National Jewish Faculty Present Research and Clinical Advice at 2002 AAAAI Conference
Faculty from National Jewish Medical and Research Center presented their latest research findings and clinical advice March 1-6, 2002, during the 58th annual meeting of the American Academy of Allergy, Asthma & Immunology in New York City. The world's largest allergy, asthma and immunology conference attracted more than 7,000 leading physicians and researchers.
Selected presentations:
Asthma as Infectious Disease
Infectious organisms have been shown in recent years to contribute to several "non-infectious" diseases, including atherosclerosis and ulcers. Monica Kraft, MD, presented evidence indicating that asthma may be another example. She also described how treatment with antibiotics can help asthma patients who show evidence of bacterial infections.
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The Biggest Cause of Asthma Attacks
The single greatest factor contributing to emergency room visits for asthma attacks is patients' failure to take their medication. Henry Milgrom, MD, outlined the extent and consequences of poor adherence. Frederick Wamboldt, MD, described new findings from a yearlong study of families and asthma on the contributions of race, age, parental advice and family dynamics to poor medication adherence.
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Biorhythms of Asthma and Allergies
For many asthma patients nighttime is the worst time, with symptoms peaking around 4 a.m. Hay fever symptoms, on the other hand, peak in the early morning, shortly after waking. Richard Martin, MD, described the circadian rhythms associated with asthma and allergies, and discussed when to take medications in order to get the most benefit. More...
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New Evidence for the Hygiene Hypothesis
According to the hygiene hypothesis, the recent rise in asthma and allergies has occurred, in part, because infants in modern industrial societies are exposed to fewer bacterial particles that properly train their immune systems. Andy Liu, MD, and his colleagues presented evidence from India supporting that hypothesis (abstract). They also identified for the first time another bacterial remnant, heat shock protein 60, that appears to play the same role as endotoxin (abstract). On Dr. Liu also co-moderated a symposium reviewing the state of the hygiene hypothesis.
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Air Pollution and Asthma
In an ongoing multi-year study of asthmatic children and air pollution, Nathan Rabinovitch, MD, and his colleagues identified a subset of children whose asthma got noticeably worse following spikes in particulate air pollution. In the following year, they found that measuring exhaled nitric oxide, a noninvasive measure of airway inflmmation, may help identify asthmatic children sensitive to air pollution (abstract).
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Food Allergies and Anaphylaxis
Pediatric allergist Dan Atkins, MD, led a seminar on the diagnosis, prevention and management of food anaphylaxis. In the afternoon, he teamed with Allan Bock, MD, and others for an interactive workshop on difficult cases of food allergy.
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Early Diagnosis of Asthma
It has become increasingly recognized that it is important to begin treating asthma as early as possible in order to prevent serious asthma attacks, improve exercise tolerance and possibly limit lung damage caused by the disease. But it can be very difficult to definitively diagnose asthma in young children. Stan Szefler, MD, outlined the challenges, benefits and tools for diagnosing asthma in young children. Mary Klinnert, PhD, described forced oscillation, a method for measuring lung function in young children (abstract).
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Who Will Benefit From Anti-IgE?
The anti-IgE monoclonal antibody has been touted as one of the most exciting new asthma and allergy medications coming down the pipeline. But high cost and its availability only by injection are likely to limit its use. Sally Wenzel, MD, presented an analysis of previous clinical trials to determine which asthma patients are likely to get the most benefit from anti-IgE treatments (abstract). Henry Milgrom, MD, discussed adverse effects associated with anti-IgE treatment.
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Eczema and Skin Infections
Eczema, also known as atopic dermatitis, is often exacerbated by skin infections. Peck Ong, MD, presented data indicating that these infections are due in part to the reduced expression of Human ß Defensin-2, a naturally occurring anti-microbial peptide found in the skin (abstract).
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Reducing Eczema Flares
A new generation of non-steroidal medications for eczema is coming onto the market. Donald Leung, MD, and his UCSD colleague Larry Eichenfield, MD, have compiled data showing how one of them, pimecrolimus (Elidel®), can be used to not only treat, but also to help prevent eczema flares. Three randomized, double-blind trials indicated that maintenance therapy with pimecrolimus could reduce eczema flares by almost half (abstract).
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Do Environment-friendly Inhalers Work?
Patient advocates and medical professionals warned about compromised medical care when the U.S. Environmental Protection Agency announced several years ago that an alternative to ozone-depleting propellants would need to be found for inhalers. But early experience with alternative propellants and breath-activated inhalers have indicated that they may actually deliver better medical care. Monica Kraft, MD, provided an overview of propellants and devices. Stanley Szefler, MD, and his colleagues presented several posters describing the safety and efficacy of QVAR™, one of the new generation inhalers. (abstract #712, abstract #721, abstract #750).
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Advance Warning for Worsening Asthma
Stanley Szefler, MD, found that nocturnal asthma symptoms woke up about one-third of 1,041 children with mild persistent asthma during a four-week period, and that nocturnal awakenings appeared to precede a deterioration of their condition. Nocturnal awakenings could be an important warning sign of declining lung function and the need to adjust treatment to prevent an attack (abstract).
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Can We Alter the Progression of Asthma?
Apparently not with current treatments. At least that is what a cross sectional study of 260 severe asthma patients indicated. Joseph Spahn, MD, reported that, among people whose asthma began in childhood, those who had the disease longest suffered the worst symptoms, were the least responsive to anti-inflammatory steroid treatments, and had the worst lung function (abstract).
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Women, Children and Asthma
Hal Jenkins, MD, discussed data indicating that severe asthma in children and adults are distinctly different diseases. Among the findings: females account for 72% of severe adult asthmatics, but only 36% of severe child asthmatics. Also, lung function in adults is significantly more impaired (abstract).
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