New research was presented at ACAAI 2018, the American College of Allergy, Asthma & Immunology 2018 Annual Scientific Meeting, from November 16-18 in Seattle. The features below highlight some of the studies emerging from the conference that focused on emergency medicine.


A Second Grass Pollen Season?

While a spring grass pollen season is well established in the Northeast US, previous studies have suggested a second grass season in late August-September. To confirm this second season, researchers reviewed pollen data collected over 6 years from Burkard air samplers at two sites where qualitative and quantitative pollen analysis was performed according to National Allergy Bureau standards. Combined station data revealed a second grass season starting in mid-late August, peaking on September 9, and ending mid-September/early October. Pollen levels were sufficient to provoke a significant allergic response in sensitive individuals. “Knowledge of this late summer/fall grass season may help identify individuals who may benefit from grass immunotherapy for those with late summer/fall grass pollinosis,” write the study authors.



Maximizing Skin Prick Testing Opportunities

Evidence indicates that many atopic patients present to an allergy clinic on medications that interfere with allergy skin prick testing (SPT) due to lack of communication among providers, clinics, and patients. To determine the effect of a mailed informational and educational brochure describing the allergy SPT procedure and instructions for holding medications on rates of allergy SPT at an initial clinic visits on appointment readiness, study investigators mailed the brochure before their appointment. The percent of eligible patients receiving SPT per month rose from 63% prior to the intervention to 84% after. As an added bonus, wait times for new allergy/immunology appointments significantly decreased from 3 months to 1 week.



Sublingual Immunotherapy Tablet for Allergic Asthma

Research has shown asthma to be a risk factor for systemic allergic reactions to subcutaneous immunotherapy. To test the safety of a house dust mite (HDM) sublingual immunotherapy (SLIT) tablet, researchers pooled data from six phase II/III double-blind, placebo-controlled trials of a HDM SLIT tablet for the treatment of allergic rhinitis or mild-to-moderate asthma and compared outcomes between patients with and without reported asthma. Proportions of patients reporting treatment-emergent adverse events (AEs) were similar between those with and without asthma in both the SLIT tablet (86% vs 85%) and placebo groups (70% vs 64%). The frequency of treatment-related AEs and rates of discontinuation due to AEs, severe AEs, and serious AEs were generally similar between those with and without asthma. A higher proportion of patients with moderate asthma experienced asthma events (13% with both SLIT tablet and placebo) compared with those with mild asthma (7% with SLIT tablet, 5% with placebo). Approximately 1% of patients with asthma discontinued treatment due to asthma events. The proportion of patients with asthma who experienced a serious asthma event was less than 1% in both the SLIT tablet and placebo groups.


Overcoming Barriers to Penicillin Testing

Large-scale efforts are underway nationwide to test and verify documented penicillin allergy in order to promote antibiotic stewardship and improve public health. To determine barriers to outpatient referrals to allergy clinics for penicillin testing so that they may be appropriately addressed, researchers electronically distributed surveys to primary care providers in order to assess perceptions of penicillin allergy and to determine barriers to referral to allergy clinic. A targeted educational intervention was implemented to address barriers identified in the provider survey. The biggest reported barriers to referral were patients’ other medical problems that take priority in time-limited encounters (41%) and not realizing that penicillin testing and challenge were available for their patients (26%), followed by other reasons (16%), concerns that allergy histories are inaccurate or unclear (12%), and not thinking patients would follow through with the referral (5%). After the targeted intervention was implemented, primary care providers were more likely to refer their patients to an allergy clinic for penicillin testing, with 70% of internists reporting they would be more likely to do with an electronic medical record reminder.



Transdermal Allergy Immunotherapy for Allergic Rhinitis

While previous studies show that some patients with allergic rhinitis (AR) experience side effects from pharmacotherapies and subcutaneous immunotherapy (SCIT), altering the mode of antigen delivery by mixing allergens with topical formulations may prove to be beneficial in treating AR in patients who have tried or failed SCIT and may confer substantially less side effects when compared to systemic medications. For a study, patients aged 12 to 64 with seasonal/perennial AR who tried/failed SCIT applied transdermal allergy immunotherapy (TdIT) with selected allergens compounded in a transdermal base cream over 3 months. At 3 months, participants experienced improved quality of life as measured by the Mini Rhinoconjunctivitis Quality of Life Questionnaire, reduced AR symptoms, a positive experience with the treatment, minimal side effects, and reductions in other allergy medication use.



Allergic Disease & Developmental Delay

Recent research has shown an association between self-reported allergic diseases and autism spectrum disorder in children. However, less is known regarding associations with developmental delay (DD) and allergic sensitization. To assess the association between DD and allergic disease in a nationally representative sample, study investigators performed a cross-sectional study of children aged 1 to 17 enrolled in the NHANES. Among more than 10,000 children, increased odds of self-reported asthma (odds ratio [OR], 1.74), milk allergy (OR, 2.45), and egg allergy (OR, 3.54) were observed in children with DD. However, there was no increased risk for food sensitization, suggesting that the self-reported food allergy may represent non-immunoglobulin E-mediated responses.