Newswise — Investigators are presenting abstracts on preliminary findings in the diagnosis and treatment of asthma, allergic and non-allergic rhinitis and other immunologic disorders at the ACAAI Annual Meeting, Nov. 12-17, in Boston. Following are highlights of some key investigations.
ALLERGIC & NON-ALLERGIC RHINITIS
1:15 pm, Nov. 15: "Grass Pollen is Often Airborne for Consecutive Daily Time Periods" (Abstract #34) " J. Anderson, London, Canada, et al " Tree and ragweed pollen grains have been previously found to be airborne for most if not all daily periods during their respective seasons. In this study, investigators found the presence of airborne grass pollen during four daily segments was sparse the first two weeks of May, but gradually increased during the next 10 days, and then was detected during most of the daily segments through the end of June.
Noon " 1 pm, Nov. 13 & 14: "Economic Burden Associated with Prior Authorizations in an Allergist Office" (Abstract #P187) " D. Bukstein, Madison, Wis. & G.A. Cherayil, Brookfield, Wis. " The cost for plans to process prior authorizations for non-formulary medications has been estimated to be $20 to $25 per request, but cost for physicians has not been extensively studied. This investigation of an allergy practice determines the total nursing and physician cost was $17.77 per prior authorization. Authors conclude that specialty physicians should have a different process for obtaining non-formulary medications since almost 100 percent of their requests are granted.
Noon " 1 pm, Nov. 13 & 14: "Complementary and Alternative Medicine Trends for Allergy and Asthma: Results of Follow-up Questionnaire 1998-2004" (Abstract #P192) " W. S. Silvers, et al, Englewood, Colo. " Allergy practice surveys of Complementary and Alternative Medicine (CAM) conducted in 1998 and 2004 indicate CAM use is growing among patients, and currently 10 percent are seeking CAM care from outside the practice. More than half of the patients were interested in pursuing "traditional with CAM" options within the allergy practice. Acupuncture was the first choice CAM modality at 48 percent in 2004, surpassing vitamin/mineral therapy in the 1998 survey.
Noon " 1 pm, Nov. 13 & 14: "Assessing Quality of Life among Allergy Sufferers: Comparison of Primary Care and Allergist Practices" (Abstract #P238) " T. Algozzine, Manchester, N.H., et al " Survey results indicate that patients treated by allergists had multiple allergies, more symptoms and utilized more prescription medications than those treated by a primary care physician. Despite these findings, patients treated by allergists reported less impact of allergies on their daily activities. The authors suggest that allergists treat more complex patients with better outcomes.
Noon " 1 pm, Nov. 13 & 14: "A Study to Determine the Impact of Nasal Congestion on the Daily Activities of Rhinitis Sufferers" (Abstract #P247) " M. Blaiss, Memphis, et al " This study confirms that nasal congestion causes the rhinitis sufferer significant problems beyond that of just a stuffy nose, with more than half the respondents finding it difficult to get a good night's sleep because of congestion, and 62 percent indicating that they were typically tired or fatigued during the day when they experience nasal congestion. In addition, 42 percent felt that activities requiring concentration, such as reading, were moderately or significantly impacted by nasal congestion.
Noon " 1 pm, Nov. 13 & 14: "Allergic Rhinitis (AR) Patients Have very Frequent Complaints of Sleep Problems and Tiredness in Clinical Practice" (Abstract #P263) " L.E. Mansfield, El Paso, Texas & C. Graham, New York " As part of the initial history, questions regarding fatigue, snoring, sleep problems and tiredness are addressed by this allergy practice. After reviewing 272 charts of patients with allergic rhinitis, investigators conclude that sleep-related problems and tiredness may be more common in patients with allergic rhinitis than previously reported. Authors suggest that questions specifically related to sleep and daytime tiredness should be included in all evaluations for allergic rhinitis.
Noon " 1 pm, Nov. 13 & 14: "Impairment with Second-Generation Antihistamines: Evidence from Published Literature" (Abstract #P265) " D. L. Spangler, Atlanta, & S.T. Varghese, Bridgewater, N.J. " Although second-generation antihistamines are less impairing than the first-generation, some of the newer antihistamines can produce impairment at or above the recommended dose. Authors conclude that these differences become important to the patient when agents cause sedation or if patients exceed the recommended dose.
Noon " 1 pm, Nov. 13 & 14: "Progression from Sinus Pain and Pressure to Acute Bacterial Sinusitis Is Not Well Predicted by Subjects with Rhinitis" (Abstract #P279) " C. K. Cook, et al, Research Triangle Park, N.C. " Research findings show that while most subjects can determine when sinus pain and pressure is due to allergic rhinitis, many cannot determine when symptoms progress to a sinus infection. Authors note that under appreciation by patients for the role of inflammation in sinus disease may result in over self-diagnosis of sinus infection and the demand for antibiotics.
ASTHMA
1:00 pm, Nov. 14: "Skin Test Variability in the Course of Treatment with Anti-IgE" (Abstract #1) " B. Lanier, Fort Worth, Texas " Since approval of the anti-IgE in 2002, clinicians have noted that even in the presence of good clinical response to asthma, skin test reactivity is still obvious and in many cases unchanged. In 22 of the 24 patients on therapy in this study, prick skin testing remained at an almost identical level to the baseline analysis, but there was a correlation between the patients with the lowest serum IgE and the likelihood of apparent reduction. There was no correlation to reduction of skin testing and clinical response to anti-IgE since all patients had experienced significant quality of life improvements.
2:15 pm, Nov. 14: "Symptom Control and Improved Functioning for Asthma Patients: The Effect of Omalizumab on ARQL (Abstract #30) " A.T. Luskin, Madison, Wis., et al " Omalizumab, a monoclonal anti-IgE antibody, significantly improves asthma-related quality of life (ARQL) for patients with moderate-severe allergic asthma who express symptoms despite moderate-high inhaled corticosteroids doses. Although patients receiving omalizumab improved more that patients receiving placebo across all component items, investigators found that patients reported the greatest improvement for: reducing "waking with symptoms in the morning;" limitations in "all activities done;" the "fear of not having medication available;" and symptoms from being "exposed to dust."
2:30 pm, Nov. 14: "Perceptions and Preferences of Pre-Teen and Teen Asthmatics" (Abstract #31) " A. Brimer, et al, Kansas City, Mo. " The perception in the adolescent population that asthma is a disease that makes people feel different, may impinge on patient adherence with medication regimens. Almost 40 percent of children with asthma surveyed indicated that having asthma made them feel different and resulted in restriction or exclusion from school activities, athletics and clubs. Since the overwhelming majority expressed a preference for participation in group activities, investigators suggest incorporating activities into an intervention, such as an asthma club, to help asthmatic youth adjust to the disease and its treatment regimen.
2:45 pm, Nov. 15: "Omalizumab (O) Administration Reduces Symptom Scores, Medication Use, and Markedly Diminishes Skin Test (ST) Reactivity" (Abstract 39A) " M. Vanghese, M., et al, Memphis, Tenn. " This study of 13 patients receiving Omalizumab found (1) an association with an improvement in symptoms and decreased use of medications (2) a prominent decline in skin test reactivity which is more marked 20 minutes after its administration compared to immediately prior to administration (3) apparent safety of administration even if patients demonstrate specific IgE to mouse antigen by skin testing.
1:15 pm, Nov. 15: "Changes in Morphology and Cell Number of Normal Human Lung Fibroblasts (NHLF) Cultured with Conditioned Media from Dust Mite-Treated Confluent Type II Alveolar Epithelial A549 Cells (Cc549)" (Abstract #49, Clemens von Pirquet Award)) " N. Horne, et al, East Meadow, N.Y. " This investigation indicates that normal human lung cell cultures exposed to dust-mite cell media release an unidentified factor or factors that may be involved in airway remodeling, a feature of chronic severe asthma.
Noon " 1 pm, Nov. 13 & 14: "Predictors of Hospital Admission Among High-Risk Asthmatics" (Abstract #P133) " W. Li-Ling, et al, Singapore " Among high-risk asthmatics, investigators identify population subgroups at greater risk for hospitalization for asthma. Among 521 high-risk asthmatics studies, 48.8 percent had at least one or more asthma hospitalization in the past 12 months prior to enrollment into the asthma program. Hospitalization was significantly associated with female gender. Other risk factors were found to be lower education levels, lower income, poor inhaler technique and not having ownership of an asthma action plan. Those hospitalized were also younger and had a lower first peak flow reading.
Noon " 1 pm, Nov. 13 & 14: "High Prevalence of Skin Test Positivity in Patients with Severe or Difficult-to-Treat Asthma" (Abstract #P155) " T. Haselkorn, South San Francisco, Calif., et al " The objective of TENOR, a 3-year, multi-center, cohort study, is to better understand the natural history of patients with severe or difficult-to-treat asthma. This analysis assessed the frequency of skin testing in this population and characterized the difference between the positive and negative subjects. Investigators demonstrated that the majority of these difficult-to-treat patients have allergic asthma, suggesting a more universal allergic evaluation in severe asthmatics. IMMUNOLOGY AND IMMUNOTHERAPY
2:00 pm, Nov. 14: "Mannose-Binding Lectin Deficiency in Children with Recurrent Infection" (Abstract #5, Clemens von Pirquet Award) " D.D. Siri, et al, St. Petersburg, Fla. " Mannose-binding lectin (MBL) is a derum protein important in innate immunity, thought to be particularly relevant in young children during the development of adaptive immunity. In children with recurrent infections, MBL deficiency was found to be approximately twice the estimated rate of the general population. The study did not reveal any correlation between MBL level and age, and, contrary to previous studies, no other significant immunologic disorders were identified. Investigators conclude that MBL deficiency alone is a risk factor for infection in children.
2:15 pm, Nov. 15: "Safety of Rapid Allergen Vaccination in Children Utilizing a 2-1/2-Hour Protocol" (Abstract #45) " W. Smits, et al., Fort Wayne, Ind. " Investigators demonstrate that rapid allergen vaccination (RAV) using a 2-1/2-hour protocol can be as safe as conventional allergen vaccination (CAV) in children suffering from allergic rhinitis and allergic asthma. Patients reached efficacious dosages almost immediately, saving six months of build-up period. Authors note that the adantages of RAV over CAV include improved adherence with almost immediate clinical efficacy, and decreased costs.
2:30 pm, Nov. 15: "Trends in Allergen Immunotherapy Prescriptions Over 12 Years" (Abstract #46) " M.M. Klote, McLean, Va., et al " A retrospective review of 38,400 allergen immunotherapy prescriptions over the past 12 years (1992-2003) found that although the inclusion of cat allergen in prescriptions increased from 10 percent to 45 percent, the dosing has remained unchanged despite published literature recommending higher volumes. Prescriptions containing dust mite rose from 20 percent to 65 percent, and 37 percent have been dosing per the guidelines.
Noon " 1 pm, Nov. 13 & 14: "A Review of the Immunological Changes Associated with Prolonged Marijuana Smoking (PMS)" (Abstract #P13) "M. I. Khan, Nowshera, Pakistan " Marijuana contains more than 426 chemical entities. The active ingredients, Delta-9-Tetrahydrocannabinol and other cannabinoids, are liquid soluble at high concentrations which alters membrane function, resulting in alterations in immune cell response. Cannabinoid has immunosuppressant properties resulting in reduction in resistance to bacterial and viral infection. Prolonged marijuana smokers with HIV infection are at higher risk of developing AIDS and infection by opportunistic bacteria, fungi, or viruses when compared to non-marijuana smokers.
Noon " 1 pm, Nov. 13 & 14: "Patient Knowledge and Improvement with Allergen Immunotherapy" (Abstract #P200) " C. C. Randolph, Waterbury, Conn. " Utilizing two published questionnaires, investigators assessed clinical improvement based on symptom and medication scoring and knowledge of immunotherapy. The majority of immunotherapy patients improved 85 percent by symptom and medication scoring over the mean of 2.7 years but only 35 percent had complete knowledge of the rationale for immunotherapy.
The ACAAI is a professional medical organization, headquartered in Arlington Heights, Ill., comprising 4,700 qualified allergists-immunologists and related health care professionals. The College is dedicated to the clinical practice of allergy, asthma and immunology through education and research to promote the highest quality of patient care. Preliminary research findings presented in abstracts should not be considered definitive until the papers have been published in a peer-reviewed medical journal.
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