Allergy Care Research Articles

P210 - The effect of L-arginine and L-citrulline on NOx production in primary human airway epithelial cells exposed to asymmetric dimethylarginine (ADMA). Asthma Institute, Division of Pulmonary, Allergy & Critical Care Medicine. University of Pittsburgh

P210 - The effect of L-arginine and L-citrulline on NOx production in primary human airway epithelial cells exposed to asymmetric dimethylarginine (ADMA). Asthma Institute, Division of Pulmonary, Allergy & Critical Care Medicine. University of Pittsburgh

Exposure to Grass- But Not Birch Pollen Affects Lung Function in Eight Year Old Children from the Swedish Birth Cohort BAMSE

Allergic response to pollen is increasing world-wide leading to high medical and social costs. However, it is unclear how different pollen species affect lung function on a population level. Additionally, various air pollutants have been suggested to affect the allergic reaction to pollen, but the evidence is not conclusive. Over 1800 children belonging to the Swedish birth cohort BAMSE were lung-function tested when 8 and 16 year old. Daily air quality measurements and meteorological data from urban background monitoring stations, together with pollen counts for 9 types of pollen in Stockholm city were estimated for the index day as well as up to six days before lung-function testing. Linear regression analysis was applied to determine the effect of pollen concentrations as well as interaction effects between pollen and pollutant levels on lung function. Exposure to grass pollen was in the range of 0-27 counts/m³ and associated with a reduced forced expiratory volume in 1 second in 8-year olds (FEV1; -34.6 mL; 95% confidence interval; CI: -55.5 to -13.8, for an increase of three pollen counts/m³ on the index day). Similar associations were seen for other averaging periods but they appeared stronger in children sensitized to pollen allergens of birch, mugwort and grass. No associations were found for birch or other pollen, or in 16-year olds. Interactions between the exposure to several types of pollen and ozone (but not to other pollutants) were detected but without any clear pattern. Although birch pollen allergens have been suggested to be the main cause for pollen allergy in Scandinavia, only an effect of grass pollen on lung function was indicated in this study. We speculate that since the grass species flower late in the pollen season the allergy care routines might be weakened during this period. The Scandinavian allergy information may need to be updated to make sure that sensitized persons continue their allergy care routines during the late summer.

Influence of sex on chronic obstructive pulmonary disease risk and treatment outcomes.

Chronic obstructive pulmonary disease (COPD), one of the most common chronic diseases and a leading cause of death, has historically been considered a disease of men. However, there has been a rapid increase in the prevalence, morbidity, and mortality of COPD in women over the last two decades. This has largely been attributed to historical increases in tobacco consumption among women. But the influence of sex on COPD is complex and involves several other factors, including differential susceptibility to the effects of tobacco, anatomic, hormonal, and behavioral differences, and differential response to therapy. Interestingly, nonsmokers with COPD are more likely to be women. In addition, women with COPD are more likely to have a chronic bronchitis phenotype, suffer from less cardiovascular comorbidity, have more concomitant depression and osteoporosis, and have a better outcome with acute exacerbations. Women historically have had lower mortality with COPD, but this is changing as well. There are also differences in how men and women respond to different therapies. Despite the changing face of COPD, care providers continue to harbor a sex bias, leading to underdiagnosis and delayed diagnosis of COPD in women. In this review, we present the current knowledge on the influence of sex on COPD risk factors, epidemiology, diagnosis, comorbidities, treatment, and outcomes, and how this knowledge may be applied to improve clinical practices and advance research.

Percutaneous and intradermal allergy skin test utilization in the United States 2012 Medicare population

Percutaneous and intradermal allergy skin test utilization in the United States 2012 Medicare population

Economic burden of inadequate management of allergic diseases in the European Union: a GA(2) LEN review.

In the European Union (EU), between 44 and 76 million individuals of the 217 million EU employees suffer from allergic disease of the airways or the skin. Up to 90% of these persons are untreated or insufficiently treated. This has major socio-economic consequences such as absence from work (absenteeism), particularly reduced productivity at work (presenteeism). We used published literature and online statistical information from Eurostat and Eurofound to assess the costs of allergic disease to society. Allergies have an impact on direct, indirect, intangible and opportunity costs. Most importantly, for the EU, avoidable indirect costs per patient insufficiently treated for allergy range between €55 and €151 billion per annum due to absenteeism and presenteeism, that is, €2405 per untreated patient per year. On the other hand, appropriate therapy for allergic diseases is available at comparatively low costs at an average of €125 per patient annually, equalling only 5% of the costs of untreated disease, allowing potential savings of up to €142 billion. A better care for allergies based on guideline-based treatment would allow Europe's economy substantial savings. In addition, allergies have an impact on learning and performance at school and university, leading to opportunity costs for society. This cannot be calculated moneywise but will have an impact in a modern knowledge-based society. Still allergies are trivialized in society, noting that the costs of therapy are paid by patients and healthcare services, whereas economic savings are made by employers and society. A change of this mindset is urgently needed.

Costs of inadequate allergy care in EU: GA2LEN review

Costs of inadequate allergy care in EU: GA2LEN review

The Ongoing Challenge of Evaluating Rescue Therapies in Acute Respiratory Distress Syndrome*

Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN * See also p. 1610 Dr. Rice served as board member for Avisa LLC; consulted for GlaxoSmithKline, LLC (C O P Serve on 2 DSMBs) and Avisa LLC (For VAP detection device); and received support for article research from the National Institutes of Health (NIH). His institution received grant support from the NIH (Dr. Rice has NIH funding). Dr. Keriwala has disclosed that he does not have any potential conflicts of interest.

Erratum to “Effects of intermittent hypoxia on sympathetic activity and blood pressure in humans” [Auton. Neurosci. 121/1-2 (2005) 87–93

Erratum to “Effects of intermittent hypoxia on sympathetic activity and blood pressure in humans” [Auton. Neurosci. 121/1-2 (2005) 87–93] Urs A. Leuenberger⁎, Derick Brubaker, Sadeq Quraishi, Cynthia S. Hogeman, Virginia A. Imadojemu, Kristen S. Gray a Division of Cardiology, MC H047, The Pennsylvania State University College of Medicine, The Milton S. Hershey Medical Center, P.O. Box 850, Hershey, PA 17033, United States b Division of Pulmonary, Allergy and Critical Care Medicine, The Pennsylvania State University College of Medicine, The Milton S. Hershey Medical Center, Hershey, PA 17033, United States

PRS69 - Impact, In Real Life Conditions, Of The Use Of A Purifier Spray On Allergy Care In Dust Mite Allergic Subjects

The study has been set-up in order to evaluate in real life conditions the perceived efficacy of a spray containing essential oils on allergy-related-symptoms, day-sleepiness and QoL of allergic subjects. Women-and-men with a known history of dust mite allergy were recruited in the study. They were asked to use in their house twice a day, the purifier spray for a period of 28days. The perceived efficacy was evaluated via self-validated questionnaires on allergy symptoms (discomfort generated by sneezing- itchy eyes-stuffy nose-nasal flow-tiredness-ear itching), on daytime-sleepiness (Epworth-Sleepiness-Scale) and on QoL (SF12). For the study outcomes, each subject was evaluated at inclusion, at day7 and day28. The satisfaction through the CSQ8-questionnaire was also evaluated at day28. 42 subjects, with an history of allergy of 21.4±11.2years, were included. They present a symptom-score at inclusion of 6.63±3.5 which was significantly reduced after 7 days of spray use with a value of 3.87±2.4 (p<0,0001). The improvement was confirmed at day28:1.85±1.6-(p<0,0001). The data were also evaluated according to symptom severity, i.e.low, moderate or severe. For the moderate or severe subpopulations, a significant improvement was observed on the symptoms score since 7days of spray use. Moreover, for the subjects showing severe symptoms, an improvement was also observed on daytime-sleepiness (p<0,05) with the Epworth score going from 9.18 ±7.1 to 4.75 ±3.9 after 28days, and on the SF12 mental dimension score (42.8 vs 48.2-p<0,04) For the studied population the overall satisfaction evaluated was above 75% after 28days. By using self-validated-questionnaires, the evaluation shows the interest of the use of the essential oils spray in allergy care for dust mite allergic subjects. The improvement on symptoms is observed whatever the severity of symptoms is, and it is noticeable that for subjects showing severe symptoms, the quality of life and the sleep is also improved.

G388 “Itchy-Sneezy-Wheezy” Survey: Comparison of GP referral reasons to diagnoses on first allergy clinic letters

AimsAllergic disease is common: 25% of patients registered in General Practice (GP) are affected, and 11% have multiple allergic conditions. We previously found that only 7% of GP referral letters...

식품 알레르기의 유병률과 알레르겐 분석

식품 알레르기에 대한 유병률과 알레르기를 일으키는 식품의 종류를 알아내기 위해, 설문지 조사와 피부단자시험을 실시하였고, 또한 최근 국내외 식품 알레르기에 대한 자료 고찰을 하였다. 본 연구결과 설문지에 의한 성별 식품 알레르기 증상 유병률은 남자에서는 25.6%, 여자는 25.8%로 남녀 간에 별 차이가 없었으며, 연령별로는 남자는 40-49세가 31.8%, 여자에서는 30-39세가 32.6%로 가장 높았다. 성별과 식품 항목에 의한 식품 알레르기의 유병률은 남자는 고등어가 6.6%로 가장 높았고, 여자는 복숭아가 7.4%로 가장 높았다. 성별에 의한 식품 알레르기 증상 유병자 중 피부단자시험 양성률을 보면 남자에서 21.4%의 양성률을, 여자에 있어서는 14.7%의 양성률을 나타내 남녀간의 유의한 차이(p=0.018)가 있었다. 식품 항목별 양성률을 보면 남자에서는 호프가 58.9%로 가장 높았고, 여자에서는 계란이 36.4%로 가장 높은 양성률을 나타냈으며, 돼지고기, 새우 가재, 호프, 그리고 토마토에서 통계적으로 남녀 간 유의한 차이가 있었다(p<0.05). 피부단자시험을 통하여 우리나라 식품 알레르기 증상 추정 유병률은 남자 5.0%, 여자 3.6%였으며, 알레르기를 일으키는 흔한 식품으로는 호프, 고등어, 새우, 가재, 게, 돼지고기, 우유, 계란 등이 포함된다고 생각한다. 최근 국내외 식품 알레르기에 관한 자료 분석에서 식품 알레르기 유병률은 1-35% 범위로 나타났으며, 알레르기를 일으키는 주요 식품은 우유, 계란, 견과류, 생선, 조개, 갑각류 그리고 과일 채소 등으로 확인 하였다. 따라서 본 연구는 지역사회 전 연령층을 대상으로 그리고 최근 국내외 식품 알레르기에 관한 자료를 분석한 첫 시도로써 향후 우리나라 식품 알레르기 질환을 예방하고 치료하는데 근거자료의 토대가 될 것이다. 또한 식품 알레르기 교육프로그램을 계획할 때는 식품 알레르기의 유병률과 알레르겐을 포함한 대처방안이 필요하다고 본다. Objectives: The purpose of this study was to estimate the prevalence of food allergies and find out food allergens. Methods: Questionnaires were completed by 2,415 subjects in D city, among whom 452 subjects believed that they had food allergy. Skin prick tests were performed on these subjects. The data were analyzed using SAS Version 9.0 and <TEX>${\chi}^2$</TEX>-test. In addition, several recent studies were reviewed. Results: The prevalence rate of food allergic symptoms was 25.6% in males and 25.8% in females, respectively. The positive rate of skin prick tests among those who were allergic to any of 14 food items was 21.4% in males and 14.7% in females(p=0.018). Therefore, it was estimated that the prevalence rate of food allergy was 5.0% in males and 3.6% in females. It was shown that the major food allergens were hop, shrimp, lobster, oyster and egg(whole) in males, and egg(whole), hop, oyster, and pork in females, respectively. The prevalence in recent studies ranged from 1 to 35%. Major food allergens were milk, egg, nuts, fish, shellfish crustacean and fruits/vegetables. Conclusions: In order to provide effective care for food allergy, it is essential to find out the prevalence of food allergies and food allergens.

Central Venous Catheter Insertion by Advanced Practice Nurses

Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN * See also p. 536. Dr. Wheeler is a consultant to Cumberland Pharmaceuticals, provided expert testimony for ad hoc legal consulting, received royalties from Williams and Wilkens, and has stock with Cumberland Pharmaceuticals. Their institution received grant support from the National Institutes of Health. Ms. Landsperger has disclosed that she does not have any potential conflicts of interest.

Management of food allergy: A survey of Australian paediatricians

The prevalence of Immunoglobulin E (IgE)-mediated food allergy in the developed world is increasing, overwhelming tertiary allergy services. Alternative models of care are required. General paediatricians could provide this care but may require further training to do so. We aimed to determine Australian general paediatricians': (i) knowledge and management of IgE-mediated food allergy; (ii) access to and use of diagnostic services; and (iii) interest in further training. Members of the Australian Paediatric Research Network completed an online survey in 2011/12. A case study elicited paediatrician's knowledge of diagnostic history taking, testing and key management principles. Study-designed questions assessed paediatricians' current practice, access to allergy services and interest in further training. One hundred sixty-eight (43%) of 390 paediatricians responded; 93 paediatricians reported managing food allergy. Diagnostic and management practices varied widely. Paediatricians had high levels of agreement (>90%) for only three of 13 questions pertaining to diagnosis and management. Only 56 (61%) correctly identified that a diagnosis of IgE-mediated food allergy requires a history consistent with a clinical reaction and a positive specific serum IgE antibody or skin prick test result. Reported waiting times for tertiary allergy services ranged from 5.4 (private) to 10.6 months (public). Most (91%) paediatricians expressed interest in further training. General paediatricians would benefit from further training if they are to practice allergy care as their diagnosis and management is often inconsistent with international guidelines. Training could be delivered online to maximise reach and uptake. If effective, such a model could relieve some of the burden experienced by Australian tertiary allergy services.

Allergy medical care network: A new model of care for specialties

In 2005 the Althaia Foundation Allergy Department performed its daily activity in the Hospital Sant Joan de Deu of Manresa. Given the increasing demand for allergy care, the department's performance was analysed and a strategic plan (SP) for 2005–2010 was designed.The main objective of the study was to assess the impact of the application of the SP on the department's operations and organisational level in terms of profitability, productivity and quality of care. Material and methodsDescriptive, retrospective study which evaluated the operation of the allergy department. The baseline situation was analysed and the SP was designed. Indicators were set to perform a comparative analysis after application of the SP. ResultsThe indicators showed an increase in medical care activity (first visits, 34%; successive visits, 29%; day hospital treatments, 51%), high rates of resolution, reduced waiting lists. Economic analysis indicated an increase in direct costs justified by increased activity and territory attended. Cost optimisation was explained by improved patient accessibility, minimised absenteeism in the workplace and improved cost per visit. ConclusionsAfter application of the SP a networking system was established for the allergy speciality that has expanded the territory for which it provides care, increased total activity and the ability to resolve patients, optimised human resources, improved quality of care and streamlined medical costs.

Defining quality metrics and improving safety and outcome in allergy care

The delivery of allergy immunotherapy in the otolaryngology office is variable and lacks standardization. Quality metrics encompasses the measurement of factors associated with good patient-centered care. These factors have yet to be defined in the delivery of allergy immunotherapy. We developed and applied quality metrics to 6 allergy practices affiliated with an academic otolaryngic allergy center. This work was conducted at a tertiary academic center providing care to over 1500 patients. We evaluated methods and variability between 6 sites. Tracking of errors and anaphylaxis was initiated across all sites. A nationwide survey of academic and private allergists was used to collect data on current practice and use of quality metrics. The most common types of errors recorded were patient identification errors (n = 4), followed by vial mixing errors (n = 3), and dosing errors (n = 2). There were 7 episodes of anaphylaxis of which 2 were secondary to dosing errors for a rate of 0.01% or 1 in every 10,000 injection visits/year. Site visits showed that 86% of key safety measures were followed. Analysis of nationwide survey responses revealed that quality metrics are still not well defined by either medical or otolaryngic allergy practices. Academic practices were statistically more likely to use quality metrics (p = 0.021) and perform systems reviews and audits in comparison to private practices (p = 0.005). Quality metrics in allergy delivery can help improve safety and quality care. These metrics need to be further defined by otolaryngic allergists in the changing health care environment.

Poster 1025: Introduction to the clinical practice of molecular allergology

Background While it has been used clinically in Europe since the early 2000, molecular allergology remains relatively unknown to a number of clinicians involved in the field of allergy and this at a time when the understanding of allergy at the level of proteins allows for novel diagnostic and therapeutic avenues. Molecular allergy offers clinicians a better understanding of the allergy dynamics of certain patients, particularly in some situations of food allergy and in multi-allergy contexts.

Indications, Protocols, and Outcomes of Drug Desensitizations for Chemotherapy and Monoclonal Antibodies in Adults and Children

Advances in the understanding of various malignancies and chronic inflammatory diseases has led to the development of better treatment options for prolonging patient survival and minimizing morbidity. The recognition of "first-line" chemotherapy and monoclonal agents for these conditions has given more urgency to the need to re-administer these drugs in cases of drug hypersensitivity reactions. Therefore, in these cases, not only is desensitization considered when there is no alternative therapy available but also when alternative treatments are considered therapeutically inferior and/or more toxic. In this article, we describe the steps involved in the evaluation of these patients, factors to consider before making a decision to desensitize, the implementation of desensitization protocols, and the outcomes of such procedures.

A Standing Dilemma: Autonomic Failure Preceding Hodgkin's Lymphoma

A Standing Dilemma: Autonomic Failure Preceding Hodgkin’s Lymphoma Cyndya Shibao, MD, Prasuna Muppa, MBBS, Matthew W. Semler, MD, Amanda C. Peltier, MD, Italo Biaggioni, MD Division of Clinical Pharmacology and Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, the Autonomic Dysfunction Center, and Department of Neurology, Vanderbilt University Medical Center, Nashville, Tenn.

More, Please*

Division of Pulmonary, Allergy, and Critical Care Emory Center for Critical Care Emory University Atlanta, GA Division of Pulmonary and Critical Care Medicine Washington Hospital Center Washington, DC * See also p. 2754. Dr. Sevransky lectured for various organizations. His institution received grant support from Abbott Laboratories. Dr. Shorr consulted and received grant support from Astellas, Bayer, Cubist, Pfizer, Forest, Trius, and Theravance. He lectured for Astellas and Pfizer.

Quality of Life Is More Impaired in Patients Seeking Medical Care for Food Allergy

Background: Food allergy (FA) affects 2-4% of adults, but only a small percentage visit an outpatient clinic for a thorough evaluation. Methods: A matched case-control study was used to compare health-related quality of life (HRQL) of the Dutch general population that did not seek medical care for their FA with outpatients who did seek medical care. All participants were diagnosed as food allergic (i.e. with a suggestive history and corresponding positive IgE). HRQL was measured using the Food Allergy Quality of Life Questionnaire - Adult Form (FAQLQ-AF). A food allergy independent measure (FAIM) was used to evaluate the adult's perception of the severity of his/her disease. Results: Total FAQLQ-AF score in individuals who never visited a doctor for their FA was significantly lower than that of patients who sought medical care (2.4 vs. 3.9, p = 0.03), indicating that the former had a better quality of life than patients who did seek medical care. Regarding the different domains of FAQLQ, the score for allergen avoidance and dietary restrictions and the score for emotional impact (EI) was significantly higher in the group that sought medical care (p = 0.02 and 0.03, respectively), indicating the importance of these domains. The FAIM score was significantly higher in the group that sought medical care, indicating that they perceived their FA as more severe. Conclusion and Clinical Relevance: Patients who seek medical care for their FA have a more impaired HRQL and perceive their FA as more severe. Food avoidance and issues related to the EI of FA are key areas of intervention aimed at improving HRQL in patients with FA.