twitter fans allergy doc conference tweeting!

[Macabre]

READ FROM THE BOTTOM UP

------------------------------------------

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

[Macabre]

 @DrAnneEllis 
From Poster Session this morning: ketotifen may help with GI side effects of peanut desensitization #AAAAI

[Macabre]

READ FROM BOTTOM UP

---------------------------

@MatthewBowdish  • Although the number of allergists is small, we can have a far reach. Rapid desens is one niche we should own #AAAAI

25m ‏ @MatthewBowdish  • Min req for rapid desens: 1-on-1 RN, CPR/ACLS, crash cart, epi at bedside, anesthesia/code team, allergist 3min from bedside #AAAAI

28m ‏ @MatthewBowdish  • Is rapid desens a universal phenomenon? Yes Can all drugs be desensitized? Yes #AAAAI

29m ‏ @MatthewBowdish  • Aspirin desens can often be performed in the outpatient setting these days, especially with the use of leukotriene inhibitors #AAAAI

36m ‏ @MatthewBowdish  • Hypersensitivity reactions to mAbs: 105 desensitizations in 23 patients, from evaluation to treatment #AAAAI
bit.ly/AchKid
40m ‏ @MatthewBowdish  • It's not always possible to desens everyone, but Mariana has had a very high rate of success (99%) #AAAAI

41m ‏ @MatthewBowdish  • Safety of rapid desens - severe rxns in only 6% of cases at the Brigham #AAAAI

45m ‏ @MatthewBowdish  • A protocol for risk stratification of patients with carboplatin-induced hypersensitivity reactions JACI 2012 #AAAAI
bit.ly/xtyrvV
47m ‏ @MatthewBowdish  • Castells has a manuscript (in publication) for skin test dosing to chemotherapeutics #AAAAI

49m ‏ @MatthewBowdish  • Pain is not a symptom of allergy but it is a symptom of angioedema - activation of kallikrein system? #AAAAI

51m ‏ @MatthewBowdish  • Exclusion for rapid desens: Type III rxns, severe skin disease, stevens johnson, TEN, DRESS, ACE-induced angioedema #AAAAI

53m ‏ @MatthewBowdish  • Allergist should always be on board for ordering rapid desens protocols, but other docs can supervise actual procedure #AAAAI

55m ‏ @MatthewBowdish  • Rapid desens is high risk, performed on critically-ill pts and without done in pts without other viable treatment options #AAAAI

1h ‏ @MatthewBowdish  • After desens, dose needs to be repeated every 2-2.5 half lives #AAAAI

1h ‏ @MatthewBowdish  • Reaction to medications can be IgE or non-IgE mediated. Often, we don't understand the exact mechanism of reaction #AAAAI

h ‏ @MatthewBowdish  • Next I'm attenidng Mariana Castells on Hypersensitivity to Drugs & Rapid Desensitization in the 21st Century #AAAAI

[Macabre]

@mrathkopf: Annette Morris, MD - Bullying and Teasing in Children with Food Allergy ..... #AAAAI


@AllergieVoeding: "@allergistmommy: Children with food allergy suffer more anxiety around food than children with diabetes. #AAAAI"

@AllergieVoeding: "@DrSilge: prior study showed roughly 1 in 4 with food allergy were bullied specifically because of their food allergy. #AAAAI

@AllergieVoeding: "@DrSilge: Most bullying verbal, some physical by being threatened with food, one resulting in an allergic reaction. #AAAAI"

@mrathkopf: 1 in 3 middle and high school students are bullied. 17% increase since 2001. #AAAAI

@mrathkopf: Ann All Asthma Immun 2010;105:282-286-Bullying Among Pediatric Patients with Food Allergy-24% reported bullying due to food allergies #AAAAI

@mrathkopf: In the study presented, 34% of the 32 children reported being bullied #AAAAI

@mrathkopf: (bullying related to food allergy). Limitations -  limited enrollment to date and fact that parents completed the questionnaire. #AAAAI

[Macabre]

@AllergieVoeding: "@mrathkopf: 80-90% of egg allergic children will have atopic dermatitis. #AAAAI"

[Mezzo]

This

19 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--

@allergydoc4kidz: Risk for unanticipated OIT rxn (not during buildup): fever, viral infection, exercise, menses #AAAAI

That is really discouraging.

[Macabre]

Related to what I posted earlier:

http://www.medpagetoday.com/MeetingCoverage/AAAAIMeeting/31492


Food Allergy May Make Kids Bullying Targets

By 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 Points

Code Select Expand

These 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.

[mnovod]

Hello,
Any chance you have the slides from the Blaiss presentation to share?
Thanks
michael

READ FROM THE BOTTOM UP

------------------------------------------

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

[CMdeux]

Michael, I'm guessing that if you want the slides to a particular presentation, the best tactic is to contact the presenting author directly.

Many authors/presenters are reluctant to share slide sets, but some will.  It sometimes depends on how close a presentation is to being published, and in some cases whether or not that is the intention of the contributors.

In a meeting like this one, it's a mixed bag, since some clinicians aren't that interested in publications, and the research crowd is very committed to them.

https://academic.uthsc.edu/faculty/facepage.php?netID=mblaiss&personnel_id=121609