twitter fans allergy doc conference tweeting!

[eragon]

@allergistmom is tweeting with others at a conference today, very interesting to follow #AAAAI

now!

[CMdeux]

Thanks!! 

[Macabre]

I came to post this. But maybe we should  hanger subject lines?  You don't have to be a twitter fan or user. Just folllow the hashtag. #aaaai

[Macabre]

"@allergistmommy: As many asthmatics have confluence of risk factors (steroids, PPI, etc) consider screening w/ bone density at regular intervals. #AAAAI"


@allergistmommy: Dysfunctional breathlessness among the most common add'l dx in pts w/ refractory asthma. More common than vocal cord dysfunction. #AAAAI

@allergistmommy: Dysfunctional breathlessness among the most common add'l dx in pts w/ refractory asthma. More common than vocal cord dysfunction. #AAAAI

@allergistmommy: Dysfunctional breathlessness can be treated with psychotherapy, biofeedback, and speech therapy. #AAAAI

[Macabre]

@allergistmommy: If FEF50/FIF50 ratio is >150% predicted, strongly indicative of vocal cord dysfunction. #AAAAI

@allergistmommy: Restrictive pattern on spirometers: does not always correlate with true restrictive disorder. #AAAAI

@allergistmommy: Flexible laryngoscopy or video stroboscopy needed to work through the dx of extrathoracic obstruction. Don't assume VCD. #AAAAI

@allergistmommy: As allergists, we usually deal w/ obstructive lung disease. Remember: restrictive lung dz is part of the Ddx for dyspnea and cough. #AAAAI

[Macabre]

@allergydoc4kidz: Next up: Wesley Burks on OIT for foods #AAAAI

@allergydoc4kidz: PN allergy increasing in prevalence, more commonly assoc with anaphylaxis, and inciting threshold often lower than other foods #AAAAI

@allergydoc4kidz: Early studies targeted 300mg PN maintenance, low but above 100mg threshold for most pts #AAAAI

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

@allergydoc4kidz: Sx with 15-25% of OIT doses, but severe in <1% #AAAAI

@allergydoc4kidz: Drop out rate of 10-20% often due to delayed GI sx early on #AAAAI

@allergydoc4kidz: 93% able to tolerate ~13 PN after completing OIT trial (had reacted to 1/6 of a PN prior) #AAAAI
@allergydoc4kidz: Corresponding changes in SPT, basophil responses, IgE/IgG4 #AAAAI

@allergydoc4kidz: f/u DBPC study with 4000mg PN maintenance, substantially greater threshold after compared to placebo #AAAAI

@allergydoc4kidz: Th2 responses decrease, with transient rise in Tregs with PN-OIT #AAAAI

@allergydoc4kidz: Desensitization vs tolerance induction - can tx be stopped without recurrence? #AAAAI
@allergydoc4kidz: 19 pts on OIT for 33-70 mths, off for 4 weeks, 11 remained tolerant to 5000mg PN #AAAAI

@allergydoc4kidz: If baseline PN-IgE >85, less likely to develop true tolerance (all have some decrease in sIgE over time) #AAAAI

@allergydoc4kidz: Milk-OIT for 5-6 months with 500mg maintenance dose #AAAAI

@allergydoc4kidz: 19 pts with 40mg threshold at entry, increased to 4000mg after tx for 12 active milk-OIT, no change for 7 controls #AAAAI

@allergydoc4kidz: Milk SLIT vs OIT; SLIT alone unsuccessful, high-dose OIT after SLIT 80% success (more side effects) #AAAAI

@allergydoc4kidz: Pre-tx with anti-IgE for milk rush OIT; 9/10 able to achieve 1000mg 1st day (usually <50) #AAAAI

@allergydoc4kidz: Egg OIT multicentre DBPC 10 month trial plus extension, 2000mg maintenance dose, rpt challenge after 4-6 wks off tx #AAAAI

@allergydoc4kidz: Small SPT at 22 months correlated with functional tolerance to eggs, study still underway #AAAAI

@allergydoc4kidz: In various OIT studies: SPT drops, early IgE rise followed by gradual decline, tolerance not well established in blinded studies #AAAAI

[suevv]

In general I find Twitter incredibly annoying.  But THIS is awesome.

Thanks,
Sue

[CMdeux]

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

[Macabre]

Later in the session someone is presenting about an  epicutaneous study. I had to map. Am hope sick.
But I'm home sick and wanted To nap while it was raining and thundering.

More later.


And really---Nyone can follow things in real time order after the fact.


You can use www.tweetgrid.com and use a 1x1 frame and put it the hashtag and just see posts. It's like listening in on a conversation.

[Macabre]

I need to see what the abbreviation tx means (since I'm prett sure they're not referring to Texas, even tho it's Mar 2). I was assuming tanox as a further abbreviation of zolair. But I could be wrong. I do know that there has been an OIT/zolair combo trial at Duke.

I gather sx=symptom, fx=function. I know I've seen both in allergists tweets. I follow these two people all the time, btw. Since the last AAAAI meeting.

[CMdeux]

Could be 'treatment' Mac.

[eragon]

this is the 2nd conference i have followed, its fasinating to follow, and of course picking up new info along the way.

do we have a thread giving our twitter names so that we can all follow when another conference crops up?

[Macabre]

No I don't think so. Mine would be too personally revealing for this place as it gives my name.

But you and I are following each other.

[Macabre]

I'm about to post a bit more.

Please remember that these are people basically taking notes of a conference session via twitter.  KNow there can be a discrepancy between what the speaker is saying/what the allergist is hearing/what the allergist is typing. 

[Macabre]

READ FROM THE BOTTOM UP  I am on my laptop rather than my phone, and it's easier to copy all at once.  So the top tweet is the most recent.

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


‏ @allergydoc4kidz
2 points from baked milk talk: 1) challenge everyone irrespective of sIgE levels, 2) maintain regular (3x/day) intake if successful #AAAAI


‏ @allergydoc4kidz
Enhanced IL-6 release may help sustain Th17 cells and maintain homeostasis #AAAAI


‏ @allergydoc4kidz
IL-6 enhancement from Treg and mast cells seems TGF-B dependent#AAAAI


‏ @allergydoc4kidz
Staphylococcal endotoxin seems an important cofactor in sensitization models, and clearly NB in atopic dermatitis #AAAAI


‏ @allergydoc4kidz
Numbers of Treg not altered, but functional capacity diminished following oral Ag sensitization #AAAAI


‏ @allergydoc4kidz
Experimental food allergy associated with diminished Treg-associated genes in gut #AAAAI


‏ @allergydoc4kidz
Induction of specific Treg cells and clonal deletion of specific Th2 cells involved in development of tolerance #AAAAI


‏ @allergydoc4kidz
Describes regulatory Th2 cells, with high IL-10 production, and IL-5 negative Th2 cells #AAAAI


‏ @allergydoc4kidz
T cell phenotypes are not static/fixed, they can transform under various circumstances #AAAAI


‏ @allergydoc4kidz
Next up, Paul Bryce on T cell heterogeneity in tolerance #AAAAI


‏ @allergydoc4kidz
Regular intake of baked milk appears to accelerate development of unheated milk tolerance compared with strict avoidance #AAAAI


‏ @allergydoc4kidz
Baked milk-tolerant subjects have increased specific Tregs in circulation #AAAAI


‏ @allergydoc4kidz
Basophil reactivity declines with intake of baked milk products #AAAAI


‏ @allergydoc4kidz
No single informative epitope has been found to distinguish between phenotypes #AAAAI


‏ @allergydoc4kidz
Greater diversity and higher affinity IgE binding in persistent CMA#AAAAI


‏ @allergydoc4kidz
Greater IgE binding stability over time associated with CMA persistence #AAAAI


‏ @allergydoc4kidz
Recognition of sequential epitopes associated with persistent CMA#AAAAI


‏ @allergydoc4kidz
Little change in sIgE levels, but casein IgG4 levels increased in tolerant group #AAAAI


‏ @allergydoc4kidz
Baked milk-tolerant 28x more likely to develop full tolerance than baked milk-reactive #AAAAI


‏ @allergydoc4kidz
88 children, mostly school age, 74% baked milk tolerant, 60% developed full tolerance over course of study, only 9% in reactive group #AAAAI


‏ @allergydoc4kidz
Published study of daily baked milk intake to assess impact on reactivity to unaltered milk #AAAAI


‏ @allergydoc4kidz
Extensively heated/cooked milk alters conformational epitopes, may render non-allergic for up to 75% of CMA pts #AAAAI


‏ @allergydoc4kidz
Up next, Jennifer Kim on potential mechanisms of tolerance induction with baked milk #AAAAI


‏ @allergydoc4kidz
OIT with heated ovalbumin protected against oral but not parenteral challenge in murine model #AAAAI


‏ @allergydoc4kidz
Soluble allergens (ALA) can induce sx orally, while insoluble allergens (casein) in murine milk model require parenteral exposure #AAAAI


‏ @allergydoc4kidz

Induction of IL-1B and IL-6 through cutaneous exposure to PN#AAAAI


‏ @allergydoc4kidz
Gut may be tolerogenic in all cases, sensitization may occur through other routes, such as the skin #AAAAI


‏ @allergydoc4kidz
Th2 skewing in dendritic cells mediated by OX40L #AAAAI


‏ @allergydoc4kidz
Local Ag-specific Treg cells induced by high-IL-10 expressing mucosal macrophages, disseminate into circulation #AAAAI


‏ @allergydoc4kidz
GI dendritic cells are main mediator of default oral tolerance #AAAAI


‏ @allergydoc4kidz
Soluble Ag's do not require Peyer's patches to cross the mucosal surface #AAAAI


‏ @allergydoc4kidz
Challenge for intestinal mucosa is to differentiate non-cell Ag's (food, etc.) from pathogens #AAAAI


‏ @allergydoc4kidz
First up, Cecilia Berin, epithelial and dendritic cell handling of food Ag's at the mucosal level #AAAAI


‏ @allergydoc4kidz
Dissecting mechanisms of oral tolerance #AAAAI