New research was to be presented at AAAAI 2020, the American Academy of Allergy Asthma & Immunology Annual Meeting, from March 13-16 in Philadelphia, prior to its cancelation due to the COVID-19 pandemic. The features below highlight some of the studies presented virtually through the AAAAI website.

Patients Should Not to Use Accidentally Washed EpiPens

While EpiPen prescribing information suggest that the carrier tubes are not waterproof, research is lacking on the effects of submerging an EpiPen in water. To determine the function and integrity of these devices after enduring a washing machine cycle, researchers washed in its carrier tube, one of 68 pairs of same-dose, same-lot, post-consumer expired EpiPens through the colors cycle of a top-loading washing machine and kept its pair at usual conditions. Bother were then fired into meat, and the mass of solution fired was estimated. Average differences in mass between washed devices and control devices were measured, the effects of device dose (0.3 mg vs 0.15 mg) and expiration date on the differences in outcomes were assessed, and moisture and damage were examined. Compared with controls, washed devices fired a greater mass of epinephrine solution and lost more mass during firing. Nearly 15% of devices failed to deploy the needle cover after firing. Dose and expiration date did not appear to play a role in the effects of washing. More than 22% of washed devices had dry needles and plungers after washing. “These devices should not be used if accidentally placed through a washing machine cycle,” warn the study authors.


Eosinophilic Esophagitis Follow-up Patterns

Although eosinophilic esophagitis (EoE) is a chronic condition that should be closely monitored by physicians and requires ongoing patient education and assessment of medication and dietary adherence, in order to prevent irreversible long-term complication such as food impactions and esophageal strictures, few studies have retrospectively studied outcomes in patients with EoE. To do just that, investigators reviewed the electronic medical record charts of patients with EoE (identified via ICD-9/10 codes) to obtain dates of clinic appointments and treatments, as well as to determine if clinical or histologic EoE resolution occurred. Patients who had not been seen for more than 1 year were deemed “lost to follow-up.” Identified patients had a median age of 20, had been followed for a median of 29 months, and had undergone an average of three esophageal biopsies. Treatment included diet for 45%, proton pump inhibitors for 95%, topical corticosteroids for 63%, and all three for 33%. At study conclusion, 43% of patients remained in care and 57% were lost to follow-up. Of those with more than one biopsy performed, 32% and 23% experienced histologic and clinical remission, respectively. “Healthcare providers should seek to improve methods of keeping EoE patients engaged in care,” suggest the study authors.


Oral Habits Linked With Food Allergy

Prior research indicates that oral habits, such as thumb-sucking, chewing on objects, or nail-biting, appear to be associated with less atopic sensitization to environmental allergens through the introduction of antigens into the oropharyngeal and gastrointestinal tracts; however, information is limited on the relationship between oral habits and food allergy. To test the hypothesis that children with oral habits have lower risk of food allergy and atopic disease in general, when compared with children without such habits, researchers asked the parents of children aged 10 or younger with a history of eczema to complete a questionnaire on their child’s oral habits, environmental exposures, and allergic disease history. Among more than 100 completed and analyzed questionnaires, logistical regression analysis adjusting for confounding variables of breastfeeding, parental allergy, smoke exposure, age and pet exposure found the above-mentioned oral habits to be significantly associated with food allergy (odds ratio [OR], 10.9) and inversely associated with asthma (OR, 0.27). No significant association between oral habits and seasonal allergies was observed.


Assessing a Daily Multi-Allergen Food Supplement for Infants

Previous studies suggest that, while exposure to a diversity of food allergens during infancy may help reduce the risk of food allergy, doing so can be difficult to achieve. To test the acceptability of a daily multi-allergen food supplement, study investigators randomized a national sample of healthy infants aged 5-11 months at enrollment to 28 days of a daily single dose of a powdered placebo or food supplement containing the 16 most common allergenic food proteins. A sub-set of infants continued the food supplement for up to 13 months. The food supplement was well accepted by parents and well tolerated by the infants. Significant differences were not observed in the proportion of reported symptoms between the groups, with 11.5% of supplement group members and 10.7% of placebo group members experiencing at least one reported symptom. Zero allergic reactions were reported across both groups. The study team observed an increase in the specific IgG4/IgE ratio in infants who continued the supplement for 13 months, when compared with controls who received the placebo. “A trend in immunologic biomarker suggesting potential immune protection against food allergy warrants further study,” write the study authors.


Ragweed SLIT-Tablets for Pediatric Allergic Rhinoconjunctivitis

Ragweed sublingual immunotherapy (SLIT)-tablets have been suggested in prior research to improve symptoms and decrease medication use among adults with allergic rhinitis with or without conjunctivitis (AR/C) during peak pollen season, as well as throughout the entire season. Data, however, are limited on the efficacy and safety of SLIT-tablets during the peak and entire season among children with AR/C. Children aged 5-17 with ragweed AR/C with or without asthma who participated in an international, double-blind trial were randomized to daily ragweed SLIT-tablets or placebo for up to 28 weeks. A total combined score (TCS) summing the rhinoconjunctivitis daily symptom score (DSS) and daily medication score (DMS) was assessed for the peak and entire ragweed pollen season. When compared with placebo, relative TCS improvement with ragweed SLIT-tablets during the peak season (z186 grains/m3/day) and entire season (z85 grains/m3/day) were -38.3% and -32.4%, respectively. During peak season, DSS was improved 35.4% and DMS 47.7% with ragweed SLIT-tablets when compared with placebo. SLIT-tablet treatment was well-tolerated, with no events of anaphylaxis, airway compromise, or severe treatment-related systemic allergic reactions reported among all participants.