (a type of fungi) allergy.

?Harmonia axyridis Ladybug Allergy in Clinical Practice.? (Abstract #P313: Nov. 11-12, Noon ? 1:00 p.m.) ? David Goetz, M.D., Ph.D., Morgantown, W.V. ? The imported ladybug, Harmonia axyridis, infests homes in northern West Virginia from fall through spring, causing allergic disease. Investigators found that ladybug allergy presents most often as allergic rhinoconjunctivitis (8 percent prevalence), asthma (2 percent) and urticaria (1 percent). They conclude that ladybug skin-test sensitization is more common in rural areas and is comparable in frequency and age distribution to cat and cockroach.

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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