New research was presented at ACAAI 2019, The 2019 Annual Scientific Meeting of the American College of Allergy, Asthma and Immunology, from November 7-11 in Houston. The features below highlight some of the studies presented at the conference.
Direct Amoxicillin Challenge to Rule Out Penicillin Allergy
Evidence indicates that the majority of pediatric patients who report penicillin allergy are not a risk for IgE-mediated reactions with repeat exposure. While penicillin allergy confirmation typically involves skin testing followed by oral challenge, emerging data suggest direct amoxicillin challenge without preliminary skin testing may be safe and effective in low-risk patients. To confirm these data, researchers conducted a retrospective chart review of direct oral amoxicillin challenges conducted between August 2015 and August 2018 in pediatric patients with a penicillin allergy label who were deemed low-risk due to report a history of benign rash or other somatic symptoms associated with penicillin exposure. During the study period, all patients passed the challenge, and none developed hypersensitivity reactions during 60-minute follow-up. The penicillin allergy label was able to be removed from the medical records of each patient.
Pediatric IgE Cut Points for Cat, Dog, and Grass Allergens
Prior research suggests that single serum allergen-specific IgE (sIgE) cut points to determine allergen sensitization may be suboptimal. Researchers who previously found that sIgE levels of 0.12 kU/L for cat and 0.2 kU/L for dog performed better than the standard 0.35 kU/L cut point when assessed in association with allergen-triggered symptom reports among a young adult, predominately European-American cohort sought to determine these cut points, as well as that for grass, in children. Optimal sIgE levels were determined by Youden’s index using receiver operating characteristic curves among children aged 9-11 who were assessed for sensitization to cat, dog, and grass. Although optimal cut points of of 0.43 kU/L for cat and 0.30 kU/L for dog were identified, sensitivity and specificity did not differ statistically from the traditional level of 0.35 kU/L for both. A cut point of 0.10 kU/L for grass was determined to perform optimally, with statistically increased sensitivity and the requisite decrease specificity.
Racial Differences in Parents’ Food Allergy Knowledge
Although food allergy (FA) knowledge is crucial for management, few studies have examined whether FA knowledge varies by race. To assess differences in FA knowledge between African-American and Caucasian parents of food allergic children, study investigators administered a 16-item, true-false or multiple choice FA knowledge survey—adapted from a validated survey—to the parent/guardian of African-American and Caucasian children aged 0-12 with a diagnosed FA. Answers were coded as correct (1) or incorrect (0) and summed for a total possible score or 16. Mean scores were significantly higher for Caucasian participants (12.2) when compared with African-American participants (9.7). Significant differences were observed between items assessing knowledge of precautionary allergen labeling requirements by law (7.5% of African-American vs 42.3% of Caucasian parents correctly answered), appropriate antihistamine use (25.0% vs 62.6%), and lactose intolerance versus milk allergy (57.6% vs 95.0%). “Efforts focusing on improving knowledge in these areas during patient counseling are necessary,” conclude the study authors.
Patient Satisfaction With Telemedicine in Allergy & Immunology
While ACAAI currently advocates for the incorporation of telemedicine in allergy and immunology practice, whether patients seen at a distance are satisfied with visits that include no physical presence of a clinician remains unclear. To shed some light on this area, researchers reviewed patient satisfaction with their allergy/immunology telemedicine program among pediatric patients seen via the program between July 2017 and June 2019. Patients/patients’ families were asked at the end of each telemedicine visit to evaluate if they were more, equally, or less satisfied when compared with a traditional, in-person appointment. Survey results show 63% of patients were equally satisfied, 37% were more satisfied, and none were less satisfied with the telemedicine appointment when compared with their most recent in-person appointment. Among satisfied patients, 76% reported satisfaction due to distance and convenience, 2.6% due to a telemedicine appointment being the earliest available, and 5% following a recommendation from others.
Epicutaneous Peanut Immunotherapy & HRQOL
With data lacking on the impact of peanut epicutaneous immunotherapy (EPIT) on health-related quality of life (HRQOL), study investigators prospectively measured HRQOL during the 12-month, double-blind, randomized, controlled PEPITES trial and through the initial 12 months of the open-label PEOPLE follow-up study. HRQOL was assessed using the Food Allergy Quality of Life Questionnaire parent form (FAQLQ-PF) and child form (FAQLQ-CF) at baseline, 12 months, and 24 months as part of both studies. At 24 months, global HRQOL scores were significantly lower in the EPIT groups than in the placebo groups. Significant 24-month FAQLQ-PF score improvements were observed in the subgroup initially randomized to treatment who met the efficacy primary endpoint and in any participant with an eliciting dose increase. Differences in the FAQLQ-PF were seen in favor of EPIT in the domains of social dietary limitations, food-related anxiety, and emotional impact. Differences in the FAQLQ-CF were seen in favor of EPIT in the domains of risk of accidental exposure and allergen avoidance.