Therapy for food allergy - Twitter summary from #ACAAI16 meeting

Dr Nadeau presented review of new immunotherapy for treating food allergy. Potential food allergy therapies in this slide:

AR101 - 100% of patients tolerated 443g (2 peanuts) and 78% tolerated the challenge (equivalent to 1g or a peanut butter cookie)

Possible biologics for peanut allergy in this slide:

There is evidence the prevalence of peanut #allergy is not on the rise from comparison of longitudinal cohorts

LEAP study: Peanut recommended to be introduced starting around 4-6 months

Guidelines for peanut introduction changing. Introduce early, test if indicated.

Peanut allergy guideline coming out Jan 2017

However, does LEAP study applies to other foods? Early egg introduction has mixed evidence, trend towards benefit in non-eczema group but towards harm in eczema group. Very mixed picture when it comes to using hydrolyzed formula vs cow's milk formula in eczema. No clear benefit.

Socioeconomic disparity in food allergy:

Income and race influence how we utilize healthcare and incur costs:

This is a Twitter summary from #ACAAI16 meeting. The post is a part of series. See the rest here:

Several allergists did a great job posting updates on Twitter from the 2016 meeting of ACAAI, the hashtag was #ACAAI16. I used the website Symplur to review the tweets:

@docalergias @drstanfineman @drsilge

Presentation handouts are available from the ACAAI website:

Adverse Food Reactions (click to enlarge the image).

What separates Allergists from other specialists: atopy and immunotherapy - Twitter summary from #ACAAI16 meeting

Dr. Hal Nelson presented on What separates Allergists from other specialists?

Allergists are not defined by an organ system. Rather we focus on 'atopy'. Coca and Cooke described Atopy in 1922 - strong hereditary component, clustering of eczema, rhinitis and asthma with positive SPT.

Pollen sensitization a risk factor for allergic rhinitis. Not so for asthma. Perennial allergen sensitization to HDM, animals is important.

House dust mite avoidance can actually reduce bronchial hyperresponsiveness (classic Davos study - moved the kids to HDM free zone) .

Because of differences of impact of seasonal vs perennial allergen sensitization, allergists become armchair Aerobiologists.

Intradermal skin testing is 1000x more sensitive than skin prick testing - is it clinically relevant though? A study showed that with positive intradermal tests (if SPT was negative) were no different than negative tests and lower/upper respiratory symptoms.

Requirements for effective immunotherapy: adequate doses of relevant allergen; attention to cross-reactivity; maintain extract potency.

SCIT effective doses established for ragweed, grass, dust mites, cat, dog, birch and Alternaria mold - of note, dog extract was changed. The RCT that established the effective dose of ragweed allergen to put in an SCIT treatment set was published in 1965!

SLIT is effective and FDA approved SLIT-T, SLIT drops are not FDA approved.

Dr. Michael Nelson presented on Allergen Immunotherapy: Current Best Practices.

Immunotherapy has been around for over 100 year now - a treatment doesn't last that long if it doesn't work.

Starting AIT - should we consider starting earlier to allow for prevention of new sensitizations, new asthma? Knowing that AIT needs to be given for at least 3-5 years to allow for disease modification means selecting the right patient to start.

Best practice is to have a trial off immunotherapy after 5 years - yes, some will recur but many will not, not a reason to do lifelong AIT.

@choirdoc: Biggest surprise in my career was learning how resistant many patients are to stopping IT.

The Payne and Nelson study of AIT prescriptions within DOD database showed only a 50% refill in AIT after 1st year of therapy.

Early and complete patient education leads to enhanced patient selection and adherence - route, procedures, AEs, duration, adherence importance.

The AIT practice parameter published in JACI 2011 shows probable effective doses for both standardized and nonstandardized US extracts.

We need to separate extracts with proteolytic enzyme activities from other extracts. Don't mix molds with pollens - need 2 vials.

This is a Twitter summary from #ACAAI16 meeting. The post is a part of series. See the rest here:

Several allergists did a great job posting updates on Twitter from the 2016 meeting of ACAAI, the hashtag was #ACAAI16. I used the website Symplur to review the tweets:


Presentation handouts are available from the ACAAI website:

Immunotherapy for allergic rhinitis - Twitter summary from #ACAAI16 meeting

Classic lecture by Dr. Nelson on 100 years on immunotherapy #ACAAI16

@docalergias: Allergy immunotherapy for AR effectively prevents asthma:

@choirdoc: Wouldn't we be celebrating discovery of a treatment to reduce risk of developing asthma by 40%? Hmm - there is one: immunotherapy. Treating parents with immunotherapy reduces risk of atopy in their future children (dose dependent, too)!

Probiotics might be able to enhance the effectiveness of immunotherapy. Dr. Nelson warns that confirmation is needed. SCIT in combination with probiotics induces regulatory B cells and 30% improvement on symptoms compared to SCIT without probiotics

@drsilge: Subcutaneous immunotherapy plus probiotics dramatically affected nasal symptoms after 6 months. Fascinating

We can safely administer grass and ragweed sublingual tabs together. Approximately $600/mo wholesale? Cetirizine and fluticasone nasal spray $6.25/mo. Value? @paallergy: That would be $7,200 per year. SCIT is much much cheaper.

Dr Durham: To check for INS spray non-compliance, ask - how many spray bottles did you use during last pollen season? The answers should be 3-4.

There is a need for more research on subtropical and tropical dust mite allergen IT.

Dr Durham explained data from several studies showing efficacy of dust mite SLIT for allergic asthma.

Effectiveness of dust mite SLIT on polisensitized asthmatics: 34% risk reduction in exacerbations - JAMA

Optimal preseason treatment for SLIT is 4 months.

Key points of SLIT vs. SCIT in this slide:

Potential mechanisms of adjuvants for allergen IT in this slide:

Possible anti-cytokines targets as adjuvants for SCIT in this slide:

Mycobacterial antigen as potential new adjuvants for SCIT:

Dr Durham reviewed his well known study of Grass SCIT showing persistent benefit 3 years after discontinuation following 3 yr course.

Grass SLIT-T was also shown to have persistent benefit for 2 years following discontinuation after a 3-year treatment period (given daily year round).

Dr Durham conducted a head to head comparison of Grass SCIT to Grass SLIT-T given over 2 years - funded by Immune Tolerance Network. Durham's SCIT vs SLIT study was placebo controlled - double blind double dummy (i.e. SLIT patients received placebo injections as well). Primary endpoint of the SLIT vs SCIT study was response to nasal allergen challenge at 3 years (2 years treatment, 1 year off treatment). 106 participants randomized - 34 SLIT-T, 36 placebo, 36 SCIT, mean skin test diameter to grass was 8 to 10 mm.

After 2 years of treatment, both SCIT and SLIT showed a significant reduction in response to nasal allergen challenge compared to placebo. After only 1 year of treatment, only SCIT was better than placebo, and in fact, was better than SLIT-T. After 2 years of treatment and 1 year of follow up - neither SCIT nor SLIT were better than placebo. Thus 2 yrs IT was not enough.

There were significant improvement in rhinitis specific QOL during grass in both SCIT and SLIT treated patients even after 1 yr treatment.

@mrathkopf: Durham, GRASS trial - 2 years of treatment is insufficient for long term tolerance for both SCIT and SLIT.

Side effect profile was different - 47% rate of mild systemic reactions in SCIT compared to 2.8% in SLIT. 2 Cases of Grade 3 SR in SCIT.

Dyspepsia occurred in 22% of SLIT treated patients - mild to moderate, no one discontinued secondary to this.

Both SLIT and SCIT reduced nasal IL-4 and IL-13 following nasal allergen challenge after 2 years of treatment. Substantial reduction in grass-specific Th2 cells shown in the SCIT-treated patients c/w placebo. SLIT reduced them as well but less so. Both SCIT and SLIT reduced late phase skin response to intradermal grass test. Grass specific IgG4 increased with both SCIT and SLIT. Both effects were more pronounced with SCIT.

Dr Durham - SCIT and SLIT are in equipoise Both are effective, SLIT is safer - ask the patient which they would prefer. Dr Durham suggests getting patient input for choice of SLIT or SCIT.

SCIT and SLIT are equally effective for seasonal outcomes but we need to treat for 3 years.

@drsilge: 2 years of SCIT OR SLIT are insufficient for lasting benefit. Dr Durham is really the only source for good data on duration.

@dranneellis: The best part of #ACAAI16 so far-spending time with immunotherapy & nasal allergen challenge guru Dr Stephen Durham!

This is a Twitter summary from #ACAAI16 meeting. The post is a part of series. See the rest here:

Several allergists did a great job posting updates on Twitter from the 2016 meeting of ACAAI, the hashtag was #ACAAI16. I used the website Symplur to review the tweets:

@docalergias @drstanfineman @dranneellis

Presentation handouts are available from the ACAAI website:

Resident education program during the 2017 meeting of Florida Allergy, Asthma & Immunology Society (FAAIS)

The Florida Allergy, Asthma & Immunology Society is proud to announce its 2017 Annual Meeting, held at JW Marriott, Orlando, Florida. The three-day meeting will host practicing allergists from Florida.

Dates: June 30 - July 2, 2017

Location: JW Marriott, 4040 Central Florida Parkway, Orlando, FL 32837

More info:

The resident education program is full with great topics which will be presented by world class speakers. Below is the official email announcement from FAAIS:


Dear FAAIS Members:

The executive board of the FAAIS is pleased to announce the return of our forum for medical residents in training, which will be held this year in lieu of our allied health program. This one day conference coincides with our annual meeting and offers those attending an extensive review of relevant topics in allergy and clinical immunology. For many, this represents the only time in their training to attend a world class forum in their backyard.

Starting with a review of allergy and immunology the resident will be able to better comprehend the concepts presented throughout the conference. The forum will cover the evaluation and management of patients with IgE mediated disorders, anaphylaxis, urticaria, hereditary angioedema, asthma, advances in targeted therapy and much more.

An important part of this educational initiative is dedicated to creating awareness of the vital role allergists play as consultants. In this regard our hope is to elevate the visibility of our field while promoting the expertise of the Florida Allergy Asthma and Immunology Society.

This promises to be a memorable event!


Thomas Lupoli, DO
FAAIS President

Nina Ramirez, MD
Resident Program Director


Jeanne Torbett, CMP, CMMM
Executive Director
Florida Allergy, Asthma & Immunology Society

phone: 904-765-7702
fax: 904-765-7767

4909 Lannie Road, Ste. B
Jacksonville, FL 32218


FAAIS 2017 Resident Program

Friday – June 30

 6:30  –  8:00 pm Pharma Dinner Event (Optional)

Saturday -  July 1

Morning Session

 7:00  –  8:00 am Breakfast in Exhibit Hall
 8:00  –  8:10 am Welcome Comments and Introduction to the Forum - Nina Ramirez, MD
 8:10  –  9:05 am An Overview of Basic Clinical Immunology & Allergy for the Resident
Physician - Vivian Hernandez-Trujillo, MD
 9:05 – 10:00 am Food Allergy, Insect Sting Allergy, Drug Allergy & Anaphylaxis
- Neil Gershman, MD
10:00 – 10:15 am Bathroom Break (Exhibit Hall Closed)
10:15 – 11:15 am Things to Consider When Your Patient Itches or Swells: Hereditary
Angioedema, Urticaria and Angioedema - Thomas Lupoli, DO
Atopic Dermatitis - Bassem Chahine, MD
11:15 – 12:15 pm Approach to the Diagnosis & Management of Primary Immune Deficiency
- Sunil Joshi, MD  
12:15  –  1:15 pm An Approach to the Evaluation & Management of Chronic Cough
- Miguel Lanz, MD
 1:15  –  2:15 pm Lunch in Exhibit Hall

Afternoon Session

 2:15  –  3:15 pm Clinical Pearls & Pitfalls in Allergy Testing & Interpretation
- Dana Wallace, MD
 3:15  –  3:45 pm Break in back of classroom & Prize Drawing
 3:45  –  4:15 pm Conventional Pharmacotherapy for Asthma – Nina Ramirez, MD
 4:15  –  4:45 pm Advances in Targeted Therapy for Asthma – Thomas Casale, MD
 5:30  –  6:30 pm Jewel Showcase Reception - Optional (Families invited)

 6:30  –  8:00 pm Pharma Dinner Event (Optional)

#ACAAI16 Tweetup/informal meeting is on November 12, Saturday, 2:30-3:30 pm, room 2009 - join us!

#ACAAI16 Tweetup/informal meeting will be on November 12, Saturday, 2:30-3:30 pm, room 2009 of the Moscone West Convention Center - join us! Here is a PDF map of the floor plan to help you find room 2009 quickly:

Here is the list of the allergists who may be using Twitter to post updates from the #ACAAI16 meeting. The list is open for edit, please feel free to add your own info.

The list shows the availability of the allergists by date and if they are planning to attend the Tweetup (a meeting of people who use Twitter or are following the tweets). If interested in a real life meeting Tweetup during the #ACAAI16, sign up in the spreadsheet above. This will be the First Annual Tweetup during ACAAI!

Here is the Tweetup info - come meet us for a chat at:

Convention Center, Room 2009 (PDF map) 
November 12, Saturday, 2:30-3:30 pm

This is a free, informal event, no ticket required. Suggested topics: how to tweet? why to tweet? who to follow? research projects using social media, Twitter for patient education, etc.

The hashtag for the meeting is #ACAAI16

The hashtag for the 2016 annual meeting of the American College of Allergy, Asthma and Immunology (ACAAI) is #ACAAI16

Type #ACAAI16 in Twitter Search box to find all recent updates from  #ACAAI16:

You can also find info about the #ACAAI16 hashtag on the website of Symplur:

How to use Twitter to post updates from #ACAAI16 meeting

See examples of best practice by  @MatthewBowdish and @DrAnneEllis posted here: (tweets were summarized in a series of blog posts by me). For example, the tweets from 2012 AAAAI meeting reached more than 250,000 people.

I would strongly encourage you to post updates on Twitter from the CME conferences that you are planning to attend in the future. Here is how to do it: Twitter for Physicians: How to use Twitter to keep track of the latest news and scientific meetings, and share information with colleagues and patients.

WAO TV Social Media Guide for Allergists

Here is WAO TV Social Media Guide for Allergists:

Dr Stukus: How to use Twitter to engage patients

Dr Bowdish: Best practices for Twitter use by allergists

Dr Bowdish: How to use Twitter during a scientific conference: AAAAI, ACAAI, etc.

Dr Ramirez: How allergists can use Facebook for patient education


The impact of social media on a major international emergency medicine conference -- Neill et al. -- Emergency Medicine Journal

PLOS ONE: Tweeting the Meeting: An In-Depth Analysis of Twitter Activity at Kidney Week 2011

Tweeting the Meeting: Investigating Twitter Activity At the 2012 AAAAI Conference - Disclaimer: I am one of the authors.

How to share up to 4 photos in a single Tweet - Great for conference posters - see example

How to Make the Most of A National Scientific Conference
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