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Doug Brunk is a San Diego-based award-winning reporter who began covering health care in 1991. Before joining the company, he wrote for the health sciences division of Columbia University and was an associate editor at Contemporary Long Term Care magazine when it won a Jesse H. Neal Award. His work has been syndicated by the Los Angeles Times and he is the author of two books related to the University of Kentucky Wildcats men's basketball program. Doug has a master’s degree in magazine journalism from the S.I. Newhouse School of Public Communications at Syracuse University. Follow him on Twitter @dougbrunk.
FDA grants Hodgkin lymphoma indication for pembrolizumab
Pembrolizumab is now approved for the treatment of adults and children who have refractory classical Hodgkin lymphoma, or who have relapsed after three or more prior lines of therapy, the Food and Drug Administration announced on March 14.
Pembrolizumab (Keytruda) is a humanized monoclonal antibody administered intravenously. According to a press release from Merck, the manufacturer of Keytruda, the approval is based on data from 210 patients aged 18 years and older in the KEYNOTE-087 trial, which found an overall response rate of 69% among patients who received 200 mg of the drug every 3 weeks. Among responders, the median duration of response was 11.1 months.
“For the patients with classical Hodgkin lymphoma who are not cured with existing treatments, there are limited options, and treating their disease becomes more challenging,” Craig H. Moskowitz, MD, clinical director of the division of hematologic oncology at Memorial Sloan Kettering Cancer Center, New York, said in the press release. “This approval is an important step forward in treating these patients, who are generally young and have a particularly poor prognosis.”
According to Merck, continued approval for this indication may be contingent upon verification and description of clinical benefit in the confirmatory trials. The revised drug label information can be found here.
dbrunk@frontlinemedcom.com
Pembrolizumab is now approved for the treatment of adults and children who have refractory classical Hodgkin lymphoma, or who have relapsed after three or more prior lines of therapy, the Food and Drug Administration announced on March 14.
Pembrolizumab (Keytruda) is a humanized monoclonal antibody administered intravenously. According to a press release from Merck, the manufacturer of Keytruda, the approval is based on data from 210 patients aged 18 years and older in the KEYNOTE-087 trial, which found an overall response rate of 69% among patients who received 200 mg of the drug every 3 weeks. Among responders, the median duration of response was 11.1 months.
“For the patients with classical Hodgkin lymphoma who are not cured with existing treatments, there are limited options, and treating their disease becomes more challenging,” Craig H. Moskowitz, MD, clinical director of the division of hematologic oncology at Memorial Sloan Kettering Cancer Center, New York, said in the press release. “This approval is an important step forward in treating these patients, who are generally young and have a particularly poor prognosis.”
According to Merck, continued approval for this indication may be contingent upon verification and description of clinical benefit in the confirmatory trials. The revised drug label information can be found here.
dbrunk@frontlinemedcom.com
Pembrolizumab is now approved for the treatment of adults and children who have refractory classical Hodgkin lymphoma, or who have relapsed after three or more prior lines of therapy, the Food and Drug Administration announced on March 14.
Pembrolizumab (Keytruda) is a humanized monoclonal antibody administered intravenously. According to a press release from Merck, the manufacturer of Keytruda, the approval is based on data from 210 patients aged 18 years and older in the KEYNOTE-087 trial, which found an overall response rate of 69% among patients who received 200 mg of the drug every 3 weeks. Among responders, the median duration of response was 11.1 months.
“For the patients with classical Hodgkin lymphoma who are not cured with existing treatments, there are limited options, and treating their disease becomes more challenging,” Craig H. Moskowitz, MD, clinical director of the division of hematologic oncology at Memorial Sloan Kettering Cancer Center, New York, said in the press release. “This approval is an important step forward in treating these patients, who are generally young and have a particularly poor prognosis.”
According to Merck, continued approval for this indication may be contingent upon verification and description of clinical benefit in the confirmatory trials. The revised drug label information can be found here.
dbrunk@frontlinemedcom.com
Chronic rhinosinusitis associated with poor sleep quality
ATLANTA – Answers on a popular self-reported sleep questionnaire correlated positively with sinonasal inflammation, suggesting that patients with chronic rhinosinusitis should be assessed for sleep-related problems, results from a single-center study showed.
“We need to be recognizing the symptoms of chronic rhinosinusitis patients more in order to help them improve their quality of life,” lead study author Jessica Hui, MD, said in an interview at the annual meeting of the American Academy of Allergy, Asthma, and Immunology. “Asking them about sleep is important.”
Dr. Hui, who is a second-year pediatrics resident at Rush University Medical Center, reported that CRS patients had significant worse sleep quality, compared with controls (a mean PSQI score of 7.44 vs. 3.31, respectively) and that a higher Lund-Mackay Score correlated with greater PSQI (Pearson correlation coefficient of 0.25; P = .03).
The mean age of CRS cases without sleep disruption was 12.08 years, while the mean age of CRS cases with sleep disruption was 34.74 years.
Poor sleep quality was also associated with higher pain index scores (Pearson correlation coefficient of 0.35; P = .002) and higher scores on the SNOT-22 (Pearson correlation coefficient of 0.25; P = .025). The researchers observed that CRS patients without nasal polyps trended towards a higher PSQI, compared with controls (a mean of 8.14 vs. 6.36; P=0.10). Sinus histopathology variables and comorbid diseases did not correlate with PSQI scores.
Dr. Hui reported having no financial disclosures.
ATLANTA – Answers on a popular self-reported sleep questionnaire correlated positively with sinonasal inflammation, suggesting that patients with chronic rhinosinusitis should be assessed for sleep-related problems, results from a single-center study showed.
“We need to be recognizing the symptoms of chronic rhinosinusitis patients more in order to help them improve their quality of life,” lead study author Jessica Hui, MD, said in an interview at the annual meeting of the American Academy of Allergy, Asthma, and Immunology. “Asking them about sleep is important.”
Dr. Hui, who is a second-year pediatrics resident at Rush University Medical Center, reported that CRS patients had significant worse sleep quality, compared with controls (a mean PSQI score of 7.44 vs. 3.31, respectively) and that a higher Lund-Mackay Score correlated with greater PSQI (Pearson correlation coefficient of 0.25; P = .03).
The mean age of CRS cases without sleep disruption was 12.08 years, while the mean age of CRS cases with sleep disruption was 34.74 years.
Poor sleep quality was also associated with higher pain index scores (Pearson correlation coefficient of 0.35; P = .002) and higher scores on the SNOT-22 (Pearson correlation coefficient of 0.25; P = .025). The researchers observed that CRS patients without nasal polyps trended towards a higher PSQI, compared with controls (a mean of 8.14 vs. 6.36; P=0.10). Sinus histopathology variables and comorbid diseases did not correlate with PSQI scores.
Dr. Hui reported having no financial disclosures.
ATLANTA – Answers on a popular self-reported sleep questionnaire correlated positively with sinonasal inflammation, suggesting that patients with chronic rhinosinusitis should be assessed for sleep-related problems, results from a single-center study showed.
“We need to be recognizing the symptoms of chronic rhinosinusitis patients more in order to help them improve their quality of life,” lead study author Jessica Hui, MD, said in an interview at the annual meeting of the American Academy of Allergy, Asthma, and Immunology. “Asking them about sleep is important.”
Dr. Hui, who is a second-year pediatrics resident at Rush University Medical Center, reported that CRS patients had significant worse sleep quality, compared with controls (a mean PSQI score of 7.44 vs. 3.31, respectively) and that a higher Lund-Mackay Score correlated with greater PSQI (Pearson correlation coefficient of 0.25; P = .03).
The mean age of CRS cases without sleep disruption was 12.08 years, while the mean age of CRS cases with sleep disruption was 34.74 years.
Poor sleep quality was also associated with higher pain index scores (Pearson correlation coefficient of 0.35; P = .002) and higher scores on the SNOT-22 (Pearson correlation coefficient of 0.25; P = .025). The researchers observed that CRS patients without nasal polyps trended towards a higher PSQI, compared with controls (a mean of 8.14 vs. 6.36; P=0.10). Sinus histopathology variables and comorbid diseases did not correlate with PSQI scores.
Dr. Hui reported having no financial disclosures.
AT 2017 AAAAI ANNUAL MEETING
Key clinical point:
Major finding: CRS patients had significant worse sleep quality, compared with controls (a mean Pittsburgh Sleep Quality Index score of 7.44 vs. 3.31, respectively).
Data source: A cohort study of 125 CRS patients with refractory disease and 41 controls.
Disclosures: Dr. Hui reported having no financial disclosures.
Gender impacts risk of atopic diseases
ATLANTA – Obese females who live in urban settings are significantly more likely to develop atopic diseases, compared with their male counterparts, results from a single-center study showed.
“Some research has shown that obese girls are much more likely to be atopic, but many of them only look at one disease alone, such as atopic dermatitis or food allergies,” lead study author Sairaman Nagarajan, MD, MPH, said in an interview at the annual meeting of the American Academy of Allergy, Asthma, and Immunology. “Most of the studies are in asthma.”
The mean age of patients was 9 years, 23% were obese, and 55% were male. The researchers observed no differences in laboratory biomarkers nor in the prevalence of individual/or cumulative atopic disease in obese children, compared with controls. When stratified by gender, obese females had a significantly higher mean atopic disease score, compared with controls (4.00 vs. 2.62, respectively; P less than .001), while males had a significantly lower mean atopic disease score, compared with controls (3 vs. 3.42; P less than .001). Regression models yielded similar results; obese females had a significantly higher mean atopic disease score, compared with controls (by a mean elevation of 1.37 points; P less than .005), while males had a significantly lower mean atopic disease score (by a mean decline of -0.42 points; P less than .006). “From this we can say that female gender is a positive risk factor for atopy, and urban obese females may be particularly likely to benefit from lifestyle modification therapy like exercise and diet in controlling weight, and thereby allergies,” Dr. Nagarajan said.
He noted that it remains unclear whether the findings would apply to children who live in nonurban settings. “It’s difficult to say because there are some variables which are unique to urban minority populations like the housing that they live in and the kind of stores they buy food from,” he said.
Dr. Nagarajan reported having no financial disclosures.
ATLANTA – Obese females who live in urban settings are significantly more likely to develop atopic diseases, compared with their male counterparts, results from a single-center study showed.
“Some research has shown that obese girls are much more likely to be atopic, but many of them only look at one disease alone, such as atopic dermatitis or food allergies,” lead study author Sairaman Nagarajan, MD, MPH, said in an interview at the annual meeting of the American Academy of Allergy, Asthma, and Immunology. “Most of the studies are in asthma.”
The mean age of patients was 9 years, 23% were obese, and 55% were male. The researchers observed no differences in laboratory biomarkers nor in the prevalence of individual/or cumulative atopic disease in obese children, compared with controls. When stratified by gender, obese females had a significantly higher mean atopic disease score, compared with controls (4.00 vs. 2.62, respectively; P less than .001), while males had a significantly lower mean atopic disease score, compared with controls (3 vs. 3.42; P less than .001). Regression models yielded similar results; obese females had a significantly higher mean atopic disease score, compared with controls (by a mean elevation of 1.37 points; P less than .005), while males had a significantly lower mean atopic disease score (by a mean decline of -0.42 points; P less than .006). “From this we can say that female gender is a positive risk factor for atopy, and urban obese females may be particularly likely to benefit from lifestyle modification therapy like exercise and diet in controlling weight, and thereby allergies,” Dr. Nagarajan said.
He noted that it remains unclear whether the findings would apply to children who live in nonurban settings. “It’s difficult to say because there are some variables which are unique to urban minority populations like the housing that they live in and the kind of stores they buy food from,” he said.
Dr. Nagarajan reported having no financial disclosures.
ATLANTA – Obese females who live in urban settings are significantly more likely to develop atopic diseases, compared with their male counterparts, results from a single-center study showed.
“Some research has shown that obese girls are much more likely to be atopic, but many of them only look at one disease alone, such as atopic dermatitis or food allergies,” lead study author Sairaman Nagarajan, MD, MPH, said in an interview at the annual meeting of the American Academy of Allergy, Asthma, and Immunology. “Most of the studies are in asthma.”
The mean age of patients was 9 years, 23% were obese, and 55% were male. The researchers observed no differences in laboratory biomarkers nor in the prevalence of individual/or cumulative atopic disease in obese children, compared with controls. When stratified by gender, obese females had a significantly higher mean atopic disease score, compared with controls (4.00 vs. 2.62, respectively; P less than .001), while males had a significantly lower mean atopic disease score, compared with controls (3 vs. 3.42; P less than .001). Regression models yielded similar results; obese females had a significantly higher mean atopic disease score, compared with controls (by a mean elevation of 1.37 points; P less than .005), while males had a significantly lower mean atopic disease score (by a mean decline of -0.42 points; P less than .006). “From this we can say that female gender is a positive risk factor for atopy, and urban obese females may be particularly likely to benefit from lifestyle modification therapy like exercise and diet in controlling weight, and thereby allergies,” Dr. Nagarajan said.
He noted that it remains unclear whether the findings would apply to children who live in nonurban settings. “It’s difficult to say because there are some variables which are unique to urban minority populations like the housing that they live in and the kind of stores they buy food from,” he said.
Dr. Nagarajan reported having no financial disclosures.
AT 2017 AAAAI ANNUAL MEETING
Key clinical point:
Major finding: When stratified by gender, obese females had a significantly higher mean atopic disease score, compared with controls (4 vs. 2.62, respectively; P less than .001), while males had a significantly lower mean atopic disease score, compared with controls (3 vs. 3.42; P less than .001).
Data source: A retrospective review of 113 children who were evaluated for a history of allergic rhinitis, eczema, asthma, food allergies, and IgE, the percentage of eosinophils, and absolute eosinophil counts.
Disclosures: Dr. Nagarajan reported having no financial disclosures.
In children, peanut IgE levels increase over time
ATLANTA – Within a cohort of children diagnosed with peanut allergy who were followed since 2001, peanut IgE levels increased significantly over time in all races, according to a preliminary analysis of data.
In an interview in advance of the annual meeting of the American Academy of Allergy, Asthma, and Immunology, lead study author Yasmin Hamzavi, MD, said that recent publications have implicated race as a factor in food sensitization, but how this may impact the management of food allergy has not been elucidated. “The novel aspect of this study is that we are not just looking at the baseline peanut IgE levels between the races, but at the rate of change in peanut IgE over time between the different races,” said Dr. Hamzavi, a fellow in the division of allergy and immunology at Northwell Health, Great Neck, N.Y. “My question was, does the level of peanut IgE decrease or increase faster in one race versus another?”
A significant increase in peanut IgE over time was observed among all races (P less than .0002). In addition, white and Asian children showed an increasing trend in peanut IgE, while black children demonstrated a decreasing trend over time (P less than .099), a finding that Dr. Hamzavi described as “surprising and unusual.” She called for larger studies exploring factors for the noted increase among all races, such as changes in testing methods, food avoidance, and increasing sensitization. “Understanding the changes in peanut sensitization over time is a crucial step in determining the likelihood of clinical reactivity,” she said.
Dr. Hamzavi is reviewing data for a similar analysis of children with milk and egg allergy. She reported having no financial disclosures.
ATLANTA – Within a cohort of children diagnosed with peanut allergy who were followed since 2001, peanut IgE levels increased significantly over time in all races, according to a preliminary analysis of data.
In an interview in advance of the annual meeting of the American Academy of Allergy, Asthma, and Immunology, lead study author Yasmin Hamzavi, MD, said that recent publications have implicated race as a factor in food sensitization, but how this may impact the management of food allergy has not been elucidated. “The novel aspect of this study is that we are not just looking at the baseline peanut IgE levels between the races, but at the rate of change in peanut IgE over time between the different races,” said Dr. Hamzavi, a fellow in the division of allergy and immunology at Northwell Health, Great Neck, N.Y. “My question was, does the level of peanut IgE decrease or increase faster in one race versus another?”
A significant increase in peanut IgE over time was observed among all races (P less than .0002). In addition, white and Asian children showed an increasing trend in peanut IgE, while black children demonstrated a decreasing trend over time (P less than .099), a finding that Dr. Hamzavi described as “surprising and unusual.” She called for larger studies exploring factors for the noted increase among all races, such as changes in testing methods, food avoidance, and increasing sensitization. “Understanding the changes in peanut sensitization over time is a crucial step in determining the likelihood of clinical reactivity,” she said.
Dr. Hamzavi is reviewing data for a similar analysis of children with milk and egg allergy. She reported having no financial disclosures.
ATLANTA – Within a cohort of children diagnosed with peanut allergy who were followed since 2001, peanut IgE levels increased significantly over time in all races, according to a preliminary analysis of data.
In an interview in advance of the annual meeting of the American Academy of Allergy, Asthma, and Immunology, lead study author Yasmin Hamzavi, MD, said that recent publications have implicated race as a factor in food sensitization, but how this may impact the management of food allergy has not been elucidated. “The novel aspect of this study is that we are not just looking at the baseline peanut IgE levels between the races, but at the rate of change in peanut IgE over time between the different races,” said Dr. Hamzavi, a fellow in the division of allergy and immunology at Northwell Health, Great Neck, N.Y. “My question was, does the level of peanut IgE decrease or increase faster in one race versus another?”
A significant increase in peanut IgE over time was observed among all races (P less than .0002). In addition, white and Asian children showed an increasing trend in peanut IgE, while black children demonstrated a decreasing trend over time (P less than .099), a finding that Dr. Hamzavi described as “surprising and unusual.” She called for larger studies exploring factors for the noted increase among all races, such as changes in testing methods, food avoidance, and increasing sensitization. “Understanding the changes in peanut sensitization over time is a crucial step in determining the likelihood of clinical reactivity,” she said.
Dr. Hamzavi is reviewing data for a similar analysis of children with milk and egg allergy. She reported having no financial disclosures.
AT 2017 AAAAI ANNUAL MEETING
Key clinical point:
Major finding: A significant increase in peanut IgE over time was observed among white, black, and Asian children (P less than .0002).
Data source: A retrospective review of 193 children diagnosed with peanut allergy .
Disclosures: Dr. Hamzavi reported having no financial disclosures.
Tree nut allergy responds to immunotherapy
AT 2017 AAAAI ANNUAL MEETING
ATLANTA – Long-term walnut oral immunotherapy induces clinically relevant treatment response in children with tree nut allergy, results from a small ongoing study showed.
“Tree nut allergy is a generally life-long and potentially life-threatening disorder without an active therapy,” study author Amy M. Scurlock, MD, said in an interview in advance of the annual meeting of the American Academy of Allergy, Asthma, and Immunology. “Significant clinical, immunologic, and serologic cross reactivity has been described among tree nut families. Multi–tree nut allergen sensitization is common with 46% reporting allergy to more than one tree nut.”
Dr. Scurlock reported on results from 9 of 14 children with allergy to walnuts and another test tree nut (pecans, cashews, hazelnuts, or pistachios) who received open-label walnut oral immunotherapy after completing 38 weeks of blinded, placebo-controlled treatment. Walnut and test tree nut desensitization oral food challenges were performed by 142 weeks. If they passed, the subjects stopped their treatment for four weeks. Next, they underwent another oral food challenge to determine if they continued to be sensitized or if they had developed sustained unresponsiveness.
The median age of the 14 randomized subjects was 9 years, 75% were male, and 9 (64%) underwent an oral food challenge by week 142. (Two subjects dropped out after randomization, and three have yet to reach the week 142 time point.) Desensitization to both walnut and a test tree nut was observed in seven out of the nine subjects (78%). After 4 weeks off of walnut oral immunotherapy, four out of those seven patients who were desensitized (57%) also demonstrated sustained unresponsiveness to both walnuts and test tree nuts, and six out of seven subjects (86%) had sustained unresponsiveness to just walnuts.
“I am always amazed by the commitment of our food allergic subjects and their families in immunotherapy trials, and this study is no exception,” Dr. Scurlock commented. “Subjects had to undergo an increased number of oral food challenges (walnut, test tree nut, placebo) at protocol-specified time points in addition to daily home dosing. While walnut oral immunotherapy was generally well tolerated, we frequently observed oral allergy/itching associated with dosing in our cohort, which was an atopic group (75% allergic rhinitis). These symptoms can complicate assessment during dosing and oral food challenges. We observed that, with long-term therapy, there were some subjects who developed ‘dosing fatigue’ that could adversely affect adherence. Future studies will need to focus on strategies that optimize long-term sustainability/tolerability of dosing.”
She acknowledged certain limitations of the study, including its single-center design and small sample size. “While the findings are encouraging and similar to outcomes observed in other oral immunotherapy trials, further study in larger cohorts is critical before advancing toward broad clinical implementation. Specific issues regarding complexity of cross-reactivity and the efficacy of specific tree nuts to induce immunomodulation across tree nut families require future study. In addition, improving the long-term sustainability/tolerability of dosing and examining novel approaches is important.”
Dr. Scurlock disclosed that she has received funding from National Institutes of Health/National Institute of Allergy and Infectious Diseases and Food Allergy Research and Education (FARE). She is also medical director for the FARE Clinical Network Center of Excellence at Arkansas Children’s Hospital.
AT 2017 AAAAI ANNUAL MEETING
ATLANTA – Long-term walnut oral immunotherapy induces clinically relevant treatment response in children with tree nut allergy, results from a small ongoing study showed.
“Tree nut allergy is a generally life-long and potentially life-threatening disorder without an active therapy,” study author Amy M. Scurlock, MD, said in an interview in advance of the annual meeting of the American Academy of Allergy, Asthma, and Immunology. “Significant clinical, immunologic, and serologic cross reactivity has been described among tree nut families. Multi–tree nut allergen sensitization is common with 46% reporting allergy to more than one tree nut.”
Dr. Scurlock reported on results from 9 of 14 children with allergy to walnuts and another test tree nut (pecans, cashews, hazelnuts, or pistachios) who received open-label walnut oral immunotherapy after completing 38 weeks of blinded, placebo-controlled treatment. Walnut and test tree nut desensitization oral food challenges were performed by 142 weeks. If they passed, the subjects stopped their treatment for four weeks. Next, they underwent another oral food challenge to determine if they continued to be sensitized or if they had developed sustained unresponsiveness.
The median age of the 14 randomized subjects was 9 years, 75% were male, and 9 (64%) underwent an oral food challenge by week 142. (Two subjects dropped out after randomization, and three have yet to reach the week 142 time point.) Desensitization to both walnut and a test tree nut was observed in seven out of the nine subjects (78%). After 4 weeks off of walnut oral immunotherapy, four out of those seven patients who were desensitized (57%) also demonstrated sustained unresponsiveness to both walnuts and test tree nuts, and six out of seven subjects (86%) had sustained unresponsiveness to just walnuts.
“I am always amazed by the commitment of our food allergic subjects and their families in immunotherapy trials, and this study is no exception,” Dr. Scurlock commented. “Subjects had to undergo an increased number of oral food challenges (walnut, test tree nut, placebo) at protocol-specified time points in addition to daily home dosing. While walnut oral immunotherapy was generally well tolerated, we frequently observed oral allergy/itching associated with dosing in our cohort, which was an atopic group (75% allergic rhinitis). These symptoms can complicate assessment during dosing and oral food challenges. We observed that, with long-term therapy, there were some subjects who developed ‘dosing fatigue’ that could adversely affect adherence. Future studies will need to focus on strategies that optimize long-term sustainability/tolerability of dosing.”
She acknowledged certain limitations of the study, including its single-center design and small sample size. “While the findings are encouraging and similar to outcomes observed in other oral immunotherapy trials, further study in larger cohorts is critical before advancing toward broad clinical implementation. Specific issues regarding complexity of cross-reactivity and the efficacy of specific tree nuts to induce immunomodulation across tree nut families require future study. In addition, improving the long-term sustainability/tolerability of dosing and examining novel approaches is important.”
Dr. Scurlock disclosed that she has received funding from National Institutes of Health/National Institute of Allergy and Infectious Diseases and Food Allergy Research and Education (FARE). She is also medical director for the FARE Clinical Network Center of Excellence at Arkansas Children’s Hospital.
AT 2017 AAAAI ANNUAL MEETING
ATLANTA – Long-term walnut oral immunotherapy induces clinically relevant treatment response in children with tree nut allergy, results from a small ongoing study showed.
“Tree nut allergy is a generally life-long and potentially life-threatening disorder without an active therapy,” study author Amy M. Scurlock, MD, said in an interview in advance of the annual meeting of the American Academy of Allergy, Asthma, and Immunology. “Significant clinical, immunologic, and serologic cross reactivity has been described among tree nut families. Multi–tree nut allergen sensitization is common with 46% reporting allergy to more than one tree nut.”
Dr. Scurlock reported on results from 9 of 14 children with allergy to walnuts and another test tree nut (pecans, cashews, hazelnuts, or pistachios) who received open-label walnut oral immunotherapy after completing 38 weeks of blinded, placebo-controlled treatment. Walnut and test tree nut desensitization oral food challenges were performed by 142 weeks. If they passed, the subjects stopped their treatment for four weeks. Next, they underwent another oral food challenge to determine if they continued to be sensitized or if they had developed sustained unresponsiveness.
The median age of the 14 randomized subjects was 9 years, 75% were male, and 9 (64%) underwent an oral food challenge by week 142. (Two subjects dropped out after randomization, and three have yet to reach the week 142 time point.) Desensitization to both walnut and a test tree nut was observed in seven out of the nine subjects (78%). After 4 weeks off of walnut oral immunotherapy, four out of those seven patients who were desensitized (57%) also demonstrated sustained unresponsiveness to both walnuts and test tree nuts, and six out of seven subjects (86%) had sustained unresponsiveness to just walnuts.
“I am always amazed by the commitment of our food allergic subjects and their families in immunotherapy trials, and this study is no exception,” Dr. Scurlock commented. “Subjects had to undergo an increased number of oral food challenges (walnut, test tree nut, placebo) at protocol-specified time points in addition to daily home dosing. While walnut oral immunotherapy was generally well tolerated, we frequently observed oral allergy/itching associated with dosing in our cohort, which was an atopic group (75% allergic rhinitis). These symptoms can complicate assessment during dosing and oral food challenges. We observed that, with long-term therapy, there were some subjects who developed ‘dosing fatigue’ that could adversely affect adherence. Future studies will need to focus on strategies that optimize long-term sustainability/tolerability of dosing.”
She acknowledged certain limitations of the study, including its single-center design and small sample size. “While the findings are encouraging and similar to outcomes observed in other oral immunotherapy trials, further study in larger cohorts is critical before advancing toward broad clinical implementation. Specific issues regarding complexity of cross-reactivity and the efficacy of specific tree nuts to induce immunomodulation across tree nut families require future study. In addition, improving the long-term sustainability/tolerability of dosing and examining novel approaches is important.”
Dr. Scurlock disclosed that she has received funding from National Institutes of Health/National Institute of Allergy and Infectious Diseases and Food Allergy Research and Education (FARE). She is also medical director for the FARE Clinical Network Center of Excellence at Arkansas Children’s Hospital.
Key clinical point:
Major finding: Of nine subjects who underwent walnut and test tree nut desensitization oral food challenges by week 142, desensitization to both was observed in seven (78%).
Data source: A review of 14 children with allergy to walnuts and another test tree nut who received open-label walnut oral immunotherapy after completing 38 weeks of blinded, placebo-controlled treatment.
Disclosures: Dr. Scurlock disclosed that she has received funding from National Institutes of Health/National Institute of Allergy and Infectious Diseases and Food Allergy Research and Education (FARE). She is also medical director for the FARE Clinical Network Center of Excellence at Arkansas Children’s Hospital.
Ask patients about sexual function at first visit
LAS VEGAS – A brief sexual history should be part of the first patient visit, according to Anita H. Clayton, MD. However, addressing sexual health can prove challenging, especially if the patient is experiencing difficulty in that aspect of life.
“In America, we don’t talk about sex in a serious kind of way,” Dr. Clayton said at an annual psychopharmacology update held by the Nevada Psychiatric Association. “If people are talking about sex they’re either bragging or lying.”
Sexual functioning assessment tools to consider using include the Changes in Sexual Functioning Questionnaire, the Sexual Interest and Desire Inventory for females, and the Decreased Sexual Desire Screener. In premenopausal women, hypoactive sexual desire disorder is a common primary sexual dysfunction. Hypoactive sexual desire disorder is equally common in postmenopausal women, Dr. Clayton said, with the addition of complaints related to vaginal atrophy or genitourinary symptoms of menopause. In men, erectile dysfunction ranks as the most common primary sexual dysfunction. It can occur at any time but tends to increase in frequency at midlife.
Dr. Clayton recommends opening the dialogue with a brief questionnaire or an open-ended question, while maintaining cultural sensitivity, including references to sexual orientation and age. “It can be helpful to define terms,” she added. “I find that people often say, ‘I don’t get aroused anymore,’ but it could possibly mean that they’re not interested in sex anymore. You have to delineate what they’re talking about. Find out if they’re doing the kind of things that previously led them to having a satisfying sexual life. If they’re dissatisfied now, what is the issue? Desire? Arousal?” Taking a ubiquity-style approach to questions also can prove helpful: “Many people with depression experience sexual dysfunction. Do you have any complaints?” Or, “As people get older, sometimes they experience problems in their sexual function or changes in their level of desire. Have you had any such changes?”
The discussion itself might be therapeutic for the patient. “You may find out that what they’re experiencing. It’s not an unusual phenomenon,” said Dr. Clayton, who is a member of the board of directors of the International Society for the Study of Women’s Sexual Health. “For example, if women at midlife are having difficulty with arousal, they might try lubricants. Or, in talking with a younger woman who may not have yet experienced an orgasm, you can tell her it’s not that uncommon and talk about how that can be helped.”
If a sexual problem persists, ask about the nature and duration of the problem and/or changes. Ask about possible stressors and try to rule out any relationship issues or situational problems. “Is the problem generalized or does it occur in all situations? If it’s situational, you probably should work on that first,” said Dr. Clayton, who also has a secondary appointment at the university as professor of clinical obstetrics and gynecology.
Diagnosis of a primary sexual dysfunction is based on clinical presentation, not on testosterone levels or other laboratory values.
Dr. Clayton disclosed having received research grants from several entities, including Forest Research Institute, Janssen, and Takeda Pharmaceuticals. She also has received advisory board fees and/or consulting fees from several companies, including Fabre-Kramer, Takeda, S1 Biopharma, and Sprout Pharmaceuticals, a division of Valeant Pharmaceuticals. Dr. Clayton also has ownership interest in Euthymics Bioscience and S1 Biopharma.
LAS VEGAS – A brief sexual history should be part of the first patient visit, according to Anita H. Clayton, MD. However, addressing sexual health can prove challenging, especially if the patient is experiencing difficulty in that aspect of life.
“In America, we don’t talk about sex in a serious kind of way,” Dr. Clayton said at an annual psychopharmacology update held by the Nevada Psychiatric Association. “If people are talking about sex they’re either bragging or lying.”
Sexual functioning assessment tools to consider using include the Changes in Sexual Functioning Questionnaire, the Sexual Interest and Desire Inventory for females, and the Decreased Sexual Desire Screener. In premenopausal women, hypoactive sexual desire disorder is a common primary sexual dysfunction. Hypoactive sexual desire disorder is equally common in postmenopausal women, Dr. Clayton said, with the addition of complaints related to vaginal atrophy or genitourinary symptoms of menopause. In men, erectile dysfunction ranks as the most common primary sexual dysfunction. It can occur at any time but tends to increase in frequency at midlife.
Dr. Clayton recommends opening the dialogue with a brief questionnaire or an open-ended question, while maintaining cultural sensitivity, including references to sexual orientation and age. “It can be helpful to define terms,” she added. “I find that people often say, ‘I don’t get aroused anymore,’ but it could possibly mean that they’re not interested in sex anymore. You have to delineate what they’re talking about. Find out if they’re doing the kind of things that previously led them to having a satisfying sexual life. If they’re dissatisfied now, what is the issue? Desire? Arousal?” Taking a ubiquity-style approach to questions also can prove helpful: “Many people with depression experience sexual dysfunction. Do you have any complaints?” Or, “As people get older, sometimes they experience problems in their sexual function or changes in their level of desire. Have you had any such changes?”
The discussion itself might be therapeutic for the patient. “You may find out that what they’re experiencing. It’s not an unusual phenomenon,” said Dr. Clayton, who is a member of the board of directors of the International Society for the Study of Women’s Sexual Health. “For example, if women at midlife are having difficulty with arousal, they might try lubricants. Or, in talking with a younger woman who may not have yet experienced an orgasm, you can tell her it’s not that uncommon and talk about how that can be helped.”
If a sexual problem persists, ask about the nature and duration of the problem and/or changes. Ask about possible stressors and try to rule out any relationship issues or situational problems. “Is the problem generalized or does it occur in all situations? If it’s situational, you probably should work on that first,” said Dr. Clayton, who also has a secondary appointment at the university as professor of clinical obstetrics and gynecology.
Diagnosis of a primary sexual dysfunction is based on clinical presentation, not on testosterone levels or other laboratory values.
Dr. Clayton disclosed having received research grants from several entities, including Forest Research Institute, Janssen, and Takeda Pharmaceuticals. She also has received advisory board fees and/or consulting fees from several companies, including Fabre-Kramer, Takeda, S1 Biopharma, and Sprout Pharmaceuticals, a division of Valeant Pharmaceuticals. Dr. Clayton also has ownership interest in Euthymics Bioscience and S1 Biopharma.
LAS VEGAS – A brief sexual history should be part of the first patient visit, according to Anita H. Clayton, MD. However, addressing sexual health can prove challenging, especially if the patient is experiencing difficulty in that aspect of life.
“In America, we don’t talk about sex in a serious kind of way,” Dr. Clayton said at an annual psychopharmacology update held by the Nevada Psychiatric Association. “If people are talking about sex they’re either bragging or lying.”
Sexual functioning assessment tools to consider using include the Changes in Sexual Functioning Questionnaire, the Sexual Interest and Desire Inventory for females, and the Decreased Sexual Desire Screener. In premenopausal women, hypoactive sexual desire disorder is a common primary sexual dysfunction. Hypoactive sexual desire disorder is equally common in postmenopausal women, Dr. Clayton said, with the addition of complaints related to vaginal atrophy or genitourinary symptoms of menopause. In men, erectile dysfunction ranks as the most common primary sexual dysfunction. It can occur at any time but tends to increase in frequency at midlife.
Dr. Clayton recommends opening the dialogue with a brief questionnaire or an open-ended question, while maintaining cultural sensitivity, including references to sexual orientation and age. “It can be helpful to define terms,” she added. “I find that people often say, ‘I don’t get aroused anymore,’ but it could possibly mean that they’re not interested in sex anymore. You have to delineate what they’re talking about. Find out if they’re doing the kind of things that previously led them to having a satisfying sexual life. If they’re dissatisfied now, what is the issue? Desire? Arousal?” Taking a ubiquity-style approach to questions also can prove helpful: “Many people with depression experience sexual dysfunction. Do you have any complaints?” Or, “As people get older, sometimes they experience problems in their sexual function or changes in their level of desire. Have you had any such changes?”
The discussion itself might be therapeutic for the patient. “You may find out that what they’re experiencing. It’s not an unusual phenomenon,” said Dr. Clayton, who is a member of the board of directors of the International Society for the Study of Women’s Sexual Health. “For example, if women at midlife are having difficulty with arousal, they might try lubricants. Or, in talking with a younger woman who may not have yet experienced an orgasm, you can tell her it’s not that uncommon and talk about how that can be helped.”
If a sexual problem persists, ask about the nature and duration of the problem and/or changes. Ask about possible stressors and try to rule out any relationship issues or situational problems. “Is the problem generalized or does it occur in all situations? If it’s situational, you probably should work on that first,” said Dr. Clayton, who also has a secondary appointment at the university as professor of clinical obstetrics and gynecology.
Diagnosis of a primary sexual dysfunction is based on clinical presentation, not on testosterone levels or other laboratory values.
Dr. Clayton disclosed having received research grants from several entities, including Forest Research Institute, Janssen, and Takeda Pharmaceuticals. She also has received advisory board fees and/or consulting fees from several companies, including Fabre-Kramer, Takeda, S1 Biopharma, and Sprout Pharmaceuticals, a division of Valeant Pharmaceuticals. Dr. Clayton also has ownership interest in Euthymics Bioscience and S1 Biopharma.
EXPERT ANALYSIS AT THE NPA PSYCHOPHARMACOLOGY UPDATE
When atopic dermatitis is really contact dermatitis
ATLANTA – When patients present with atopic dermatitis that worsens, changes distribution, fails to improve, or immediately rebounds, think contact dermatitis, Luz Fonacier, MD, advised at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.
Clinical signs of contact dermatitis include lesions with an atypical distribution/pattern, such as head, eyelid, or cheilitis/perioral predominance, or lesions on the hand or foot. Also elevate your suspicion in patients with therapy-resistant hand eczema, adult- or childhood-onset atopic dermatitis without childhood eczema, as well as in cases of severe or widespread dermatitis prior to initiating a systemic immunosuppressant. The list of potential allergens to consider includes metal (especially nickel, cobalt, and potassium dichromate), fragrances such as formaldehyde and balsam of Peru, preservatives, as well as topical emollients, corticosteroids, antibiotics, and antiseptics.
Dr. Fonacier, professor of medicine at the State University of New York at Stony Brook and section head of allergy at Winthrop University Hospital, Mineola, N.Y., recommends loading acrylates, fragrances, and allergens in an aqueous vehicle immediately before application. She noted that delayed patch test readings are common to metals, topical antibiotics, and topical corticosteroids, and that positive reactions to gold are often not clinically relevant. “The patch test positivity of gold can be as high as 30% in adults and a little bit less in children, but results from two large studies show clinical relevance in only 10%-15% of cases,” she said. A trial of gold avoidance may be warranted in patients with suspected jewelry allergy, facial or eyelid dermatitis, or exposure through gold dental restorations.
She went on to share tips for reading skin patch tests. The first reading should be done after 48 hours, while the second should be done 3, 4, or 7 days after application. “The second reading helps distinguish irritant from allergic responses,” she said. “Thirty percent of negative tests at 48 hours may be positive on delayed readings.” Most true allergic reactions occur between 72 and 96 hours. Allergens that may peak early include thiuram mix, carba mix, and balsam of Peru. Those that disappear after 5 days include balsam of Peru, benzoic acid, disperse blue #124, fragrance mix, mercury, methyldibromo glutaronitrile, phenoxyethanol, and octyl gallate. Delayed patch test reactions after five days include metals (gold potassium dichromate, nickel, and cobalt), topical antibiotics (neomycin and bacitracin) as well as topic corticosteroids.
Resources she recommended to attendees include the American Contact Dermatitis Society and the Contact Dermatitis Institute. Health and safety information about household products can be found here.
Dr. Fonacier disclosed that she has received research and educational grants from Baxter and Genentech. She is also a consultant to Church and Dwight and Regeneron.
ATLANTA – When patients present with atopic dermatitis that worsens, changes distribution, fails to improve, or immediately rebounds, think contact dermatitis, Luz Fonacier, MD, advised at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.
Clinical signs of contact dermatitis include lesions with an atypical distribution/pattern, such as head, eyelid, or cheilitis/perioral predominance, or lesions on the hand or foot. Also elevate your suspicion in patients with therapy-resistant hand eczema, adult- or childhood-onset atopic dermatitis without childhood eczema, as well as in cases of severe or widespread dermatitis prior to initiating a systemic immunosuppressant. The list of potential allergens to consider includes metal (especially nickel, cobalt, and potassium dichromate), fragrances such as formaldehyde and balsam of Peru, preservatives, as well as topical emollients, corticosteroids, antibiotics, and antiseptics.
Dr. Fonacier, professor of medicine at the State University of New York at Stony Brook and section head of allergy at Winthrop University Hospital, Mineola, N.Y., recommends loading acrylates, fragrances, and allergens in an aqueous vehicle immediately before application. She noted that delayed patch test readings are common to metals, topical antibiotics, and topical corticosteroids, and that positive reactions to gold are often not clinically relevant. “The patch test positivity of gold can be as high as 30% in adults and a little bit less in children, but results from two large studies show clinical relevance in only 10%-15% of cases,” she said. A trial of gold avoidance may be warranted in patients with suspected jewelry allergy, facial or eyelid dermatitis, or exposure through gold dental restorations.
She went on to share tips for reading skin patch tests. The first reading should be done after 48 hours, while the second should be done 3, 4, or 7 days after application. “The second reading helps distinguish irritant from allergic responses,” she said. “Thirty percent of negative tests at 48 hours may be positive on delayed readings.” Most true allergic reactions occur between 72 and 96 hours. Allergens that may peak early include thiuram mix, carba mix, and balsam of Peru. Those that disappear after 5 days include balsam of Peru, benzoic acid, disperse blue #124, fragrance mix, mercury, methyldibromo glutaronitrile, phenoxyethanol, and octyl gallate. Delayed patch test reactions after five days include metals (gold potassium dichromate, nickel, and cobalt), topical antibiotics (neomycin and bacitracin) as well as topic corticosteroids.
Resources she recommended to attendees include the American Contact Dermatitis Society and the Contact Dermatitis Institute. Health and safety information about household products can be found here.
Dr. Fonacier disclosed that she has received research and educational grants from Baxter and Genentech. She is also a consultant to Church and Dwight and Regeneron.
ATLANTA – When patients present with atopic dermatitis that worsens, changes distribution, fails to improve, or immediately rebounds, think contact dermatitis, Luz Fonacier, MD, advised at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.
Clinical signs of contact dermatitis include lesions with an atypical distribution/pattern, such as head, eyelid, or cheilitis/perioral predominance, or lesions on the hand or foot. Also elevate your suspicion in patients with therapy-resistant hand eczema, adult- or childhood-onset atopic dermatitis without childhood eczema, as well as in cases of severe or widespread dermatitis prior to initiating a systemic immunosuppressant. The list of potential allergens to consider includes metal (especially nickel, cobalt, and potassium dichromate), fragrances such as formaldehyde and balsam of Peru, preservatives, as well as topical emollients, corticosteroids, antibiotics, and antiseptics.
Dr. Fonacier, professor of medicine at the State University of New York at Stony Brook and section head of allergy at Winthrop University Hospital, Mineola, N.Y., recommends loading acrylates, fragrances, and allergens in an aqueous vehicle immediately before application. She noted that delayed patch test readings are common to metals, topical antibiotics, and topical corticosteroids, and that positive reactions to gold are often not clinically relevant. “The patch test positivity of gold can be as high as 30% in adults and a little bit less in children, but results from two large studies show clinical relevance in only 10%-15% of cases,” she said. A trial of gold avoidance may be warranted in patients with suspected jewelry allergy, facial or eyelid dermatitis, or exposure through gold dental restorations.
She went on to share tips for reading skin patch tests. The first reading should be done after 48 hours, while the second should be done 3, 4, or 7 days after application. “The second reading helps distinguish irritant from allergic responses,” she said. “Thirty percent of negative tests at 48 hours may be positive on delayed readings.” Most true allergic reactions occur between 72 and 96 hours. Allergens that may peak early include thiuram mix, carba mix, and balsam of Peru. Those that disappear after 5 days include balsam of Peru, benzoic acid, disperse blue #124, fragrance mix, mercury, methyldibromo glutaronitrile, phenoxyethanol, and octyl gallate. Delayed patch test reactions after five days include metals (gold potassium dichromate, nickel, and cobalt), topical antibiotics (neomycin and bacitracin) as well as topic corticosteroids.
Resources she recommended to attendees include the American Contact Dermatitis Society and the Contact Dermatitis Institute. Health and safety information about household products can be found here.
Dr. Fonacier disclosed that she has received research and educational grants from Baxter and Genentech. She is also a consultant to Church and Dwight and Regeneron.
EXPERT ANALYSIS AT THE 2017 AAAAI ANNUAL MEETING
Long-term peanut sublingual immunotherapy found safe
ATLANTA – Peanut sublingual immunotherapy induces clinically significant desensitization in the majority of subjects and can induce sustained unresponsiveness in a subset of children treated for 36-60 months, results from a small study suggest.
“Sublingual immunotherapy [SLIT] is an easy-to-administer treatment that appears to be safe, and with extended treatment, may provide a clinically significant amount of protection with the potential for a lasting effect,” one of the study authors, Edwin H. Kim, MD, said in an interview in advance of the annual meeting of the American Academy of Allergy, Asthma, and Immunology.
To find out, the researchers treated 37 patients with 2 mg of peanut SLIT for 36-60 months and then assessed a 5,000-mg peanut oral food challenge to further assess desensitization. Those who passed the challenge discontinued SLIT for 2-4 weeks and were then re-challenged with 5,000 mg of peanut protein to assess for sustained unresponsiveness.
“Existing data suggested that about 50% of patients on oral immunotherapy develop sustained unresponsiveness, which was defined by being able to tolerate the same full amount of peanut 1 month after stopping therapy,” Dr. Kim said. “As the assumption was that SLIT would have a more modest effect, it was unclear if any patients at all on SLIT would develop sustained unresponsiveness.”
Of the 37 subjects who completed the study, 32 (86%) safely ingested more than 300 mg of peanut and 12 (32%) passed the oral food challenge at the end of SLIT therapy. The median amount of peanut tolerated was 1,750 mg (compared with 1,710 mg in the original 12-month paper). The 12 subjects who passed the oral food challenge were re-challenged with 5,000 mg of peanut 2-4 weeks after discontinuing SLIT. Of these, 10 (27%) demonstrated sustained unresponsiveness. Dr. Kim characterized the results as “better than we would have expected.”
He acknowledged certain limitations to the study, including the lack of an entry food challenge to determine a baseline reaction threshold and the lack of a placebo arm for the study’s extended maintenance phase.
Dr. Kim reported having no financial disclosures.
dbrunk@frontlinemedcom.com
ATLANTA – Peanut sublingual immunotherapy induces clinically significant desensitization in the majority of subjects and can induce sustained unresponsiveness in a subset of children treated for 36-60 months, results from a small study suggest.
“Sublingual immunotherapy [SLIT] is an easy-to-administer treatment that appears to be safe, and with extended treatment, may provide a clinically significant amount of protection with the potential for a lasting effect,” one of the study authors, Edwin H. Kim, MD, said in an interview in advance of the annual meeting of the American Academy of Allergy, Asthma, and Immunology.
To find out, the researchers treated 37 patients with 2 mg of peanut SLIT for 36-60 months and then assessed a 5,000-mg peanut oral food challenge to further assess desensitization. Those who passed the challenge discontinued SLIT for 2-4 weeks and were then re-challenged with 5,000 mg of peanut protein to assess for sustained unresponsiveness.
“Existing data suggested that about 50% of patients on oral immunotherapy develop sustained unresponsiveness, which was defined by being able to tolerate the same full amount of peanut 1 month after stopping therapy,” Dr. Kim said. “As the assumption was that SLIT would have a more modest effect, it was unclear if any patients at all on SLIT would develop sustained unresponsiveness.”
Of the 37 subjects who completed the study, 32 (86%) safely ingested more than 300 mg of peanut and 12 (32%) passed the oral food challenge at the end of SLIT therapy. The median amount of peanut tolerated was 1,750 mg (compared with 1,710 mg in the original 12-month paper). The 12 subjects who passed the oral food challenge were re-challenged with 5,000 mg of peanut 2-4 weeks after discontinuing SLIT. Of these, 10 (27%) demonstrated sustained unresponsiveness. Dr. Kim characterized the results as “better than we would have expected.”
He acknowledged certain limitations to the study, including the lack of an entry food challenge to determine a baseline reaction threshold and the lack of a placebo arm for the study’s extended maintenance phase.
Dr. Kim reported having no financial disclosures.
dbrunk@frontlinemedcom.com
ATLANTA – Peanut sublingual immunotherapy induces clinically significant desensitization in the majority of subjects and can induce sustained unresponsiveness in a subset of children treated for 36-60 months, results from a small study suggest.
“Sublingual immunotherapy [SLIT] is an easy-to-administer treatment that appears to be safe, and with extended treatment, may provide a clinically significant amount of protection with the potential for a lasting effect,” one of the study authors, Edwin H. Kim, MD, said in an interview in advance of the annual meeting of the American Academy of Allergy, Asthma, and Immunology.
To find out, the researchers treated 37 patients with 2 mg of peanut SLIT for 36-60 months and then assessed a 5,000-mg peanut oral food challenge to further assess desensitization. Those who passed the challenge discontinued SLIT for 2-4 weeks and were then re-challenged with 5,000 mg of peanut protein to assess for sustained unresponsiveness.
“Existing data suggested that about 50% of patients on oral immunotherapy develop sustained unresponsiveness, which was defined by being able to tolerate the same full amount of peanut 1 month after stopping therapy,” Dr. Kim said. “As the assumption was that SLIT would have a more modest effect, it was unclear if any patients at all on SLIT would develop sustained unresponsiveness.”
Of the 37 subjects who completed the study, 32 (86%) safely ingested more than 300 mg of peanut and 12 (32%) passed the oral food challenge at the end of SLIT therapy. The median amount of peanut tolerated was 1,750 mg (compared with 1,710 mg in the original 12-month paper). The 12 subjects who passed the oral food challenge were re-challenged with 5,000 mg of peanut 2-4 weeks after discontinuing SLIT. Of these, 10 (27%) demonstrated sustained unresponsiveness. Dr. Kim characterized the results as “better than we would have expected.”
He acknowledged certain limitations to the study, including the lack of an entry food challenge to determine a baseline reaction threshold and the lack of a placebo arm for the study’s extended maintenance phase.
Dr. Kim reported having no financial disclosures.
dbrunk@frontlinemedcom.com
AT THE 2017 AAAAI ANNUAL MEETING
Key clinical point:
Major finding: Of the children who completed the study, 86% safely ingested more than 300 mg of peanut and 32% passed the oral food challenge at the end of SLIT therapy.
Data source: A study of 37 patients who were treated with 2 mg of peanut SLIT for 36-60 months.
Disclosures: Dr. Kim reported having no financial disclosures.
Chronic rhinosinusitis exacerbation factors identified
ATLANTA – Clinical factors associated with acute exacerbations of chronic rhinosinusitis include female sex, nonwhite race, and a higher body mass index, results from a retrospective study suggest.
“Previous research has shown associations between various risk factors and the development of chronic rhinosinusitis,” study author Jason H. Kwah, MD, said in an interview in advance of the annual meeting of the American Academy of Allergy, Asthma, and Immunology. “However, there is minimal data regarding risk factor associations with frequent acute exacerbations of chronic rhinosinusitis. This is an important question as much of the morbidity and financial burden of this disease stems from costs and symptoms related to the management of acute exacerbations with antibiotics and steroids. If associations can be identified, the hope would be that modification of some of these risk factors could lead to improved control of the condition.”
Of the 3,109 CRS patients, 936 were frequent exacerbators while 2,173 were infrequent exacerbators. Univariate analysis revealed that the following factors were associated with frequent exacerbations, compared with infrequent exacerbations: female sex, nonwhite race, higher body mass index, having any drug allergy, allergic rhinitis, peripheral eosinophilia, asthma, lower forced expiratory volume in 1 second, previous sinus surgery, severe sinusitis on CT, one or more steroid prescriptions, and the presence of autoimmune disease. Multivariate analysis adjusted for race and sex revealed that allergic rhinitis (odds ratio, 1.48), peripheral eosinophilia (OR, 1.30), asthma (OR, 1.90), and autoimmune disease (OR, 1.61) remained significantly associated with frequent CRS exacerbations.
“We found it surprising that there were so many risk factors associated with frequent acute exacerbations of CRS, as well as the strengths of these associations,” Dr. Kwah said. “Acute exacerbations of CRS cause significant morbidity and financial burden, and based on the results of our study, are likely associated with many clinically relevant risk factors. Further study is needed to confirm the presence of these associations, study the mechanism of disease, and ultimately establish treatment protocols that can improve the control of frequent acute exacerbations of CRS.”
He acknowledged certain limitations of the study, including the challenges of establishing an accurate definition for acute exacerbations of CRS in a retrospective study. “While we felt our protocol for retrospective analysis was sufficient given our inclusion criteria, a prospective trial would be helpful in further delineating the presence of acute exacerbations of CRS and how they are associated with clinical risk factors,” he said.
The study was supported in part by the NIH National Center for Advancing Translational Sciences, the Chronic Rhinosinusitis Integrative Studies Program, the Ernest Bazley Foundation, and the Division of Allergy and Immunology at the Northwestern Feinberg School of Medicine. Dr. Kwah reported having no financial disclosures.
dbrunk@frontlinemedcom.com
ATLANTA – Clinical factors associated with acute exacerbations of chronic rhinosinusitis include female sex, nonwhite race, and a higher body mass index, results from a retrospective study suggest.
“Previous research has shown associations between various risk factors and the development of chronic rhinosinusitis,” study author Jason H. Kwah, MD, said in an interview in advance of the annual meeting of the American Academy of Allergy, Asthma, and Immunology. “However, there is minimal data regarding risk factor associations with frequent acute exacerbations of chronic rhinosinusitis. This is an important question as much of the morbidity and financial burden of this disease stems from costs and symptoms related to the management of acute exacerbations with antibiotics and steroids. If associations can be identified, the hope would be that modification of some of these risk factors could lead to improved control of the condition.”
Of the 3,109 CRS patients, 936 were frequent exacerbators while 2,173 were infrequent exacerbators. Univariate analysis revealed that the following factors were associated with frequent exacerbations, compared with infrequent exacerbations: female sex, nonwhite race, higher body mass index, having any drug allergy, allergic rhinitis, peripheral eosinophilia, asthma, lower forced expiratory volume in 1 second, previous sinus surgery, severe sinusitis on CT, one or more steroid prescriptions, and the presence of autoimmune disease. Multivariate analysis adjusted for race and sex revealed that allergic rhinitis (odds ratio, 1.48), peripheral eosinophilia (OR, 1.30), asthma (OR, 1.90), and autoimmune disease (OR, 1.61) remained significantly associated with frequent CRS exacerbations.
“We found it surprising that there were so many risk factors associated with frequent acute exacerbations of CRS, as well as the strengths of these associations,” Dr. Kwah said. “Acute exacerbations of CRS cause significant morbidity and financial burden, and based on the results of our study, are likely associated with many clinically relevant risk factors. Further study is needed to confirm the presence of these associations, study the mechanism of disease, and ultimately establish treatment protocols that can improve the control of frequent acute exacerbations of CRS.”
He acknowledged certain limitations of the study, including the challenges of establishing an accurate definition for acute exacerbations of CRS in a retrospective study. “While we felt our protocol for retrospective analysis was sufficient given our inclusion criteria, a prospective trial would be helpful in further delineating the presence of acute exacerbations of CRS and how they are associated with clinical risk factors,” he said.
The study was supported in part by the NIH National Center for Advancing Translational Sciences, the Chronic Rhinosinusitis Integrative Studies Program, the Ernest Bazley Foundation, and the Division of Allergy and Immunology at the Northwestern Feinberg School of Medicine. Dr. Kwah reported having no financial disclosures.
dbrunk@frontlinemedcom.com
ATLANTA – Clinical factors associated with acute exacerbations of chronic rhinosinusitis include female sex, nonwhite race, and a higher body mass index, results from a retrospective study suggest.
“Previous research has shown associations between various risk factors and the development of chronic rhinosinusitis,” study author Jason H. Kwah, MD, said in an interview in advance of the annual meeting of the American Academy of Allergy, Asthma, and Immunology. “However, there is minimal data regarding risk factor associations with frequent acute exacerbations of chronic rhinosinusitis. This is an important question as much of the morbidity and financial burden of this disease stems from costs and symptoms related to the management of acute exacerbations with antibiotics and steroids. If associations can be identified, the hope would be that modification of some of these risk factors could lead to improved control of the condition.”
Of the 3,109 CRS patients, 936 were frequent exacerbators while 2,173 were infrequent exacerbators. Univariate analysis revealed that the following factors were associated with frequent exacerbations, compared with infrequent exacerbations: female sex, nonwhite race, higher body mass index, having any drug allergy, allergic rhinitis, peripheral eosinophilia, asthma, lower forced expiratory volume in 1 second, previous sinus surgery, severe sinusitis on CT, one or more steroid prescriptions, and the presence of autoimmune disease. Multivariate analysis adjusted for race and sex revealed that allergic rhinitis (odds ratio, 1.48), peripheral eosinophilia (OR, 1.30), asthma (OR, 1.90), and autoimmune disease (OR, 1.61) remained significantly associated with frequent CRS exacerbations.
“We found it surprising that there were so many risk factors associated with frequent acute exacerbations of CRS, as well as the strengths of these associations,” Dr. Kwah said. “Acute exacerbations of CRS cause significant morbidity and financial burden, and based on the results of our study, are likely associated with many clinically relevant risk factors. Further study is needed to confirm the presence of these associations, study the mechanism of disease, and ultimately establish treatment protocols that can improve the control of frequent acute exacerbations of CRS.”
He acknowledged certain limitations of the study, including the challenges of establishing an accurate definition for acute exacerbations of CRS in a retrospective study. “While we felt our protocol for retrospective analysis was sufficient given our inclusion criteria, a prospective trial would be helpful in further delineating the presence of acute exacerbations of CRS and how they are associated with clinical risk factors,” he said.
The study was supported in part by the NIH National Center for Advancing Translational Sciences, the Chronic Rhinosinusitis Integrative Studies Program, the Ernest Bazley Foundation, and the Division of Allergy and Immunology at the Northwestern Feinberg School of Medicine. Dr. Kwah reported having no financial disclosures.
dbrunk@frontlinemedcom.com
AT THE 2017 AAAAI ANNUAL MEETING
Key clinical point:
Major finding: On multivariate analysis, allergic rhinitis (odds ratio, 1.48), peripheral eosinophilia (OR, 1.30), asthma (OR, 1.90), and autoimmune disease (OR, 1.61) remained significantly associated with frequent CRS exacerbations.
Data source: A retrospective review of 3,109 patients who were treated for CRS from January 2014 to December 2015.
Disclosures: The study was supported in part by the NIH National Center for Advancing Translational Sciences, the Chronic Rhinosinusitis Integrative Studies Program, the Ernest Bazley Foundation, and the Division of Allergy and Immunology at the Northwestern Feinberg School of Medicine. Dr. Kwah reported having no financial disclosures.
Maternal vitamin E isoform levels possible marker for infant wheezing risk
ATLANTA – Increasing maternal postpartum–plasma alpha-tocopherol isoform concentration was associated with a decreased likelihood of wheezing at age 2 years, defined as wheezing in the past 12 months, use of asthma medications in the past 12 months, or diagnosis of asthma, results from a large analysis showed.
“For now, this is an association and not causation,” study author Cosby Stone, MD, MPH, said in an interview in advance of the annual meeting of the American Academy of Allergy, Asthma, and Immunology. “We need a clinical trial to evaluate the effect of giving more alpha-tocopherol to mothers during pregnancy before anyone should jump to giving supplements.”
The median age of children at the time of maternal sample collection was 50 days. 47% were female, and 61% were white. Of the 652 children, 167 (26%) met criteria for wheezing at age 2 years. These children had mothers with significantly lower postpartum concentrations of plasma alpha-tocopherol, compared with those who did not meet criteria for wheezing at 2 years (a mean of 69 micromol/L vs. 75 micromol/L, respectively; P = .02). In multivariable regression analysis, the researchers detected a significant interaction between gamma-tocopherol and alpha-tocopherol, where the highest amounts of maternal gamma-tocopherol modified and mitigated the protective association of maternal alpha-tocopherol with risk of wheezing at 2 years (P = .05).
Dr. Stone cautioned that, what is currently labeled as vitamin E or alpha-tocopherol in foods and supplements, “could be any of eight different isoforms, and alpha-tocopherol may not actually be the dominant isoform being provided. In addition, the oils that we eat are the main sources of tocopherols in our diet, and they vary widely in terms of their tocopherol isoforms. Sunflower and safflower oil, for example, provide predominantly alpha-tocopherol as their isoform of vitamin E, while corn and soy oil provide predominantly gamma-tocopherol.”
For now, he continued, correcting maternal alpha-tocopherol deficiency, currently defined by a serum alpha-tocopherol concentration less than 11.6 micromol/L, is certainly reasonable. Down the road, modification of maternal alpha-tocopherol or gamma-tocopherol concentrations through dietary counseling may provide clinicians with a tool to prevent wheezing or asthma in affected children. “In the future there may be a role for checking tocopherol isoforms in pregnant women and then modifying dietary oil consumption to protect the health of their children,” he said.
He acknowledged certain limitations of the study, including that researchers obtained maternal vitamin E isoform measurements at enrollment, when the infants were, on average, 6 weeks post partum, and not during pregnancy. “However, the literature has shown that postpartum vitamin E levels at this time point are very similar to those during the second trimester of pregnancy,” Dr. Stone said. “The literature has also shown that plasma vitamin E isoform concentrations are tightly tied to diet and body stores and do not change very rapidly (such that a woman would not be likely to go from the highest quartile to the lowest, or vice versa). People’s diets don’t tend to change that much, in general.”
INSPIRE is funded by the National Institutes of Health. Dr. Stone is funded by an NIH training grant through Vanderbilt University. He reported having no relevant financial disclosures.
ATLANTA – Increasing maternal postpartum–plasma alpha-tocopherol isoform concentration was associated with a decreased likelihood of wheezing at age 2 years, defined as wheezing in the past 12 months, use of asthma medications in the past 12 months, or diagnosis of asthma, results from a large analysis showed.
“For now, this is an association and not causation,” study author Cosby Stone, MD, MPH, said in an interview in advance of the annual meeting of the American Academy of Allergy, Asthma, and Immunology. “We need a clinical trial to evaluate the effect of giving more alpha-tocopherol to mothers during pregnancy before anyone should jump to giving supplements.”
The median age of children at the time of maternal sample collection was 50 days. 47% were female, and 61% were white. Of the 652 children, 167 (26%) met criteria for wheezing at age 2 years. These children had mothers with significantly lower postpartum concentrations of plasma alpha-tocopherol, compared with those who did not meet criteria for wheezing at 2 years (a mean of 69 micromol/L vs. 75 micromol/L, respectively; P = .02). In multivariable regression analysis, the researchers detected a significant interaction between gamma-tocopherol and alpha-tocopherol, where the highest amounts of maternal gamma-tocopherol modified and mitigated the protective association of maternal alpha-tocopherol with risk of wheezing at 2 years (P = .05).
Dr. Stone cautioned that, what is currently labeled as vitamin E or alpha-tocopherol in foods and supplements, “could be any of eight different isoforms, and alpha-tocopherol may not actually be the dominant isoform being provided. In addition, the oils that we eat are the main sources of tocopherols in our diet, and they vary widely in terms of their tocopherol isoforms. Sunflower and safflower oil, for example, provide predominantly alpha-tocopherol as their isoform of vitamin E, while corn and soy oil provide predominantly gamma-tocopherol.”
For now, he continued, correcting maternal alpha-tocopherol deficiency, currently defined by a serum alpha-tocopherol concentration less than 11.6 micromol/L, is certainly reasonable. Down the road, modification of maternal alpha-tocopherol or gamma-tocopherol concentrations through dietary counseling may provide clinicians with a tool to prevent wheezing or asthma in affected children. “In the future there may be a role for checking tocopherol isoforms in pregnant women and then modifying dietary oil consumption to protect the health of their children,” he said.
He acknowledged certain limitations of the study, including that researchers obtained maternal vitamin E isoform measurements at enrollment, when the infants were, on average, 6 weeks post partum, and not during pregnancy. “However, the literature has shown that postpartum vitamin E levels at this time point are very similar to those during the second trimester of pregnancy,” Dr. Stone said. “The literature has also shown that plasma vitamin E isoform concentrations are tightly tied to diet and body stores and do not change very rapidly (such that a woman would not be likely to go from the highest quartile to the lowest, or vice versa). People’s diets don’t tend to change that much, in general.”
INSPIRE is funded by the National Institutes of Health. Dr. Stone is funded by an NIH training grant through Vanderbilt University. He reported having no relevant financial disclosures.
ATLANTA – Increasing maternal postpartum–plasma alpha-tocopherol isoform concentration was associated with a decreased likelihood of wheezing at age 2 years, defined as wheezing in the past 12 months, use of asthma medications in the past 12 months, or diagnosis of asthma, results from a large analysis showed.
“For now, this is an association and not causation,” study author Cosby Stone, MD, MPH, said in an interview in advance of the annual meeting of the American Academy of Allergy, Asthma, and Immunology. “We need a clinical trial to evaluate the effect of giving more alpha-tocopherol to mothers during pregnancy before anyone should jump to giving supplements.”
The median age of children at the time of maternal sample collection was 50 days. 47% were female, and 61% were white. Of the 652 children, 167 (26%) met criteria for wheezing at age 2 years. These children had mothers with significantly lower postpartum concentrations of plasma alpha-tocopherol, compared with those who did not meet criteria for wheezing at 2 years (a mean of 69 micromol/L vs. 75 micromol/L, respectively; P = .02). In multivariable regression analysis, the researchers detected a significant interaction between gamma-tocopherol and alpha-tocopherol, where the highest amounts of maternal gamma-tocopherol modified and mitigated the protective association of maternal alpha-tocopherol with risk of wheezing at 2 years (P = .05).
Dr. Stone cautioned that, what is currently labeled as vitamin E or alpha-tocopherol in foods and supplements, “could be any of eight different isoforms, and alpha-tocopherol may not actually be the dominant isoform being provided. In addition, the oils that we eat are the main sources of tocopherols in our diet, and they vary widely in terms of their tocopherol isoforms. Sunflower and safflower oil, for example, provide predominantly alpha-tocopherol as their isoform of vitamin E, while corn and soy oil provide predominantly gamma-tocopherol.”
For now, he continued, correcting maternal alpha-tocopherol deficiency, currently defined by a serum alpha-tocopherol concentration less than 11.6 micromol/L, is certainly reasonable. Down the road, modification of maternal alpha-tocopherol or gamma-tocopherol concentrations through dietary counseling may provide clinicians with a tool to prevent wheezing or asthma in affected children. “In the future there may be a role for checking tocopherol isoforms in pregnant women and then modifying dietary oil consumption to protect the health of their children,” he said.
He acknowledged certain limitations of the study, including that researchers obtained maternal vitamin E isoform measurements at enrollment, when the infants were, on average, 6 weeks post partum, and not during pregnancy. “However, the literature has shown that postpartum vitamin E levels at this time point are very similar to those during the second trimester of pregnancy,” Dr. Stone said. “The literature has also shown that plasma vitamin E isoform concentrations are tightly tied to diet and body stores and do not change very rapidly (such that a woman would not be likely to go from the highest quartile to the lowest, or vice versa). People’s diets don’t tend to change that much, in general.”
INSPIRE is funded by the National Institutes of Health. Dr. Stone is funded by an NIH training grant through Vanderbilt University. He reported having no relevant financial disclosures.
AT THE 2017 AAAAI ANNUAL MEETING
Key clinical point:
Major finding: Increasing maternal postpartum–plasma alpha-tocopherol concentration was associated with a decreased likelihood of wheezing requiring asthma medications at 2 years (P = .02).
Data source: A prospective evaluation of 652 children with maternal postpartum–plasma vitamin E isoforms measured at study enrollment.
Disclosures: INSPIRE is funded by the National Institutes of Health. Dr. Stone is funded by an NIH training grant through Vanderbilt University. He reported having no relevant financial disclosures.