The American Academy of Allergy, Asthma & Immunology
The annual meeting of the American Academy of Allergy, Asthma & Immunology was held from Feb. 20 to 24 in Houston and attracted more than 5,000 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 allergy, asthma, and immunology.
As part of the Preventative Omalizumab or Step-Up Therapy for Severe Fall Exacerbations study, Ann T. Esquivel, M.D., of the University of Wisconsin in Madison, and colleagues evaluated viral data from over 6,000 nasal samples taken from inner city children in eight U.S. cities during the fall of 2012 or 2013. The children, aged 6 to 17 years, all had allergies and asthma, and were randomized to receive either injections of omalizumab, an increase of their usual fluticasone to two times the usual dose, or placebo (guidelines-based care).
“Viruses were detected 67 percent of the time during an asthma exacerbation, and 57 percent of the time this was rhinovirus, making this common cold virus the most important pathogen associated with asthma exacerbations,” Esquivel said. “We were interested in the species most commonly found during these exacerbations, and we discovered that rhinovirus-C was the type most often associated with exacerbations. Rhinovirus-A was also significantly associated, and rhinovirus-B was not significantly associated with exacerbations.”
The investigators also found that the group receiving omalizumab, as compared to the placebo group, had a significantly decreased rate of viral detection. Fluticasone boost had no effect on viral detection.
“Omalizumab significantly decreased viral detection in this study, implicating immunoglobulin E in the regulation of anti-viral responses,” Esquivel added.
Another group of studies presented at the conference focused on data from the Wayne County Health Environment Allergy and Asthma Longitudinal Study in Detroit, linking an infant’s microbiome to the development of their immune system, allergic diseases, and asthma. In one study, Christine Cole Johnson, Ph.D., M.P.H., of the Henry Ford Hospital and Health System in Detroit, and colleagues collected data on environmental and behavioral risk factors; a microbial “fingerprint” of the baby’s gut at 1 and 6 months of age using stool samples from the babies’ diapers; and a variety of outcomes, including the baby’s regulatory T-cell count, immunoglobulin E antibodies to tetanus vaccination, and parental report of allergic symptoms around cats and dogs at about age 4 years. Data were collected from a Detroit area-based birth cohort.
“We found that a number of factors were related to the microbial community in the baby’s gastrointestinal tract and that these microbial community patterns were related to the outcomes, in complex ways,” Johnson said. “Current breastfeeding and mode of delivery had the biggest impact at 1 month of age. At 6 months, a number of other factors became important, including endotoxin levels measured in house dust samples, first born status, and pets in the home.”
The investigators also found that certain patterns in the babies’ gut microbiomes were associated with whether the child had higher levels of anti-inflammatory regulatory T cells, lower levels of immunoglobulin E to an antigen (tetanus toxoid), and less likelihood of having allergic-like symptoms to cats and dogs.
“The key conclusion in our minds is that the baby’s gut microbiota community, its development, or assemblage during early life, is the underpinning for immune education and the development of an optimal immune balance and the avoidance of allergic disorders, and that this community can be affected by early-life exposures and behaviors,” Johnson added.
Abstract No. 504
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In the SNIFFLE study, Paul J. Turner, Ph.D., of the Imperial College London, and colleagues found that live attenuated influenza vaccine (LAIV) was safe for children with egg allergies as well as for those with well-controlled asthma. Two hundred and eighty two children with egg allergy were administered 433 doses of LAIV. Approximately two-thirds of these children also had a physician diagnosis of asthma/recurrent wheezing.
The investigators found that no children with egg allergies experienced any systemic allergic reactions. In addition, among those children also diagnosed with asthma/recurrent wheezing, no increase in significant respiratory symptoms was noted.
“The SNIFFLE project has demonstrated that it is very likely that the LAIV would not cause allergic reactions due to the egg content in the vaccine, even in children with previous anaphylaxis to egg,” Turner said in a statement. “Furthermore, we did not see children with well-controlled asthma experience lower airway symptoms following vaccination more than that reported for non-asthmatic, low-risk children.”
In another study, Amber M. Patterson, M.D., of Nationwide Children’s Hospital in Columbus, Ohio, and colleagues found that intralymphatic immunotherapy (ILIT) was safe for the treatment of grass pollen allergies among teenagers.
In a randomized, double-blind, placebo controlled pilot trial, the investigators evaluated the safety of ILIT, administered as three injections, among 15 teenagers. The teenagers were assessed for adverse events two hours, five hours, and one week after each injection. The researchers found that all teenagers were compliant and there was no difference in total safety scores between those who received ILIT and those who received placebo.
“ILIT injections were remarkably well-tolerated, and parents appreciated the convenience of only three injections to treat their children’s allergies,” Patterson said in a statement. “This could revolutionize immunotherapy treatments by offering a convenient and safe option for our patients who have difficulty adhering to the traditional allergy shot schedule.”
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