Quote from: Macabre on March 03, 2012, 12:35:46 PM
READ FROM THE BOTTOM UP
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3m @allergistmommy
Seems unlikely that drop method for SLIT will be FDA approved anytime soon. Tablets are more likely, but are less versatile. #AAAAI
5m @allergistmommy
Pts receiving SLIT able to tolerate 2500mg peanut, significantly more than placebo. #AAAAI
7m @allergistmommy
Recent study showed SLIT w/crude peanut extract (max dose 5000mcg/ml) had 11.5% reaction rate, predominantly oropharyngeal.#AAAAI
9m @allergistmommy
SLIT for food allergy. Is it safer than OIT? #AAAAI
10m @allergistmommy
Dose-dependent decrease in combined sx/Rx score for 6 and 12 Amb dose. #AAAAI
12m @allergistmommy
Ragweed tablet: evaluating 3 doses. 1.5, 6, and 12 Amb. #AAAAI
13m @allergistmommy
32% decrease in average combined sx/Rx score with grass pollen tablet (in adults). Mild adverse rxns (mainly oral pruritus). #AAAAI
17m @allergistmommy
SLIT reduced symptoms/medication scores, and increased IgG4.#AAAAI
18m @allergistmommy
Both adults and children in study. Most of them were multi sensitized. ~25% had asthma. #AAAAI
20m @allergistmommy
Tablet to Timothy grass studied over 2 years in a DBPC Randomized multicenter trial. Looked at combined symptom and Rx score. #AAAAI
24m @allergistmommy
Should SLIT be given pre- or co-seasonally? High or low dose?#AAAAI
26m @allergistmommy
Does SLIT work for multi-allergen treatment? Appears less effective. Are we saturating Langerhans cells, or are volumes too high? #AAAAI
27m @allergistmommy
FDA has not made clear what would be required for approval. Will likely be a higher standard than for Rx. Guess? P value < 0.005!#AAAAI
29m @allergistmommy
SLIT should not be considered a medication. It is more accurately described as a vaccine. #AAAAI
30m @allergistmommy
SLIT studies complicated by variability in pollen levels. #AAAAI
31m @allergistmommy
Why has it been so hard to get SLIT approved by the FDA? #AAAAI
32m @allergistmommy
Michael Blaiss presenting. Only recently do we have double-blind placebo controlled studies for SLIT. #AAAAI
34m @allergistmommy
Correction: timothy grass SLIT low dose was 15mcg (20,000 BAU), high dose 150mcg (200,000 BAU). #AAAAI
35m @allergistmommy
Caution that these results are preliminary, with very small "n". #AAAAI
37m @allergistmommy
The T helper cells aren't switching, per se. It appears to be a new clonal population of cells. #AAAAI
39m @allergistmommy
In high dose group, effector cells "switched" from Th2 to Th1. #AAAAI
43m @allergistmommy
IgG as a function of timothy grass SLIT dose: High-dose > low-dose > placebo. Sx: high < low < placebo. #AAAAI
47m @allergistmommy
Patients reached maintenance 1 month into therapy. Top dose administered daily for 12 months. Administered with metered dose pump. #AAAAI
49m @allergistmommy
Comparison of high (150mcg daily) and low dose (5mcg daily)Timothy grass SLIT. #AAAAI
50m @allergistmommy
Decreased T cell proliferation can be noted 2 months into SLIT therapy. #AAAAI
52m @allergistmommy
After SLIT, eosinophils are decreased in nasal, oral and bronchial mucosa. #AAAAI
53m @allergistmommy
IL10 (my favorite cytokine) and TGFbeta increase during SLIT.#AAAAI
54m @allergistmommy
Immature state of oral Langerhans cells appears critical for tolerance induction in SLIT. #AAAAI
55m @allergistmommy
SLIT induces/maintains desensitization. Shifts towards Th1, IgG4, possibly IgA. #AAAAI
57m @allergistmommy
Kari Nadeau discussing immunological mechanisms of SLIT. #AAAAI
58m @allergistmommy
State of sublingual immunotherapy in the U.S. #AAAAI
QuoteBy John Gever, Senior Editor, MedPage Today
Published: March 05, 2012
Reviewed by Dori F. Zaleznik, MD; Associate Clinical Professor of Medicine, Harvard Medical School, Boston.
Action PointsThese studies were published as abstracts and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.
Explain that about a third of children in each of two survey studies reported being bullied because of their food allergies.
Note that in one of the surveys, in which parents and children were interviewed separately, nearly one-third of parents were unaware of the bullying, and for children who reported bullying episodes more than once a month, nearly two-thirds of those parents did not know about the bullying.
ORLANDO -- About one-third of children with food allergies are teased or harassed at school because of their condition, researchers said here.
The prevalence of bullying among children with food allergies was 29% in New York City and 34% in Jackson, Miss., according to reports from two separate surveys presented at the American Academy of Allergy, Asthma, and Immunology's (AAAAI) annual meeting.
Bullying tended to take place at school and was usually perpetrated by classmates and peers, but adults -- including teachers -- also were reported to have victimized children with food allergies.
And, in the New York study, parents often had no idea that their children had been bullied.
Children with any kind of minority status at school or in their neighborhoods are often singled out for verbal ridicule, social isolation, or even physical abuse.
A. Erika Morris, MD, of the University of Mississippi Medical Center in Jackson, Miss., noted that the constant dietary vigilance and the impacts on school attendance and performance can easily mark a child as different from peers and expose them to harassment.
She said her study was patterned after one published in 2010 by researchers in New York City led by Scott Sicherer, MD, of Mount Sinai Medical Center. It was the first to document clearly that food allergy is a stigmatizing factor, finding that 24% of food-allergic individuals (including adults and teens as well as young children) had experienced bullying related to their allergies.
The Mississippi study used the same questionnaire as in the earlier New York research, adapted to be more understandable to the lower socioeconomic-status population served in the Jackson clinic. Morris and colleagues administered it to 32 children or their parents (mostly the latter).
Some 85% of the children involved were younger than 12. Peanut and egg allergies were the most common.
Results indicated that 11 children, or 34%, had been bullied in some way -- harassed, taunted, teased, or physically abused -- because of their food allergies.
Morris said that, in line with earlier bullying studies, the bullying took place mainly at school and mainly by classmates. But, she said, in more than one instance teachers were perpetrators.
Most of the bullying was verbal, but parents or teen respondents reported that they were struck, pushed, or tripped.
There also were instances where bullies waved allergy-producing food items in the victims' faces or threw food at them. One respondent reported an allergic reaction occurring as a result.
Eight of the 11 children had been bullied for other reasons as well, including their size, race, age, or other medical conditions (including eczema in two cases).
Meanwhile, Sicherer and a different group of colleagues reported a new survey-based study at the AAAAI meeting following up on the 2010 effort.
Whereas the earlier study queried only teens and adults (mainly parents responding for their children), the new survey asked children eight to 17 years old and, separately, their parents about bullying the children had experienced.
The overall prevalence of allergy-related bullying was 28.8% among the 111 families included in the study. A slightly higher proportion (32.6%) of those in sixth through 10th grade reported having been bullied for their allergies.
Notably, Sicherer and colleagues found that, in 32% of allergy-related bullying cases reported by the children, their parents were unaware of it. And for 11 children who had reported being bullied more than once a month, 64% of parents did not know it.
"These results provide a strong argument that practitioners should specifically ask about bullying in this vulnerable population," the researchers said in their poster presentation.
Clinicians also should "provide anticipatory guidance about it even if it is not initially disclosed," they added.
Quote from: CMdeux on March 02, 2012, 01:51:11 PM
ThisQuote19 pts on OIT for 33-70 mths, off for 4 weeks, 11 remained tolerant to 5000mg
Is fairly disheartening, really.
It suggests pretty strongly that around half of PA patients probably cannot be truly "desensitized" unto tolerance. Makes me think (personally, after looking at all this science and research for over a decade now) that a LOT more basic research is needed in order to tease apart just who is and is not likely to benefit from this kind of intervention.
I mean, I suppose that it's better to need daily dosing forever than to be at risk of fatal anaphylaxis from an inadvertent exposure. But for female patients, that may not be so simple, either--Quote
@allergydoc4kidz: Risk for unanticipated OIT rxn (not during buildup): fever, viral infection, exercise, menses #AAAAI