American College Of Allergy, Asthma And Immunology Research Articles

Trends in the proportion of women speakers at North American Allergy and Immunology conferences, 2008 to 2020

BackgroundWomen in medicine continue to be underrepresented at medical conferences. Previous studies have evaluated the proportion of invited female speakers across multiple specialties and evaluated factors that may have led to this disparity. The field of Allergy and Immunology has often been excluded and analyses have not illustrated how the trends have changed over the past decade. ObjectiveTo evaluate the distribution of invited speakers by gender over time at the 3 largest North American Allergy and Immunology conferences. MethodsThis retrospective longitudinal analysis used conference programs from 2008 to 2020 from the American Academy of Allergy, Asthma, and Immunology (AAAAI), the American College of Allergy, Asthma, and Immunology (ACAAI), and the Canadian Society of Allergy and Clinical Immunology (CSACI). The gender (binary definition, man or woman, based on names, photos, pronouns, from conference programs and institutional profiles) of invited speakers was analyzed as the primary outcome, and planning committee members, and multispeaker sessions as secondary outcomes. These data were compared with publicly available data on the composition of the specialty by gender in the United States and Canada. ResultsWomen speakers at AAAAI, ACAAI, and CSACI conferences have historically been lower than male speakers and underrepresented compared with specialty composition. However, there has been a significant increase in the proportion of women speakers over time for all 3 conferences individually (AAAAI: 23.7% in 2008, 41.1% by 2020; ACAAI: 16.7% in 2008, 37.3% by 2020; CSACI: 19.4% in 2008, 54.8% by 2020; P < .001 for each) and combined (21.3% in 2008, 40.7% by 2020, P < .001). This trend coincides with a significant increase in women on the planning committee (all conferences: 20% in 2008, 50.6% by 2020; P < .001). There is also a decreasing trend over time for men-only multispeaker sessions. ConclusionThis study sheds light on the trends of women speaker representation at Allergy and Immunology conferences and provides clarity on future needs to reach equal representation in this field.

Proposed solutions by the American College of Allergy, Asthma, and Immunology and advocacy experts to address racial disparities in atopic dermatitis and food allergy

Atopic dermatitis (AD) and food allergies are more prevalent and more severe in people with skin of color than White individuals. The American College of Allergy, Asthma, and Immunology (ACAAI) sought to understand the effects of racial disparities among patients with skin of color with AD and food allergies. The ACAAI surveyed its members (N = 200 completed), conducted interviews with health care providers and advocacy leaders, and hosted a roundtable to explore the challenges of diagnosis and management of AD and food allergies in people with skin of color and to discuss potential solutions. Most of the survey respondents (68%) agreed that racial disparities make it difficult for people with skin of color to receive adequate treatment for AD and food allergies. The interviews and roundtable identified access to care, burden of costs, policies and infrastructure that limit access to safe foods and patient education, and inadequate research involving people with skin of color as obstacles to care. Proposed solutions included identifying ways to recruit more people with skin of color into clinical trials and medical school, educating health care providers about diagnosis and treating AD and food allergy in people with skin of color, improving access to safe foods, creating and disseminating culturally appropriate materials for patients, and working toward longer appointment times for patients who need them. Challenges in AD and food allergy in persons with skin of color were identified by the ACAAI members. Solutions to these challenges were proposed to inspire actions to mitigate racial disparities in AD and food allergy.

Editorial introductions.

Editorial introductions.

Drug allergy: A 2022 practice parameter update

Drug allergy: A 2022 practice parameter update

Editorial introductions.

Editorial introductions.

Allergy and Immunology Physician Workforce: Where do we stand today?

Nearly 15 years ago, an American College of Allergy, Asthma, and Immunology (ACAAI) White Paper estimated that the number of full-time equivalent allergist/immunologists would decline 7% from 3660 in 2006 to 3400 in 2020, whereas demand was projected to increase by 35% to more than 5500. It concluded that the federal government was the only entity that had the resources to fund training of the next generation of physicians. 1 American College of Allergy, Asthma, and Immunology.Allergist Report: America Faces an Allergy/Asthma Crisis. Available at: http://college.acaai.org/sites/default/files/AllergistReport.pdf. Accessed June 6, 2021. Google Scholar Hampering efforts to expand graduate medical education (GME) is a continuing rule from the 1990s that caps the total number of GME slots.

Multidisciplinary consensus on a stepwise treatment algorithm for management of chronic rhinosinusitis with nasal polyps.

Multidisciplinary consensus on a stepwise treatment algorithm for management of chronic rhinosinusitis with nasal polyps.

Clinical Guideline Highlights for the Hospitalist: Anaphylaxis Management in Adults and Children.

Anaphylaxis-A 2020 practice parameter update, systematic review, and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) analysis RELEASE DATE: April 2020 PRIOR VERSION: Anaphylaxis - a 2019 practice parameter and GRADE analysis DEVELOPER: American Academy of Allergy, Asthma & Immunology (AAAAI) and the American College of Allergy, Asthma, and Immunology (ACAAI) FUNDING SOURCE: None TARGET POPULATION: Adult and pediatric patients with anaphylaxis.

AAAAI Work Group Report: Trends in Oral Food Challenge Practices Among Allergists in the United States

The oral food challenge (OFC) is the criterion standard for diagnosing food allergy, but prior studies indicate many allergists may not be using OFCs for various reasons. To better understand current OFC trends, practices, and barriers, the American Academy of Allergy Asthma and Immunology (AAAAI) Adverse Reactions to Foods Committee subcommittee updated a 19-item survey (previously administered in 2009) and sent it to AAAAI and American College of Allergy, Asthma, and Immunology (ACAAI) membership. There were a total of 546 respondents who represented approximately a 10% response rate. Among the 546 respondents, compared with 2009, significantly more providers offer OFCs (95% vs 84.5%), offer >10 OFCs per month (17% vs 5.6%), obtain informed consent (82.2% vs 53.6%), and performed OFCs in fellowship (71% vs 45%) (all P < .001). Fellowship OFC training was limited, with 56% performing <10 OFCs in fellowship and 29% performing none. Although 94% see patients <12 months of age, 35.5% do not offer OFCs for early peanut introduction. Although 79% dedicate a supervising medical provider (MD, NP, PA) and 86% have a written OFC protocol, only 60% had a standardized reaction treatment protocol and 56% prepared emergency medications before OFC. Compared with 2009, there was significant worsening of perceived barriers to performing OFCs, including time (65.6% vs 55%), space (55.3% vs 27.1%), staffing (59.6% vs 44.3%), experience (16.9% vs 11.5%), and hospital proximity (10.9% vs 7.9%), though reimbursement as a barrier improved (45.9% vs 53.7%) (all P < .01). Compared with 2009, although more providers offer OFCs, multiple perceived barriers to performing OFCs have worsened. Hesitancy to challenge infants and emergency preparedness issues are emerging potential concerns.

Subcutaneous terbutaline as an alternative to metered-dose inhalers for asthma during the COVID-19 pandemic.

In a well-written and informative article, Whittle et al1 “Respiratory Support for Adult Patients with COVID-19,” correctly recommend against using nebulizer therapy for asthmatics and suggests metered-dose inhalers. During the COVID-19 epidemic, asthmatics will continue to have exacerbations, frequently requiring emergency room care in a physician's office, urgent care center, or emergency department of a hospital. It is recommended that asthmatic patients continue to be managed according to asthma guideline recommendations.2 Nebulizer use is discouraged unless essential during a pandemic because nebulized therapy is more likely to aerosolize SARS-CoV-2 and increase risk of contagion. As such, asthma therapy delivered by a metered-dose inhaler would be more appropriate in the healthcare setting.3 Nevertheless, some patients are so tight that using a metered-dose inhaler, even with a spacer, might be problematic, particularly if they have uncontrolled coughing, have severe life-threatening asthma, or those who are uncooperative or unable to follow directions required for the metered-dose inhaler, even with a spacer. A recent article4 demonstrated that, in a prospective study, 85 asthmatic patients treated with subcutaneous terbutaline significantly improved after already receiving multiple albuterol treatments with either nebulized aerosols or albuterol metered-dose inhalers. Advantages of terbutaline over epinephrine include: (1) a more pronounced effect with a longer duration of action on forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC),5 and (2) preferred over epinephrine in pregnancy.6 Terbutaline is inexpensive and readily accessible, even though a previous survey of physicians in the Cleveland area reveal that 98% of physicians rarely or never use subcutaneous terbutaline for an exacerbation of asthma.7 From a colleague in New York City reading about my work with terbutaline, “This is great! Not only that, but the feasibility of subcutaneous terbutaline as an administration route during a high-volume/war-like situation is underappreciated.” Additionally, the American College of Allergy, Asthma, and Immunology (ACAAI) has reported that some areas around the country are experiencing shortages in albuterol inhalers as a result of an increased demand, because hospitals are using inhalers rather than nebulizers to treat COVID-19 patients.8 Finally, although metered-dose inhalers frequently work, the use of subcutaneous terbutaline would obviate the need for these inhalers or aerosols.

Perception and practice of sublingual immunotherapy among practicing allergists in the United States: A follow-up survey

BackgroundLimited information is available regarding the current perception and practice of sublingual immunotherapy (SLIT) use among US and international allergists. In light of 4 recent US Food and Drug Administration (FDA)–approved SLIT options, perceptions and practices may be changing. ObjectiveTo provide updated information about current allergists' practice and perception of SLIT relative to 2007 and 2011. MethodsOn behalf of the American College of Allergy, Asthma, and Immunology (ACAAI) Immunotherapy and Diagnostics Committee, an electronic survey was sent to all US and international allergists who were members of the ACAAI. Data were compared with previous surveys conducted and published in 2007 and 2011. ResultsOf the 305 respondents, 268 (87.9%) practiced in the United States. A total of 197 of 268 respondents (73.5%) reported experience using SLIT compared with 45 of 766 US allergists (5.9%) in 2007 and 59 of 519 US allergists (11.4%) in 2011 (P < .001). Of the 188 respondents in the United States who used SLIT in their practice, 129 (68.6%) used FDA-approved SLIT tablets only, 44 (23.4%) used both FDA-approved SLIT tablets and SLIT drops using an extract that is FDA approved for subcutaneous immunotherapy, and 15 (8.0%) reported using only SLIT drops. Limitation of only treating one allergen was the primary barrier in using SLIT among 197 of 268 respondents (73.5%). ConclusionThere has been a significant increase in SLIT use in the last 5 years, with 73.5% of respondents reporting experience with it. With 4 FDA-approved SLIT therapies, this likely contributes to its more widespread use. The greatest barrier to SLIT use is the limitation of only treating one allergen.

PERCEPTION AND PRACTICE OF SUBLINGUAL IMMUNOTHERAPY AMONG PRACTICING ALLERGISTS IN THE US: 2018 FOLLOW-UP SURVEY.

Introduction Limited information regarding current trends of sublingual immunotherapy (SLIT) use in the United States and perception of SLIT relative to 2007 and 2013 is available, especially in light of recent FDA-approved SLIT options. Methods On behalf the American College of Allergy, Asthma, and Immunology (ACAAI) Immunotherapy and Diagnostics Committee, an electronic survey was sent to all ACAAI allergists practicing in the United States in July 2018. Results 150 of 202 respondents (74.3%) reported experience using SLIT compared with 59 of 519 (11.4%) in 2013 (P Conclusions There has been a six-fold increase in SLIT use in the last 5 years, with 74% of respondents reporting SLIT use. With four FDA-approved SLIT therapies, this likely contributes to its more widespread use. Current barrier to more SLIT use appears to limited by ability to only use one allergen. It is anticipated that if there was FDA-approval of SLIT that included multiple allergens, this could become a more favorable treatment option for allergists.

Editorial introductions

Editorial introductions

Pharmacologic Treatment of Seasonal Allergic Rhinitis: Synopsis of Guidance From the 2017 Joint Task Force on Practice Parameters.

The Joint Task Force on Practice Parameters, which comprises representatives of the American Academy of Allergy, Asthma and Immunology (AAAAI) and the American College of Allergy, Asthma and Immunology (ACAAI), formed a workgroup to review evidence and provide guidance to health care providers on the initial pharmacologic treatment of seasonal allergic rhinitis in patients aged 12 years or older. To update a prior systematic review, the workgroup searched MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials from 18 July 2012 to 29 July 2016 to identify studies that addressed efficacy and adverse effects of single or combination pharmacotherapy for seasonal allergic rhinitis. In conjunction with the Joint Task Force, the workgroup reviewed the evidence and developed recommendations about initial treatment approaches by using the Grading of Recommendations Assessment, Development and Evaluation approach. Members of the AAAAI, the ACAAI, and the general public provided feedback on the draft document, which the Joint Task Force reviewed before finalizing the guideline. For initial treatment of seasonal allergic rhinitis in persons aged 12 years or older, routinely prescribe monotherapy with an intranasal corticosteroid rather than an intranasal corticosteroid in combination with an oral antihistamine. (Strong recommendation). For initial treatment of seasonal allergic rhinitis in persons aged 15 years or older, recommend an intranasal corticosteroid over a leukotriene receptor antagonist. (Strong recommendation). For treatment of moderate to severe seasonal allergic rhinitis in persons aged 12 years or older, the clinician may recommend the combination of an intranasal corticosteroid and an intranasal antihistamine for initial treatment. (Weak recommendation).

Editorial introductions

Editorial introductions

International consensus (ICON) on: clinical consequences of mite hypersensitivity, a global problem

Since mite allergens are the most relevant inducers of allergic diseases worldwide, resulting in significant morbidity and increased burden on health services, the International Collaboration in Asthma, Allergy and Immunology (iCAALL), formed by the American Academy of Allergy, Asthma and Immunology (AAAAI), the American College of Allergy, Asthma and Immunology (ACAAI), the European Academy of Allergy and Clinical Immunology (EAACI), and the World Allergy Organization (WAO), has proposed to issue an International Consensus (ICON) on the clinical consequences of mite hypersensitivity. The objectives of this document are to highlight aspects of mite biology that are clinically relevant, to update the current knowledge on mite allergens, routes of sensitization, the genetics of IgE responses to mites, the epidemiologic aspects of mite hypersensitivity, the clinical pictures induced by mites, the diagnosis, specific immunotherapeutic approaches, and prevention.

Editorial introductions

Editorial introductions

Optimization and simplification of the Allergic and Hypersensitivity conditions classification for the ICD-11.

Since 2013, an international collaboration of Allergy Academies, including first the World Allergy Organization (WAO), the American Academy of Allergy Asthma and Immunology (AAAAI), and the European Academy of Allergy and Clinical Immunology (EAACI), and then the American College of Allergy, Asthma and Immunology (ACAAI), the Latin American Society of Allergy, Asthma and Immunology (SLAAI), and the Asia Pacific Association of Allergy, Asthma and Clinical Immunology (APAAACI), has spent tremendous efforts to have a better and updated classification of allergic and hypersensitivity conditions in the forthcoming International Classification of Diseases (ICD)-11 version by providing evidences and promoting actions for the need for changes. The latest action was the implementation of a classification proposal of hypersensitivity/allergic diseases built by crowdsourcing the Allergy Academy leaderships. Following bilateral discussions with the representatives of the ICD-11 revision, a face-to-face meeting was held at the United Nations Office in Geneva and a simplification process of the hypersensitivity/allergic disorders classification was carried out to better fit the ICD structure. We are here presenting the end result of what we consider to be a model of good collaboration between the World Health Organization and a specialty. We strongly believe that the outcomes of all past and future actions will impact positively the recognition of the allergy specialty as well as the quality improvement of healthcare system for allergic and hypersensitivity conditions worldwide.

International Consensus (ICON): allergic reactions to vaccines

Background Routine immunization, one of the most effective public health interventions, has effectively reduced death and morbidity due to a variety of infectious diseases. However, allergic reactions to vaccines occur very rarely and can be life threatening. Given the large numbers of vaccines administered worldwide, there is a need for an international consensus regarding the evaluation and management of allergic reactions to vaccines.Methods Following a review of the literature, and with the active participation of representatives from the World Allergy Organization (WAO), the European Academy of Allergy and Clinical Immunology (EAACI), the American Academy of Allergy, Asthma, and Immunology (AAAAI), and the American College of Allergy, Asthma, and Immunology (ACAAI), the final committee was formed with the purpose of having members who represented a wide-range of countries, had previously worked on vaccine safety, and included both allergist/immunologists as well as vaccinologists.Results Consensus was reached on a variety of topics, including: definition of immediate allergic reactions, including anaphylaxis, approaches to distinguish association from causality, approaches to patients with a history of an allergic reaction to a previous vaccine, and approaches to patients with a history of an allergic reaction to components of vaccines.Conclusions This document provides comprehensive and internationally accepted guidelines and access to on-line documents to help practitioners around the world identify allergic reactions following immunization. It also provides a framework for the evaluation and further management of patients who present either following an allergic reaction to a vaccine or with a history of allergy to a component of vaccines.

Editorial introductions

Editorial introductions