The annual meeting of the American Academy of Allergy, Asthma & Immunology was held from Feb. 25 to 28 in Phoenix and attracted participants from around the world, including clinicians, academicians, allied health professionals, and others interested in allergic and immunologic disease. The conference highlighted recent advances in the fields of allergy, asthma, and immunology.

In one study, Edmond S. Chan, M.D., of the University of British Columbia and British Columbia Children’s Hospital Research Institute in Vancouver, Canada, and colleagues identified predictive factors of reactions to nut oral immunotherapy (OIT) among preschool-age children.

The authors explored the relationship between baseline patient characteristics and reactions during peanut OIT to better understand factors influencing OIT safety. They conducted a retrospective analysis on data from 672 preschoolers across Canada, who underwent peanut OIT. During the buildup phase of OIT, increasing peanut doses were administered approximately every two weeks, and any symptoms were documented. These symptoms were classified using a modified World Allergy Organization Subcutaneous Immunotherapy Reaction Grading System (1 = mildest; 5 = fatal). Multivariate logistic regression modeling was used, with the safety outcome being maximum grade of reaction (grade 2+ versus grade 1/no reaction) over the course of OIT. The researchers found that older age, higher baseline serum immunoglobulin E, a reaction of grade 2 or higher prior to OIT start, and lower eliciting dose were predictive of reactions of grade 2 or higher during OIT.

“These preliminary results will help in the development of a personalized approach to improve OIT safety, including selecting appropriate starting doses and frequency of buildup, and encourage shared decision making between families and health care providers,” Chan said.

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In another study, Onyinye I. Iweala, M.D., Ph.D., of the University of North Carolina at Chapel Hill, and colleagues found that COVID-19 vaccines are tolerated in patients with suspected or confirmed mast cell activation syndrome (MCAS), despite increased vaccine hesitancy in this population.

The authors performed a retrospective chart review of 379 patients seen at a single academic allergy and immunology practice from January through December 2021 for confirmed or suspected MCAS, and they determined the proportion receiving at least one dose of any COVID-19 vaccine. The researchers found that replication-incompetent adenovirus and mRNA COVID-19 vaccines were tolerated in patients with suspected or confirmed MCAS. However, as of Dec. 31, 2021, the proportion of patients with confirmed MCAS receiving at least one vaccine dose (64 percent) has been lower than the proportion of North Carolina residents 18 years or older who have received at least one vaccine dose (71 percent) and lower than the proportion of U.S. residents 18 years or older who have received at least one dose (74 percent). This suggests a degree of vaccine hesitancy among this population.

In addition, only three of 41 patients required emergency treatment with medication for acute allergic-like reaction within zero to four hours after vaccination. One of those three required epinephrine, and two required oral antihistamines only.

“This study provides a little bit more information for allergy doctors and other health care providers to present to their patients with symptoms of twitchy or unstable mast cells, when those patients come to them for guidance on whether to get vaccinated against COVID-19. In my opinion, it suggests to me that the benefits of protection against severe COVID-19 that you get from the vaccines outweighs the risk of developing side effects from vaccination,” Iweala said. “In addition, it can help patients and providers get a sense of the types of side effects they might experience should they choose to be vaccinated and how long they might expect to be managing the side effects.”

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Margaret S. Kim, M.D., of Northwestern Medicine in Chicago, and colleagues found that chronic rhinosinusitis is common in patients with asthma and bronchiectasis, and the presence of asthma and bronchiectasis is associated with increased health care utilization.

The authors reviewed electronic medical records and identified asthma and comorbid chronic rhinosinusitis and/or bronchiectasis patients. International Classification of Diseases codes were used to identify asthma and chronic rhinosinusitis; computed tomography of the chest scans were used to identify bronchiectasis. The researchers found that chronic rhinosinusitis in patients with asthma and bronchiectasis produced a subset of patients with high health care utilization.

“We should evaluate for signs and symptoms of chronic rhinosinusitis in patients with asthma and bronchiectasis, and, vice versa, should look for bronchiectasis in patients with asthma and chronic rhinosinusitis,” Kim said.

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In a two-center, phase I, open-label, randomized study, John Oppenheimer, M.D., of the University of Medicine and Dentistry of New Jersey Rutgers Pulmonary, and Allergy Associates in Newark, and colleagues found that AQST-109 (epinephrine prodrug sublingual film) shows promise as a novel alternative for patients who are in need of acute treatment for anaphylaxis.

The authors aimed to assess the safety and tolerability of AQST-109 across four film formulations at doses ranging from 3 to 24 mg in healthy young male volunteers. Twelve individuals were randomly assigned to receive either AQST-109 formulation 1 or 2 in single-ascending dose fashion. Participants were monitored for adverse events and local tolerability. Pharmacokinetic and pharmacodynamic measurements (systolic blood pressure, diastolic blood pressure, and heart rate) were taken predose and at postdose intervals for six hours. The pharmacokinetic results showed that dosing with AQST-109 resulted in maximum epinephrine blood concentrations and time to maximum blood concentration (Tmax) values comparable to published data for autoinjectors. Similarly, the pharmacodynamic results showed changes in heart rate and blood pressure similar to injected epinephrine.

“AQST-109 sublingual film demonstrated relatively consistent Tmax values in a tighter range than reported for injectable epinephrine. These formulations were safe and well tolerated across dose levels. Importantly, this is the first time it has been demonstrated that therapeutic plasma concentrations of epinephrine can be achieved following sublingual administration,” Oppenheimer said. “AQST-109 continues to show promise as a viable alternative to epinephrine injection for the treatment of anaphylaxis.”

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AAAAI: Add-On Inhaled Glucocorticoid Lowers Severe Asthma Exacerbations

TUESDAY, March 1, 2022 (HealthDay News) — Provision of an inhaled glucocorticoid and instruction on its use, in addition to usual care, is associated with a lower rate of severe asthma exacerbations among Black and Latinx adults with moderate-to-severe asthma, according to a study published online Feb. 26 in the New England Journal of Medicine to coincide with the annual meeting of the American Academy of Allergy, Asthma & Immunology, held from Feb. 25 to 28 in Phoenix.

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