AAAAI: Travel Difficult for People with Food Allergies

WASHINGTON, March 16 -- When members of a family have food allergies, vacation planning often requires significant effort to minimize risks, researchers said here.

Action Points

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• Explain to interested patients that families with food-allergic members are accustomed to having reactions occur unexpectedly when they eat unfamiliar foods.



• Explain that anaphylactic reactions are life threatening without immediate treatment.



• Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.

More than 90% of such families have packed their own food when they go on vacation, and have mapped out locations of hospitals at their destinations, reported Scott Sicherer, M.D., of Mount Sinai School of Medicine in New York, at the American Academy of Allergy, Asthma, and Immunology meeting here.

His data emerged from a survey of 410 attendees of conferences sponsored by the Food Allergy and Anaphylaxis Network, a nonprofit advocacy and support group.

"Food allergies limit where and how families with food-allergic individuals vacation," Dr. Sicherer said.

Although 94% of respondents said they still take vacations, about three-quarters indicated that they chose destinations on the basis of available medical care.

Some 80% have avoided cruises for that reason, the survey found.

In addition, 90% have not left the U.S., in part because of issues involving the availability of medical care and in part because of unfamiliar foods that might trigger reactions.

Food allergies affecting participants' families included peanuts (85%), tree nuts (69%), egg (48%), dairy (45%), and shellfish (24%).

Other findings from the survey included:

• 65% have tried to avoid air travel, primarily because of potential peanut exposure
• 53% have requested special airplane accommodations
• 65% carried extra medical documentation
• 67% obtained extra epinephrine injectors
• 51% ate most meals in their own rooms
• 86% arranged for special meals at restaurants
• 82% said arranging special meals was not difficult

Dr. Sicherer said that for families with members who have food allergies leaving home means "you're talking about a lot of detailed information to deal with, a lot of potential anxiety with everything that goes on all day. It's like living in a minefield."

Vacation planning is just one of the many effects food allergies have on quality of life, he said.

Robert Wood, M.D., a pediatric allergist at Johns Hopkins University in Baltimore, a discussant at the session who was not involved in the study, commented that food allergy incidence in children, and eventually in adults as well, appears to be rising.

Food allergy "may be a different disease now," he said. Some allergies that formerly seemed to be confined mainly to children are now persisting more frequently into adulthood, he said.

AAAAI: Patch Helps Allergic Kids Tolerate Milk

WASHINGTON, March 17 -- Children with dairy allergies were able to tolerate significant quantities of cow's milk after treatment with an investigational dermal patch-based immunotherapy (Viaskin), a researcher said here.

In eight of 13 evaluable children receiving the treatment for three months in a placebo-controlled pilot trial, the maximum amount of milk they were able to tolerate increased at least threefold, reported Christophe Dupont, M.D., Ph.D., of Hopital Saint Vincent de Paul in Paris.

None of the seven children in the placebo group showed that high an increase in tolerance, he said here at the American Academy of Allergy, Asthma, and Immunology meeting.

He said the improvements seen with the treatment were clinically significant.

"In some of [the children], you can normalize the diet," he said. One participant in the study was able to tolerate 670 mL (nearly 3 cups) after three months. But that was exceptional, as the median tolerance after three months was less than 6 mL.

Action Points

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• Explain to interested patients that milk allergy is among the most common childhood food allergies.



• Note that it seldom persists in adulthood, but is still potentially dangerous to children and creates significant lifestyle disruptions.



• Explain that the patch product in this study is investigational and not available outside a clinical trial setting.



• Note that this study was published as an abstract and presented orally at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.

However, Dr. Dupont said, the improvements seen in most participants were enough to prevent them from reacting to foods with trace quantities of milk proteins.

The patch contained 1 mg of milk protein or placebo and was applied every other day to children in the study. Participants were from three months to 15 years of age and underwent oral milk challenges at baseline and after two and three months in the trial.

The mean maximum tolerated milk dose at baseline was 2.1 mL (SD 2.6) and 4.4 mL (SD 5.9) in the active-treatment and placebo groups, respectively.

After three months, the mean tolerated dose tended to increase to 21 mL (SD 24.3) in the active-treatment group compared with 5.4 (SD 5.9) in the placebo group (P=0.37).

But when the summary results were expressed as the median change from baseline, the improvements seen with the active patch were significantly greater than with placebo (5.6 mL versus 0.17 mL, P=0.02).

Skin prick testing also showed substantial reduction in wheal diameters in most of the treated children. Little change was seen in the placebo group.

About half of the children in both groups reported occasional dermatitis or itching at the patch site. Other adverse effects were less common and did not differ between groups.

Patch-based immunotherapy is an attractive approach to treating milk allergy because it is a proven technology, said Dr. Dupont, who is also co-founder of the company developing the product, DBV Technologies.

Subcutaneous immunotherapy is already available for milk allergy. "We thought we could get the same effect just by applying the patch on the skin," he said.

The main advantage is safety, he added. "If you see a reaction, you can remove the patch," he said, whereas subcutaneous injections can't be reversed.

A. Wesley Burks, M.D., a pediatric allergist at Duke University in Durham, N.C., who was not involved with the study, said the milk-allergy patch was a promising approach.

"It's an easy way to stimulate the immune system," he said, although more safety data are needed.

"Topically [delivered immunotherapy] can be quite sensitizing," Dr. Burks said, and dangerous reactions may not appear immediately.

Consequently, children treated with patches would need close monitoring, he said.

The manufacturer of the patch, DBV Technologies, is also developing a similar patch-based immunotherapy for dust mite allergies.

Asthma Attacks in Pregnant Women Not Linked to Sex of Fetus

MONTREAL, March 13 -- The gender of a fetus has no detectable significant effect on the risk of asthma exacerbations in pregnant women, researchers here said.

Action Points

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• Explain to interested patients that some studies have suggested that asthmatic women pregnant with girls might have a greater risk of exacerbations than those carrying a male fetus.



• Note that this large study found no significant increase in risk.

In a retrospective analysis of more than 5,500 pregnancies, gender also had no bearing on the mother's use of asthma medications, according to Lucie Blais, Ph.D., of the University of Montreal, and colleagues.

The finding contrasts with earlier -- but smaller -- studies that had hinted that women carrying girls were more likely to have asthma exacerbations, the researchers said in the January issue of Respiratory Medicine.

The study doesn't rule out a minor impact of fetal gender on maternal symptoms, the researchers said, but it "provides evidence that these changes are not serious enough to lead to a moderate to severe exacerbation," they argued.

So, physicians should aim at asthma control during pregnancy regardless of the gender of the fetus, Dr. Blais and colleagues said.

For the analysis, the researchers studied three large databases in the Canadian province of Quebec, which provided information on medical services, prescriptions, acute care hospitalizations, births, and stillbirths.

Through the linked databases, Dr. Blais and colleagues found a cohort of asthmatic women with 11,257 singleton pregnancies between 1990 and 2002, nearly equally split between female and male fetuses. Women could be included in the cohort more than once.

The researchers found:

• Among women carrying a girl, 15.3% had an exacerbation at any time during the pregnancy, compared with 15.1% of those carrying a boy. The difference was not significant.
• Differences were also not significant in any trimester.
• On average, the dose per week of short-acting beta-agonists was similar in each trimester and during the overall pregnancy, regardless of the gender of the fetus.
• The proportion of women who used at least one dose of a short-acting beta-agonist per week on average was 62.5% for those carrying a girl and 62.6% for those expecting a boy.
• Similar proportions of women in each group used inhaled corticosteroids in each trimester and during the entire pregnancy, where the rates were 41.6% for those carrying a female fetus and 41.0% for those with a male fetus.
• Daily steroid doses were also similar between groups.

Dr. Blais and colleagues found 1,674 women who had more than one pregnancy during the study period and, of those, 874 had both a boy and a girl.

But there was no significant difference in exacerbation rates associated with differences in fetal gender, they found.

The researchers said the medication data reflect dispensing and might not correspond exactly to use. Also, the outcome was evaluated for trimesters or the entire pregnancy, which may have missed some short-term changes in asthma control.

The researchers also did not have access to clinical data, which precludes evaluation of a mild lack of asthma control that might be perceived by the mother.

Steroid Lavage Passes Test in Chronic Rhinosinusitis

ST. LOUIS, March 16 -- In patients with chronic rhinosinusitis, 30 days of daily steroid-saline nasal lavage had no deleterious effect on adrenal sufficiency, researchers here said.

Action Points

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• Explain to interested patients that this study evaluated an off-label use of the steroid budesonide, as part of a nasal lavage, to treat chronic rhinosinusitis.



• Note that the results showed symptomatic improvement with no adverse effect on adrenal sufficiency, suggesting minimal systemic absorption of the drug.

At the same time, the therapy offered a clinically significant improvement in symptoms in a small open-label study, according to Jay Piccirillo, M.D., and colleagues at Washington University.

The finding begins to clarify the risk of using budesonide as part of a nasal lavage, the researchers said in the March issue of Archives of Otolaryngology -- Head & Neck Surgery.

But they cautioned that the treatment protocol is off-label and still requires a randomized, placebo-controlled trial to assess other risks, such as potential loss of bone mineral density, as well as benefits in chronic rhinosinusitis.

Budesonide, in an aqueous nasal spray, has been shown to be safe and effective for chronic rhinosinusitis and perennial allergic rhinitis.

But used as part of daily nasal lavage, it might be absorbed systemically, causing such unwanted side effects as adrenal suppression.

To test that, the researchers used budesonide respules (sold under the brand name Pulmicort Respules), which are small, plastic, liquid-containing devices that can be used to deliver unit-dose medications in a sterile fashion.

Nine patients with chronic rhinosinusitis were instructed to administer 0.25 milligrams of budesonide, diluted with 5.0 milliliters of isotonic saline daily for 30 days.

Their blood cortisol levels were measured before and after the 30 days using the standard cosyntropin stimulation test. Efficacy of the treatment was assessed using the Sino-Nasal Outcome Test-20 (SNOT-20).

Analysis showed:

• There was little difference in average post-stimulation cortisol levels at baseline and after 30 days -- 33.9 micrograms per deciliter compared with 35.2
• After 30 days, no patient had a post-stimulation cortisol level below the critical level (18 to 20 micrograms per deciliter) that would indicate adrenal insufficiency
• The total SNOT-20 score was 2.4 on average at baseline and 1.4 at the 30-day visit, an improvement that was both statistically and clinically significant (at P=0.02)

The researchers cautioned that the lack of a control group makes it impossible to conclude that the symptomatic improvement resulted from the budesonide therapy. They also acknowledged that they did not document compliance with daily administration.

But, they said, the decrease in SNOT-20 scores was consistent for all patients, "supporting the evidence for the clinical efficacy of this intervention."

Although the use of the medication as part of nasal lavage has not been approved by the FDA, the researchers said, "the off-label use of medications is legal and an accepted part of medical practice."

Dr. Piccirillo and colleagues said their study will help physicians who want to use the method explain potential risks and benefits to patients.

AAAAI: Reports Conflict on Statin Benefit in Asthma

WASHINGTON, March 17 -- Statin therapy may or may not help improve adult asthma control, according to two database studies.

Asthma patients who took statins were 33% less likely to have an asthma-related hospitalization or emergency room visit during the next year, according to one analysis of a claims database reported at the American Academy of Allergy, Asthma, and Immunology meeting.

But those findings were tempered by an independent review of another claims database, also presented here, which found no particular benefit for statins in patients with severe asthma at baseline in terms of these and other markers of disease activity.

As a result, uncertainty over whether the documented anti-inflammatory effects of statins can affect the course of asthma is likely to remain for the near future.

Action Points

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• Explain to interested patients that statin drugs are prescribed to reduce cholesterol, but a number of studies have indicated that they have anti-inflammatory effects as well.



• Explain that asthma is an inflammatory condition, and some studies, though by no means all, have suggested that statins might reduce disease severity in asthma.



• Note that the two studies in this report both retrospectively analyzed large databases and therefore have important limitations.



• Note, too, that this study was published as an abstract and presented orally at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.

The first study, reported by Eric Stanek, Pharm.D., of the pharmacy benefits manager Medco Health Solutions, looked at ER visits and hospitalizations for asthma among patients in the firm's 12-million member database.

The Medco analysis focused on some 6,600 patients identified as poorly controlled asthmatics on the basis of having received a prescription for inhaled corticosteroids and at least one hospitalization or ER visit during the preceding year. Roughly one-third were also prescribed a statin drug.

Dr. Stanek said the raw data indicated that, among those taking statins, hospitalizations in the following year were 18% lower and ER visits 44% lower.

After adjusting for a variety of other factors that differed between the statin and no-statin patients -- rates of major cardiovascular events, diabetes, age, sex, and very poor asthma control -- the odds rate for hospitalization or ER visit remained significant at 0.67 (95% CI 0.58 to 0.76).

Looked at separately, the effect was nearly identical for hospitalizations and ER visits, with odds ratios of 0.73 and 0.72, respectively (P<0.001>

But a different analysis -- by researchers from Kaiser Permanente in San Diego using that organization's massive database -- found no suggestion that statins do much for patients with severe asthma.

Their study examined one-year outcomes among about 7,800 asthmatics after they started taking statins for high cholesterol.

According to Kaiser researcher Sandra Christiansen, M.D., the statin-treated patients were initially much sicker -- in terms of asthma severity as well as comorbid disease -- than those not given statins.

Compared with no-statin controls, the statin group was more likely to be taking corticosteroids and to have other diseases such as diabetes; the proportion of statin users with diabetes was greater in this study than in the Medco study.

ER visits and hospitalizations were also significantly more common in the statin-prescribed patients at baseline.

"Statin therapy did not narrow these discrepancies," Dr. Christiansen reported, with similar or even higher adjusted rates of such asthma severity markers as hospitalizations, ER visits, and use of rescue albuterol and oral corticosteroids.

Dr. Christiansen said it appears that asthma patients selected for statin prescription "appear to have inherently more severe disease," which statin treatment can't overcome.

She suggested that perhaps the Medco study had failed to control for as many variables as her own, as the Kaiser database contains more clinical detail on its members.

Dr. Christiansen acknowledged that, despite her group's findings, it remains possible that statins can help at least a subset of asthma patients.

"We just didn't see it," she shrugged.

For his part, Dr. Stanek said the two studies were not actually in conflict. He said the statin-treated asthmatic patients in the Kaiser study appeared much sicker than those in the Medco database.

He agreed that, in that population, statins may not be beneficial, but could still be helpful in patients with less severe initial disease.

He emphasized that the issue needs to be addressed in prospective studies and that it would be premature to prescribe statins as asthma therapy.

Nancy Ostrom, M.D., moderator of the session where Dr. Stanek presented and co-director of the Allergy and Asthma Medical Group and Research Center in San Diego, echoed those remarks.

"I don't think we have enough information to make a global change in how we practice," she said.

Ladies You Dont Need To Become Larger And Heavier

Despite your desire to be slim and trim somehow your body has not conveyed this to your mind as it is not happening the way you would like it too. Each week as you creep on the bathroom scales you expect to see some progress but when this situation just seems to be getting worse you become more frustrated and anxious. You look at yourself in the mirror and wonder how the fat just continues to sneak on despite your serious attempts at healthy eating and exercise.

If this situation sounds familiar to you don't despair, fat loss is a greater challenge for women than it is for men. But with a greater understanding of what happens to women as they get older fat loss can be successful. Many women believe that their metabolism (the body's engine) is slowing once they get past 30 years and they are right.

The reason for this is that unwelcome visitor that comes knocking at our door sooner rather than later - Father Time. Starting in our mid 20's women (and men too but to a lesser degree) lose approximately 7 pounds of lean muscle tissue and gain 15 pounds of body fat every decade. This causes enormous changes to the shape and tone of our body and the way we burn fuel (calories) every single day.

Muscle tissue is very metabolically active tissue and its loss means our engine (our metabolism) is not going to be burning as much fuel. It goes from a V-8 down to a V-4 if we do nothing to stop it. Most women would not be aware that this is happening as the increase in body fat hides the muscle loss. But you will notice your body is becoming larger and heavier, clothes don't fit as well and your energy levels drop as the increased body fat tends to make you sluggish.

So, by the mid 40's a women may have lost 15 pounds of muscle tissue and replaced it with 30 pounds (or more) of body fat. This means the body composition which is the muscle/body fat ratio has changed to an unhealthy balance along with other unfavorable changes being triggered including a weakening of the immune system.

While the scales may tell us that we have gained 15 pounds the situation is much worse underneath the surface with the muscle loss. Muscle tissue is precious as it drives the metabolism and downsizing the metabolism with its loss delivers a drain of vitality, vigor, energy and your get-up-and-go. Your youthfulness will slide away faster than you would believe.

Unfortunately it gets worse for women as after menopause the rate of muscle tissue loss doubles accelerating from 7 pounds per decade to 14 pounds per decade. By the time a woman is in her 60's she can have as little as 20-30 pounds of muscle tissue left.

Not only will she be very displeased with her figure she has now become much weaker not only in muscle strength but bone strength as well. She is at risk of falling and breaking bones as well as more prone to serious disease.

The very good news is these unhealthy changes are the result of not doing enough muscle building and maintaining activity. This can all be changed and reversed by simply putting in place a proper exercise program that contains strength training exercise.

Forget the old fashioned notion that walking, jogging or cycling or any other recreational long, slow, steady state activity is what you need to rebuild lost muscle tissue and rebuild your metabolism. These activities are just a part of an active lifestyle and can never, ever replace a proper exercise program.

Make sure you enlist the help of a fitness professional to set up your program and teach you correct exercise technique. You also need to be shown the correct level of intensity (degree of difficulty) to ensure you get the results you wish to achieve.

Get started as soon as possible, today would be good. Reverse this negative health situation and knock 10 or more years off your looks in the process. You will be so glad you did.

Age Not Responsible For Weight Gain

If you are among the many people who think becoming overweight goes hand in hand with getting older it is time to change your thinking. The truth is you really can not use age as an excuse for gaining weight or being out of shape. The loss of youth does not have to mean the loss of strength and fitness.

Until recently, getting older has been associated with unwelcome weight gain, loss of strength and increased susceptibility to disease and injury. The real culprit largely to blame for these symptoms is not actually aging; however, it is the loss of muscle tissue that occurs because of our increasingly sedentary lifestyles as we grow older.

Those who don't exercise and use muscle building and maintaining activity lose strength and fitness and often become overweight - adding up to 5 pounds of body fat a year. This is mostly abdominal fat, which increases the risk of the 'big three' heart disease, cancer and diabetes.

Not doing enough proper exercise causes an average muscle tissue loss of 5-7 pounds per decade which leads to a metabolic rate (the rate your body burns fuel) reduction of 2-5% per decade. Calories that were previously used for muscle energy and being active are now put into fat storage, resulting in gradual weight gain. Muscle tissue even at rest continuously burns fuel (calories) just like an idling engine.

Less muscle tissue means fewer calories are burned each day. The end result is that you gain unwanted fat more easily and find it difficult to take off once you have it. We often forget the importance of our muscle. Not only does it help us stay slim and trim it is vital for the body's every movement, for its function and for support of the skeleton holding it upright.

If you don't believe it is important take a look in any nursing home if you want to see the consequences of the loss of muscle tissue. Many residents are mentally alert and have no illness, but are frail and weak and lack the physical ability to care for themselves. No doubt the loss of 5 pounds of muscle tissue per decade contributes to their frailty and loss of independence.

A firm toned muscle burns a lot more calories than an un-toned flabby muscle. Muscle tissue is the body's most efficient burner of calories; the more we have, the greater the rate we burn calories, even at rest. The state of your muscles is determined by your activity level and has little to do with your age. Anyone of any age can build and keep strong muscles to help offset the loss of this precious tissue.

Whether you are 20 or 60 years old your muscles will respond to strength training exercise in exactly the same way creating a positive cycle for people to feel better and stay active at any age. Preserving muscle mass can help ward off or withstand illness.

When sick, the body burns protein faster than usual, pulling protein components from muscles for the immune system which is needed to fight the invaders and stay healthy.

Often people view exercise narrowly as a way to just lose weight. Although this is a health improving incentive there is a lot more benefits to be gained. Exercise is really about a person taking charge of his or her health, preventing chronic diseases like heart disease and cancer, and living longer and better.

Do not allow inactivity and a sedentary lifestyle to erode the health, mobility and independence that you want to enjoy for as long as possible. You want to keep that for your whole lifespan. So, take it upon yourself and stay or continue your strength training program so you can stay strong and fit throughout your life to protect your future.