Eliminating mold after natural disasters is vital for those with mold allergy
HEPA filters remain most effective in removing airborne particles
IMAGE:
ACAAI 2023 ANNUAL SCIENTIFIC MEETING
view moreCREDIT: ACAAI
ANAHEIM, Calif. (Nov. 9, 2023) – Severe weather events such as hurricanes, floods and extreme precipitation have increased in recent years and are projected to become more frequent. With those events can come a surge in growth of mold throughout houses and residences. Two new studies being presented at this year’s American College of Allergy, Asthma and Immunology (ACAAI) Annual Scientific Meeting in Anaheim, Calif. show the harmful health effects of excess mold on those with asthma, while also discussing methods for getting rid of mold and other airborne allergens in the most efficient way possible.
“Allergists routinely discuss avoidance of mold with their patients who test positive for mold allergy,” said Amber Hardeman, MD, MPH, MBA, ACAAI member and lead author of the study. “We conducted a review of recent articles on flooding and mold exposure after natural disasters to assess the strength of evidence supporting common recommendations for mold remediation provided by physicians.”
Said the authors, “Post-storm, local hospitals witness a nearly twofold increase in diagnoses related to mold exposure. Individuals with respiratory conditions like asthma, weakened immune systems, and allergies are most at risk. Those with asthma face a two times higher risk of death when mold counts exceed 1000 spores/m3. A concentration of mold spores above 500 spores/m3 is considered high. In addition, concerns about mold exposure may lead to interventions such as bleach use, which can be more harmful than the mold itself. Allergists and other physicians should focus on recommending effective home drying methods and discouraging detrimental or expensive practices for patients exposed to mold.”
In a second study, researchers at the iAIR Institute examined interventions to improve indoor air quality (IAQ), such as source control, monitoring, and the use of air cleaners and said they can significantly improve health outcomes, particularly for people with asthma and allergies.
“This study provides an update on state-of-the-art air cleaning technology to equip doctors to advise their patients,” said Gráinne Cunniffe, PhD, lead author of the study. “HEPA filters remain most effective in removing airborne particles, including allergens and fine particulate matter. Additionally, activated carbon filters were found to be highly effective in removing volatile organic compounds (VOCs) and odors. UV-based technology can be effective when used in filtered HVAC systems.”
Air cleaners and ionizers that are ozone-producing were identified as technologies to consider cautiously as some have been shown to release harmful ozone gas. According to the authors, patients should also be encouraged to consider factors such as room size, cost, maintenance requirements, independent testing and third-party certification, and noise levels when selecting an air cleaner.
Abstract Title: Health Consequences and Remediation of Mold Exposure Following Natural Disasters: A Scoping Review
Presenter: Amber Hardeman, MD, MPH, MBA
Abstract Title: A Breath of Fresh Information on Air Cleaning Technology
Presenter: Gráinne Cunniffe, PhD
For more information about improving indoor air quality, or to find an allergist in your area, visit AllergyandAsthmaRelief.org. The ACAAI Annual Scientific Meeting is Nov. 9-13. For more news and research from the ACAAI Scientific Meeting, go to our newsroom and follow the conversation on X/Twitter #ACAAI23.
About ACAAI
The American College of Allergy, Asthma & Immunology (ACAAI) is a professional medical organization of more than 6,000 allergists-immunologists and allied health professionals, headquartered in Arlington Heights, Ill. Founded in 1942, the College fosters a culture of collaboration and congeniality in which its members work together and with others toward the common goals of patient care, education, advocacy, and research. ACAAI allergists are board-certified physicians trained to diagnose allergies and asthma, administer immunotherapy, and provide patients with the best treatment outcomes. For more information and to find relief, visit AllergyandAsthmaRelief.org. Join us on Facebook, Pinterest, Instagram and X/Twitter.
P037
HEALTH CONSEQUENCES AND REMEDIATION OF MOLD EXPOSURE FOLLOWING NATURAL DISASTERS:
A SCOPING REVIEW
A. Hardeman*, A. Hidalgo, E. Lindgren, J. Carlson, New Orleans, LA.
Introduction: With increasing global warming, the frequency of severe weather events, including floods and hurricanes, is rising. Allergists play a significant role in mold exposure remediation, evaluation, and providing guidance on remediation strategies.
Methods: We conducted a scoping review of recent articles on flooding and mold exposure after natural disasters to assess the strength of evidence supporting common recommendations for mold remediation provided by physicians.
Results: Moisture deteriorates building materials and furnishings, leading to mold growth and the release of material (e.g. spores and volatile organic compounds). Higher precipitation results in increased mold growth and aeroallergen levels, exacerbating air quality issues and triggering asthma in susceptible individuals. Post-storm, local hospitals witness a nearly twofold increase in ICD-10 diagnosis codes related to mold exposure. Individuals with respiratory conditions, weakened immune systems, and allergies are most at risk. Approximately 18% of the global population has asthma, highlighting the growing global health concern of mold exposure after floods.. Asthmatics face a 2.16 times higher mortality risk when mold counts exceed 1000 spores/m3. Concerns about mold exposure may lead to interventions (e.g., bleach use, airborne particles from home repairs) that can be more harmful than the mold itself.
Conclusion: Mold remediation is a complex field that requires further research to enhance safety guidelines. Allergists and other physicians should focus on recommending effective home drying methods and discouraging detrimental or expensive practices for patients exposed to mold.
P036
A BREATH OF FRESH INFORMATION ON AIR CLEANING TECHNOLOGY
G. Cunniffe*1, J. Whelan2, A. Byrne2, J. Ryan2, K. Lestage2, J. McKeon2, 1. Dublin, Dublin, Ireland; 2. Dublin, Ireland.
Introduction: Interventions to improve indoor air quality (IAQ), such as source control, monitoring and the use of air cleaners can significantly improve health outcomes, particularly for people with asthma and allergies. Doctors are a trusted source of information for patients. This study provides an update on state-of-the-art air cleaning technology to equip doctors to advise their patients.
JOURNAL
Annals of Allergy Asthma & Immunology
METHOD OF RESEARCH
Literature review
SUBJECT OF RESEARCH
Not applicable
ARTICLE TITLE
HEALTH CONSEQUENCES AND REMEDIATION OF MOLD EXPOSURE FOLLOWING NATURAL DISASTERS: A SCOPING REVIEW
ARTICLE PUBLICATION DATE
9-Nov-2023
How accurate was ChatGPT for common allergy myths? Pretty accurate
ChatGPT had an accurate or somewhat accurate response in 91% of cases
ANAHEIM, Calif. (Nov. 9, 2023) – Artificial intelligence language models such as ChatGPT are increasingly being used in many different professions, and medicine is not an exception. In a new study being presented at this year’s American College of Allergy, Asthma and Immunology (ACAAI) Annual Scientific Meeting in Anaheim, Calif., ChatGPT was asked to rate 10 common allergy myths, and it judged their accuracy correctly 91% of the time.
“We searched the PubMed and Google Scholar databases to identify all articles on common allergy myths between 2000-2023,” says Ricardo Estrada-Mendizabal, MD, ACAAI member and lead author of the study. “Our goal was to assess the accuracy of ChatGPT in correctly identifying common allergy myths. We know allergy and asthma patients are constantly exposed to misinformation on the internet. We thought that the surge of public language models could represent a bigger threat to misinformation spread, especially because ChatGPT is unable to provide references.”
Ten myths were selected and entered in ChatGPT 4.0 with the prompt “true or false.” ChatGPT answers were graded by 24 allergists on a Likert scale of 1-4 (1=inaccurate [100% not true], 2=somewhat inaccurate [>30% not true], 3= somewhat accurate [<10% not true], 4=accurate [100% true]). Finally, allergists were asked their likelihood of using ChatGPT for patient education with a Likert scale of 1-5 (1=not likely at all–5=very likely). Overall, ChatGPT had an accurate or somewhat accurate response in 91% of cases and an inaccurate or somewhat inaccurate response in 9%.
Said Dr. Estrada-Mendizabal, “The response to whether a positive allergy test indicates a clinical allergy was the most accurate response (96% accurate), whereas the response to if hypoallergenic animals were better for people with asthma and allergies was the most inaccurate (17% inaccurate and 21% somewhat inaccurate response). Eighteen allergists (75%) were open (likely or very likely) to using ChatGPT in the future for patient education.”
The authors of the paper say more studies are required to interpret the validity of ChatGPT in providing accurate medical information.
Abstract Title: Dear ChatGPT, should I get a hypoallergenic dog?: Accuracy of ChatGPT for common allergy myths
Presenter: Ricardo Estrada-Mendizabal, MD
For more information about allergies and asthma, or to find an allergist in your area, visit AllergyandAsthmaRelief.org. The ACAAI Annual Scientific Meeting is Nov. 9-13. For more news and research from the ACAAI Scientific Meeting, go to our newsroom and follow the conversation on X/Twitter #ACAAI23.
About ACAAI
The American College of Allergy, Asthma & Immunology (ACAAI) is a professional medical organization of more than 6,000 allergists-immunologists and allied health professionals, headquartered in Arlington Heights, Ill. Founded in 1942, the College fosters a culture of collaboration and congeniality in which its members work together and with others toward the common goals of patient care, education, advocacy, and research. ACAAI allergists are board-certified physicians trained to diagnose allergies and asthma, administer immunotherapy, and provide patients with the best treatment outcomes. For more information and to find relief, visit AllergyandAsthmaRelief.org. Join us on Facebook, Pinterest, Instagram and X/Twitter.
D015 (A037)
DEAR CHATGPT, SHOULD I GET A HYPOALLERGENIC DOG?: ACCURACY OF CHATGPT FOR COMMON ALLERGY MYTHS
R. Estrada-Mendizabal*1, G. Cojuc-Konigsberg2, E. Labib3, C. de la Cruz-de la Cruz4, A. Gonzalez-Estrada3, L. Cuervo-Pardo5, R. Zwiener6, A. Canel-Paredes4, 1. San Luis Potosi, Mexico; 2. Mexico City, Mexico; 3. Scottsdale, AZ; 4. Monterrey, Nuevo Leon, Mexico; 5. Gainesville, FL; 6. Caba, Argentina.
Introduction: Artificial language models such as chat generative pre-trained transformers (ChatGPT) are expected to change clinical practice. We aim to assess the accuracy of ChatGPT in correctly identifying common allergy myths.
Methods: We searched the PubMed and Google Scholar databases to identify all articles on common allergy myths between 2000-2023. Ten myths were selected by convenience and entered into ChatGPT 4.0 by two sub-investigators independently with the prompt “true or false”; a third sub-investigator selected the most complete answer. ChatGPT answers were graded by 24 allergists on a Likert scale of 1-4 (1=inaccurate [100% not true], 2=somewhat inaccurate [>30% not true], 3= somewhat accurate [<10% not true], 4=accurate [100% true]). Finally, allergists were asked the likelihood of using ChatGPT for patient education with a Likert scale of 1-5 (1=not likely at all–5=very likely).
Results: Overall, ChatGPT had an accurate or somewhat accurate response in 91% of cases, and an inaccurate or somewhat inaccurate response in 9%. The response to whether a positive allergy test means a clinical allergy was the most accurate (96% accurate response), whereas the response to if hypoallergenic animals were better for people with asthma and allergies was the most inaccurate (17% inaccurate and 21% somewhat inaccurate response) (Table). Eighteen allergists (75%) were open (likely or very likely) to using ChatGPT in the future for patient education.
Conclusion: An accurate response was provided by ChatGPT for most of the presented myths. More studies are required to elucidate the validity of ChatGPT in providing accurate medical information.
Top 10 myths, ChatGPT responses, and response rating by allergists.
JOURNAL
Annals of Allergy Asthma & Immunology
METHOD OF RESEARCH
Content analysis
New study examines potential factors related to the development of adult-onset food allergy
Food allergic patients have a variety of theories on how their allergy started
Peer-Reviewed PublicationANAHEIM, Calif. (Nov. 9, 2023) – It’s estimated that 33 million Americans have food allergies, including 5.6 million children under age 18. The cause of food allergies is unknown, although researchers and food allergy experts have ruled out some common theories of how they develop. A new study being presented at this year’s American College of Allergy, Asthma and Immunology (ACAAI) Annual Scientific Meeting in Anaheim, Calif. shows that, among people who suffer from food allergies, common themes arose regarding when their food allergy developed and coinciding with certain events including, eating too much of the allergenic food; genetics and family history; antibiotic use; and eating too little of the allergenic food.
“Through an NIH-supported Food Allergy Prevalence Questionnaire, we collected nationally representative data for 38,408 children and 40,443 adults,” said Christopher Warren, PhD, ACAAI member and co-author of the study. "We know there are many theories about how food allergies develop, and there are many causal factors that likely contribute to the present food allergy epidemic. We have never had the opportunity to directly ask a large, national sample of food allergy patients and pediatric caregivers about the factors they noticed as related to their own food allergy development. When we directly engaged these food allergy patients/caregivers, nearly one in five reported that eating too much of an allergenic food coincided with their food allergy development, while 12% of adults reported that antibiotic use did. Notably, nearly one in four caregivers of children under the age of 17 reported that their child's food allergy development coincided with a viral infection.”
Survey respondents were categorized as having self-/parent-proxy reported food allergy, convincing food allergy according to reported food-allergic reaction symptoms consistent with an IgE-mediated response, as well as reported cases of convincing food allergy that were physician diagnosed.
“We now know that eating certain allergenic foods, like peanuts, if eaten starting in infancy, can prevent peanut allergy,” says Ruchi Gupta, MD, ACAAI member and senior author of the study. “Allergists and other health care professionals can help get the word out to parents of infants and others that it’s preventative to introduce certain allergenic foods early in life. For new-onset adult allergies, understanding potential triggers that may be involved with the development of an allergy is critical. Factors like infections, changes in the environment, and hormonal changes may be factors contributing to developing an allergy later in life and need more exploration.”
Abstract Title: Understanding perceived determinants of food allergy in a US population-based sample of children and adults
Presenter: Rachelle Liu, BA
For more information about severe food allergies and anaphylaxis, or to find an allergist in your area, visit AllergyandAsthmaRelief.org. The ACAAI Annual Scientific Meeting is Nov. 9-13. For more news and research from the ACAAI Scientific Meeting, go to our newsroom and follow the conversation on X/Twitter #ACAAI23.
About ACAAI
The American College of Allergy, Asthma & Immunology (ACAAI) is a professional medical organization of more than 6,000 allergists-immunologists and allied health professionals, headquartered in Arlington Heights, Ill. Founded in 1942, the College fosters a culture of collaboration and congeniality in which its members work together and with others toward the common goals of patient care, education, advocacy, and research. ACAAI allergists are board-certified physicians trained to diagnose allergies and asthma, administer immunotherapy, and provide patients with the best treatment outcomes. For more information and to find relief, visit AllergyandAsthmaRelief.org. Join us on Facebook, Pinterest, Instagram and X/Twitter.
P187
UNDERSTANDING PERCEIVED DETERMINANTS OF FOOD ALLERGY IN A US POPULATION-BASED SAMPLE OF CHILDREN AND ADULTS
R. Liu*, C. Warren, R. Gupta, Chicago, IL.
Introduction: Food allergy (FA) is a major public health problem, and little work to date has aimed to understand the perceived etiology of FA. This knowledge would provide context for current health behavior and potentially identify areas for targeted interventions, including patient and caregiver education.
Methods: A cross-sectional food allergy survey was administered to patients and caregivers via phone and web via a NIH-supported Food Allergy Prevalence Questionnaire in 2015-2016, which collected nationally-representative data for 38,408 children and 40,443 adults. Respondents were categorized as having self-/parent-proxy reported FA, convincing FA according to reported food-allergic reaction symptoms consistent with an IgE-mediated response, as well as reported cases of convincing FA that are physician diagnosed.
Results: In adults and children with physician confirmed FA, the measures most perceived to be associated with development of FA were eating too much of the allergenic food [18.6% (95%CI:17.0-20.3)], genetics and family history [16.3% (95%CI:14.8-17.9)], antibiotic use [12.5% (95%CI:11.3-13.8)], and eating too little of the allergenic food [10.2% (95%CI:8.8-11.8)]. In populations 0-10 and 11-17 years old, respondents associated developing FA with a viral infection [23.8% (95%CI:21.1-26.7), 25.6% (95%CI:22.0-29.5)].
Conclusion: The findings highlight important factors such as diet, genetics, family history, and infection that are believed by parents and adult patients to be associated with FA development. Understanding these perceptions can inform targeted interventions and patient education efforts to improve FA management and prevention.
JOURNAL
Annals of Allergy Asthma & Immunology
METHOD OF RESEARCH
Survey
SUBJECT OF RESEARCH
People
ARTICLE TITLE
UNDERSTANDING PERCEIVED DETERMINANTS OF FOOD ALLERGY IN A US POPULATION-BASED SAMPLE OF CHILDREN AND ADULTS
ARTICLE PUBLICATION DATE
9-Nov-2023
Special toothpaste may lower risk of allergic reactions for adults with peanut allergy
New study shows specially formulated toothpaste successful in peanut immunotherapy for adults
Reports and ProceedingsANAHEIM, Calif. (Nov. 9, 2023) – Oral immunotherapy for peanut allergy – introducing small amounts of peanut over a period of time to cause less of a reaction if the person eats something with peanut – has been used by allergists for years to help desensitize those with peanut allergy. A new late breaking abstract being presented at this year’s American College of Allergy, Asthma and Immunology (ACAAI) Annual Scientific Meeting in Anaheim, Calif. demonstrates that a specially formulated toothpaste can be successfully used for Oral Mucosal Immunotherapy (OMIT).
“OMIT uses a specially formulated toothpaste to deliver allergenic peanut proteins to areas of the oral cavity,” says allergist William Berger, MD, ACAAI member and author of the study. “OMIT as a delivery mechanism for peanut protein has great potential for food allergy desensitization. Due to its targeted delivery and simple administration, it supports the goal of improved adherence.”
This study enrolled 32 adults, age 18-55, with peanut allergy in a 3:1 ratio of active treatment to placebo control. Participants received either an escalating dose of peanut toothpaste or placebo. During this 48-week trial, safety was monitored during the up-dosing and maintenance phases. Exploratory biomarkers were also evaluated, and oral food challenges were conducted. (Exploratory biomarkers are blood tests used to show if a person’s immune system is responding to treatment with an allergen such as peanut.)
“We noted that 100% of those being treated with the toothpaste consistently tolerated the pre-specified protocol highest dose,” says Dr. Berger. “No moderate nor severe systemic reactions occurred in active participants. Non-systemic adverse reactions were mostly local (oral itching), mild, and transient. There was 97% adherence to treatment with no dropouts due to study medication. OMIT appears to be a safe and convenient option for adults with food allergies. The results support continued development of this toothpaste in the pediatric population.”
Additional long-term studies are planned to further evaluate the ongoing use of the toothpaste therapy to provide long-term protection against accidental ingestion of peanut.
Late Breaking Abstract Title: A Randomized, Placebo-Controlled Phase 1 Safety Study of OMIT in Adults with Peanut Allergy
Presenter: William Berger, MD
For more information about food allergies and anaphylaxis, or to find an allergist in your area, visit AllergyandAsthmaRelief.org. The ACAAI Annual Scientific Meeting is Nov. 9-13. For more news and research from the ACAAI Scientific Meeting, go to our newsroom and follow the conversation on X/Twitter #ACAAI23.
About ACAAI
The American College of Allergy, Asthma & Immunology (ACAAI) is a professional medical organization of more than 6,000 allergists-immunologists and allied health professionals, headquartered in Arlington Heights, Ill. Founded in 1942, the College fosters a culture of collaboration and congeniality in which its members work together and with others toward the common goals of patient care, education, advocacy, and research. ACAAI allergists are board-certified physicians trained to diagnose allergies and asthma, administer immunotherapy, and provide patients with the best treatment outcomes. For more information and to find relief, visit AllergyandAsthmaRelief.org. Join us on Facebook, Pinterest, Instagram and X/Twitter.
LB011
A RANDOMIZED, PLACEBO-CONTROLLED PHASE 1 SAFETY STUDY OF OMIT IN ADULTS WITH PEANUT ALLERGY.
W. Berger*, New York, NY.
Introduction: Oral Mucosal Immunotherapy (OMIT) uses a specially formulated toothpaste to deliver allergenic proteins to immunologically active areas of the oral cavity, a delivery mechanism which has the greatest potential for food allergy desensitization. OMIT presents advantages over other approaches to allergy immunotherapy due to its targeted delivery and simplified administration, supporting the goal of improved adherence.
Methods: This study enrolled 32 adults, age 18-55, with peanut allergy in a 3:1 ratio to receive either an escalating dose of INT301 or placebo. Inclusion criteria included a positive SPT with a wheal diameter at least 3mm greater than control and/or psIgE ≥ 0.35 kU/L. Additionally, subjects were required to fail an oral food challenge ≤ 100 mg of peanut protein. During this 48-week trial, safety profile was monitored during the up-dosing and maintenance phases. Exploratory biomarkers were evaluated.
Results: 100% of active subjects consistently tolerated the pre-specified protocol highest dose. No moderate nor severe systemic reactions in active participants. Non-systemic adverse reactions were mostly local (oral itching), mild and transient. 97% adherence to treatment with no dropouts due to study medication. Exploratory biomarkers were consistent with an immunologic response to treatment in a designated subset of subjects.
Conclusion: In this phase 1 OMEGA trial, adherence and safety profile of INT301 successfully achieved the primary and secondary endpoints. OMIT appears to be a safe and convenient option for individuals with food allergies. Immunologic response to treatment suggests further evaluation. These results support continued development of INT301 in the pediatric population.
Flaxseed allergy appearing more frequently – present in foods and other substances
Many may not know flaxseed is an ingredient in food products and art supplies
Peer-Reviewed PublicationANAHEIM, Calif. (Nov. 9, 2023) – Flaxseed is an increasingly popular ingredient in baked goods and other food products due to its perceived health benefits. It is even used as a substitute for egg in some recipes. Two new medically challenging cases being presented at this year’s American College of Allergy, Asthma and Immunology (ACAAI) Annual Scientific Meeting in Anaheim, Calif. show that flaxseed can cause allergic reaction – both after being ingested and also after touching the skin.
“Flaxseed allergy has been reported in adults, but not as often in children,” says Alana Xavier De Almeida, MD, ACAAI member and lead author of the paper, titled “IgE Mediated Flaxseed Allergy in Non-Atopic Toddler Polysensitized to Tree Nuts but Tolerating Other Seeds.” Dr. Xavier De Almeida is in training as an allergist. “We saw an 18-month-old patient with a rash throughout his face and chest 20 minutes after eating a packet of oatmeal with premixed flaxseed,” she says. “This was the first time the patient had eaten flaxseed, and the event self-resolved within 4 hours. A skin prick test was performed revealing positive results for various nuts and seeds, including flaxseed. Evaluation also included measurement of serum IgE levels. Based on the history and test results, a diagnosis of an IgE mediated reaction to flaxseed was made. A direct oral flaxseed challenge test was offered to confirm allergy but was never performed due to parents’ preference not to proceed.”
The second medically challenging case, titled, “Contact dermatitis of the hands caused by flaxseed in artist’s paint,“ involved a patient who was seen for recurrent rashes on her hands. The patient was an artist painting with oil paints. A history was obtained regarding items she used while painting including paint, charcoal, solutions to clean brushes and more. Review of items used showed that her oil paints contained Linseed/flaxseed-based oil as do many of the oil paints artists use.
“Her hand dermatitis was severe and disrupted her painting,” said allergist Richard Harris, MD, ACAAI member and lead author of the paper. “She exclusively used oils to paint. We asked her to bring all items and products she used while working on her art pieces. Patch testing was done using test wells taped on the back for 48 hours. Flaxseed reacted significantly at her patch test site at 48 and 72 hours.
Both flaxseed oil and linseed oil are derived from the dark brown seeds of the plant Linum Usitatissimum. Linseed oil is used in oil paint since it speeds up drying time and reduces visibility of brush strokes. In this case, it caused severe contact dermatitis, but it is also reported as an ingested allergen often seen in cereals and baked goods.”
Both cases illustrate that flaxseed, used in both food products and art supplies, should be considered as a trigger for an allergic reaction.
Medically Challenging Case Abstract Title: IgE Mediated Flaxseed Allergy in Non-Atopic Toddler Polysensitized to Tree Nuts but Tolerating Other Seeds
Presenter: Alana Xavier De Almeida, MD
Medically Challenging Case Abstract Title: Contact dermatitis of the hands caused by flaxseed in artist’s paint
Presenter: Richard Harris, MD
For more information about food allergies and anaphylaxis, or to find an allergist in your area, visit AllergyandAsthmaRelief.org. The ACAAI Annual Scientific Meeting is Nov. 9-13. For more news and research from the ACAAI Scientific Meeting, go to our newsroom and follow the conversation on X/Twitter #ACAAI23.
About ACAAI
The American College of Allergy, Asthma & Immunology (ACAAI) is a professional medical organization of more than 6,000 allergists-immunologists and allied health professionals, headquartered in Arlington Heights, Ill. Founded in 1942, the College fosters a culture of collaboration and congeniality in which its members work together and with others toward the common goals of patient care, education, advocacy, and research. ACAAI allergists are board-certified physicians trained to diagnose allergies and asthma, administer immunotherapy, and provide patients with the best treatment outcomes. For more information and to find relief, visit AllergyandAsthmaRelief.org. Join us on Facebook, Pinterest, Instagram and X/Twitter.
M328
IGE MEDIATED FLAXSEED ALLERGY IN NON-ATOPIC TODDLER POLYSENSITIZED TO TREE NUTS BUT TOLERATING OTHER SEEDS
A. Xavier De Almeida*1, T. Satnarine1, H. Sampson2, G. Kleiner1, M. Gans1, 1. Miami, FL; 2. New York, NY.
Introduction: The popularity of flaxseed consumption has grown significantly due to its reported health benefits, leading to an increase in allergic reactions associated with this seed. While hypersensitivity to flaxseed has been reported in adults, there is limited information regarding its effects on children.
Case Description: 18-month-old male non-atopic patient presented with a raised erythematous pruritic rash throughout his face and chest about 20 minutes after consuming an entire packet of oatmeal with premixed flaxseed. He consumed approximately 1800-2200 mg of flaxseed protein per manufacture. The event self-resolved within 4 hours. This was the first time that the patient orally ingested flaxseed.
Skin prick test was performed revealing positive results for various nuts and seeds, including flaxseed. Evaluation also included measurement of serum IgE levels (table 1), the flaxseed specific IgE was very high (15.20 kUA/L, 47.50 kUA/L) with a mildly elevated total IgE. Based on the history and test results, a diagnosis of an IgE mediated reaction to flaxseed was made. A direct oral flaxseed challenge test was offered to confirm allergy, but was never performed per parents’ preference.
Discussion: With the increasing use of flaxseed, allergists need to be aware of its potential to induce allergic reactions. Further research is necessary to investigate cross-reactivity between flaxseed and other nuts, legumes, and seeds, as well as establish the positive predictive values of flaxseed-specific IgE. Understanding these factors will aid in the diagnosis and management of flaxseed allergy, ensuring appropriate dietary recommendations for affected individuals.
M452
CONTACT DERMATITIS OF THE HANDS CAUSED BY FLAXSEED IN ARTISTS PAINT
R. Harris, M. Johnson,MD*, Los Angeles, CA.
Introduction: This patient was referred to us for recurrent rashes on her hands. History revealed that she was an artist painting with oil paints. A history was obtained regarding items she used while painting including paint, charcoal, solutions to clean brushes and more.
Review of items used showed that her oil paints contained Linseed/flaxseed-based oil as do many of the oil paints artists use.
Case Description: Her hand dermatitis was severe and disrupted her painting. She exclusively used oils to paint. We asked her to bring all items and products she used while working on her art pieces. Patch testing was done using test wells taped on the back for 48 hours. The wells were removed at 48 hours and read for local reactions. The patient returned at 72 hours for a final reading (although reactions can occur in up to 7 days). Flaxseed reacted significantly at her patch test site at 48 and 72 hours.
Discussion: Both flaxseed oil and Linseed oil are derived from the dark brown seeds of the plant Linum Usitatissimu. Linseed oil is used in oil paint since it speeds up drying time and reduces visibility of brush strokes. In this case it caused severe contact dermatitis, but it is also reported as an ingested allergen often seen in cereals and baked goods.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3374192/
https://jamanetwork.com/journals/jama/article-abstract/234846
JOURNAL
Annals of Allergy Asthma & Immunology
ARTICLE TITLE
IGE MEDIATED FLAXSEED ALLERGY IN NON-ATOPIC TODDLER POLYSENSITIZED TO TREE NUTS BUT TOLERATING OTHER SEEDS
ARTICLE PUBLICATION DATE
9-Nov-2023
Study shows children with private insurance more likely to outgrow food allergies
Milk and egg allergy most frequently outgrown food allergies
Peer-Reviewed PublicationANAHEIM, Calif. (Nov. 9, 2023) – Some children will outgrow a food allergy, but how this happens is not well understood. A new study being presented at this year’s American College of Allergy, Asthma and Immunology (ACAAI) Annual Scientific Meeting in Anaheim, Calif. shows that children with private insurance are more likely to outgrow food allergies than children who use public insurance.
“We reviewed a cohort of food allergy patients enrolled in the FORWARD (Food Allergy Management and Outcomes Related to Racial/Ethnic Differences from Infancy through Adolescence) study to try to determine which had outgrown their food allergies,” said allergist Arabelle Abellard, MD, MSc., ACAAI member and lead author on the study. “Milk and egg allergy were the most frequently outgrown allergies. And children with public insurance (12%) compared to children with private insurance (29%) were significantly less likely to report outgrowing food allergy.”
The cohort at the study site included 188 children consisting of 62% male, 51% Black, 32% White and 16% Latinx participants. 21% of the children outgrew at least one food allergy, with a total of 72 food allergies outgrown. The mean age at which food was outgrown was 5 years. The foods that were most frequently outgrown were milk followed by egg, then tree nuts, soy and peanut.
“This study provides additional information to our growing body of research on how and why children outgrow food allergies, specifically studying, for the first time, children from various racial groups,” says allergist Amal Assa'ad, MD, ACAAI member and co-author of the study. “As food allergies cause social, emotional and physical burdens on children and their families, food allergy researchers seek data to assist in our search for cures.”
An additional study being presented – a medically challenging case titled, “Successful Egg Reintroduction in Adolescent Patient with Recalcitrant Egg Allergy” shows the importance of baked egg oral food challenges in adolescent patients who previously had anaphylaxis to egg products. In the case, a 15-year-old patient came to an allergy clinic with a diagnosis of multiple food allergies, including severe anaphylactic reactions to scrambled eggs. One year later, the clinic performed skin testing and the results were not clear regarding the severity of her egg allergy. Because of the vague results, an oral food challenge was attempted, and she was able to tolerate baked egg muffins. She can now eat eggs in baked form which has improved her quality of life significantly despite past elevation in blood tests and recent anaphylaxis.
The authors note that increasing exposure to baked eggs in patients with a history of anaphylaxis to eggs, and continued re-evaluation of adolescents with egg allergies is helpful. This case demonstrates the importance of baked egg oral food challenges in adolescent patients who previously had anaphylaxis to egg products even as recently as one year prior.
Abstract Title: Development of Tolerance In Children with Food Allergy
Presenter: Arabelle Abellard, MD, MSc
Medically Challenging Case Abstract Title: Successful Egg Reintroduction in Adolescent Patient with Recalcitrant Egg Allergy
Presenter: Lily Tran, BS
For more information about food allergies and anaphylaxis, or to find an allergist in your area, visit AllergyandAsthmaRelief.org. The ACAAI Annual Scientific Meeting is Nov. 9-13. For more news and research from the ACAAI Scientific Meeting, go to our newsroom and follow the conversation on X/Twitter #ACAAI23.
About ACAAI
The American College of Allergy, Asthma & Immunology (ACAAI) is a professional medical organization of more than 6,000 allergists-immunologists and allied health professionals, headquartered in Arlington Heights, Ill. Founded in 1942, the College fosters a culture of collaboration and congeniality in which its members work together and with others toward the common goals of patient care, education, advocacy, and research. ACAAI allergists are board-certified physicians trained to diagnose allergies and asthma, administer immunotherapy, and provide patients with the best treatment outcomes. For more information and to find relief, visit AllergyandAsthmaRelief.org. Join us on Facebook, Pinterest, Instagram and X/Twitter.
P189
DEVELOPMENT OF TOLERANCE IN CHILDREN WITH FOOD ALLERGY
S. Alabduljabbar1, L. Bilaver1, A. Assa'ad2, C. Warren1, J. Jiang1, R. Gupta1, M. Mahdavinia1, 1. Chicago, IL; 2. Cincinnati, OH.
Introduction: Despite the rising prevalence of food allergy (FA), some children outgrow their food allergies. However, factors associated with the development of clinical tolerance are not understood. We aim to investigate a prospective cohort of children with FA at our institution, a site of the FORWARD (Food Allergy Management and Outcomes Related to Racial/Ethnic Differences from infancy through Adolescence) study to answer this question.
Methods: The study included Black, White and Latinx children aged 0 to 12 years with IgE-mediated, physician-diagnosed FA. Participants were surveyed about outgrowing any food allergies with specific questions.
Results: The cohort at this site included 188 children consisting of 62% male, 51% Black, 32% White and 16% Latinx participants. 39 (21%) children outgrew at least one food allergy, with a total of 72 food allergies outgrown. Mean age at which food was outgrown was 5.31 years (SD=3.50). The foods that were most frequently outgrown were milk followed by egg, then tree nuts, soy and peanut. Insurance coverage was associated with outgrowing food allergy; 9 (12%) publicly insured children outgrew foods, compared to 26 (29%) privately insured children. Mean age of development of FA among those who developed tolerance was (M=3.19 years, SD=2.70), which was significantly less than the mean age of development of FA among those who never developed tolerance (M=4.30 years, SD=3.61), t=1.72, p=.043.
Conclusion: Milk and egg allergy were the most frequently outgrown allergies. Children with public insurance compared to children with private insurance were significantly less likely to report outgrowing food allergy.
Comparison of Subjects with and without Development of Food Tolerance
M325
SUCCESSFUL EGG REINTRODUCTION IN ADOLESCENT PATIENT WITH RECALCITRANT EGG ALLERGY
L. Tran*1, M. Dickinson Matson1, C. Enweasor2, G. Odudu3, 1. Redlands, CA; 2. Sacramento, CA; 3. Loma Linda, CA.
Introduction: Egg allergy is a common food allergy in the pediatric population, affecting 0.5-2.5% of young children. Recent studies have shown that early introduction can decrease the development of food allergies in young children; however, research for reintroduction in older children is lacking. We report a case of egg reintroduction in an adolescent with a severe allergy to eggs.
Case Description: A 15-year-old patient presented to the allergy clinic with a diagnosis of multiple food allergies, including severe anaphylactic reactions to scrambled eggs. Skin testing one year after recent anaphylaxis was equivocal with wheals of 0 mm to egg white and 6 mm to egg yolk. Given these results, an oral food challenge was attempted, and she was able to tolerate baked egg muffins. She can now eat eggs in baked form which has improved her quality of life significantly despite past elevation in blood tests and recent anaphylaxis.
Discussion: Despite recent anaphylaxis to cooked eggs, a 15-year-old patient tolerated baked eggs in an oral food challenge 1 year after her initial reaction. Food allergy management tends to be static and limiting, especially in older pediatric patients. Additionally, egg tolerance rates have been decreasing. Therefore, increasing exposure to baked eggs in patients with a history of anaphylaxis to eggs and continual re-evaluation of adolescents with egg allergies are quintessential. This case demonstrates the importance of baked egg oral food challenges in adolescent patients who previously had anaphylaxis to egg products even as recently as 1 year.
JOURNAL
Annals of Allergy Asthma & Immunology
ARTICLE TITLE
Development of Tolerance In Children with Food Allergy
ARTICLE PUBLICATION DATE
9-Nov-2023
Community grant projects empower allergists to address barriers to allergy and asthma care
The Allergists’ Foundation annual awards support innovative projects focused on disparities in care
Peer-Reviewed PublicationANAHEIM, Calif. (Nov. 9, 2023) – Beginning in 2021, The Allergists’ Foundation, the philanthropic arm of the American College of Allergy, Asthma and Immunology, began funding community grant projects that address challenges faced by community practicing allergists.
Grants are awarded in the following two categories:
- Planning/exploratory projects (up to $10,000 for 12 months) to address issues that have not been fully explored, for which data needs to be gathered.
- Implementation grants (up to $25,000 for 12-24 months) for projects in which preliminary data has been gathered and initial planning has taken place. These grants help take the work to the “next level.”
This year, six grantees are presenting on their work at the ACAAI National Scientific Meeting in Anaheim, Calif. The awards are made possible thanks to generous donations from College members, and support by GSK.
“We have awarded nearly $100,000 in grants each year to support innovative means for addressing challenges faced by community practicing allergists, including health disparities in underserved communities, says allergist David Engler, MD, FACAAI, 2023 president of The Allergists’ Foundation. “These projects exemplify the creativity and resourcefulness of the College’s membership and have the potential to make an important difference in our efforts to improve the care for allergy and asthma in every community.”
An introduction to each project presented at this year’s meeting is given below:
P230
EASING THE CONVERSATION: CANNABIS EDUCATION FOR ALLERGISTS
Introduction: Dissemination of knowledge about cannabis in the medical setting has lagged- behind increasing legalization and cannabis use. There is an unmet need to determine the level of cannabis knowledge of allergists, and whether allergists address potential cannabis allergy in their patients. To address both topics cannabis educational modules and intake questions were developed.
P195
ADOLESCENTS DEMONSTRATE IMPROVED COMFORT WITH SELF-MANAGEMENT OF FOOD ALLERGIES WITH IMPLEMENTATION OF TAILORED EDUCATION VISIT
Introduction: Adolescents with food allergies have an increased risk of anaphylaxis and fatal reactions secondary to food allergen exposure. Previous studies have shown that adolescents are less likely to carry their epinephrine auto-injector and engage in risk-taking behaviors. There is limited literature on transitions of care guidelines for teens with food allergies, and it is unknown if a dedicated transitions of care education visit would improve outcomes for these patients.
P288
ASTHMA AND ATOPIC DERMATITIS-RELATED OUTCOMES IN URBAN CHILDREN
Introduction: Atopic Dermatitis (AD) affects 13% of children and is highly co-morbid with asthma. Disease management in urban children can be challenging due to poverty, decreased access to care and urban stressors. Our goal was to examine asthma and AD outcomes in children with both conditions.
P010
PATIENT PERSPECTIVES ON PENICILLIN ALLERGY EVALUATION DURING PREGNANCY: A QUALITATIVE STUDY
Introduction: Prenatal penicillin testing is often not completed, despite it being part of guideline-concordant obstetrics care. We conducted qualitative interviews eliciting patient perspectives to improve testing uptake and patient experience.
P183
NATIONAL NEEDS ASSESSMENT FOR AN INFANT AND TODDLER FOOD ALLERGY CURRICULUM FOR PEDIATRIC RESIDENTS
Introduction: The prevalence of pediatric food allergies is increasing. 6% of children ages 0 to 2 years have food allergies. The need for community practicing allergists managing infant/toddler food allergies is increasing, yet fewer residents pursue allergy/immunology fellowship. Pediatric residents are frontline providers for children with food allergies, but little is known about their educational experiences with infant/toddler food allergies and exposure to the field of allergy/immunology.
P259
A QUALITY IMPROVEMENT INITIATIVE INCREASING FORMAL EVALUATIONS OF UNCONFIRMED PENICILLIN ALLERGIES IN A PEDIATRIC HOSPITAL
Introduction: Penicillin (PCN) allergy is the most common drug allergy, but less than 10% of children are confirmed to have true IgE-mediated reactions. Despite recommendations for formal testing, children with unconfirmed PCN allergy labels are infrequently evaluated. The SMART aim of this initiative was to increase the number of formal PCN allergy evaluations (completed telemedicine and in-person testing) from 4 per month to 20 per month by June 2023.
For more information about allergies and asthma, or to find an allergist in your area, visit AllergyandAsthmaRelief.org. The ACAAI Annual Scientific Meeting is Nov. 9-13. For more news and research from the ACAAI Scientific Meeting, go to our newsroom and follow the conversation on X/Twitter #ACAAI23.
About ACAAI
The American College of Allergy, Asthma & Immunology (ACAAI) is a professional medical organization of more than 6,000 allergists-immunologists and allied health professionals, headquartered in Arlington Heights, Ill. Founded in 1942, the College fosters a culture of collaboration and congeniality in which its members work together and with others toward the common goals of patient care, education, advocacy, and research. ACAAI allergists are board-certified physicians trained to diagnose allergies and asthma, administer immunotherapy, and provide patients with the best treatment outcomes. For more information and to find relief, visit AllergyandAsthmaRelief.org. Join us on Facebook, Pinterest, Instagram and X/Twitter.
JOURNAL
Annals of Allergy Asthma & Immunology
ARTICLE TITLE
EASING THE CONVERSATION: CANNABIS EDUCATION FOR ALLERGISTS
ARTICLE PUBLICATION DATE
9-Nov-2023
Survey reveals 42% of primary care physicians are unfamiliar with biologics to treat asthma
82% of PCPs do not get labs to help determine treatment options
Peer-Reviewed PublicationANAHEIM, Calif. (Nov. 9, 2023) – Biologics for the treatment of asthma were first introduced about 20 years ago. Since then, more and more people with asthma have found them to be an effective treatment in getting their symptoms under control. A new study being presented at this year’s American College of Allergy, Asthma and Immunology (ACAAI) Annual Scientific Meeting in Anaheim, Calif. shows that 42% of the primary care physicians (PCPs) surveyed were unfamiliar with asthma biologics. They didn’t know the criteria for starting them – including the need for lab work - and often waited until a patient had experienced two or more exacerbations in a year before referring to an asthma specialist.
“We know that many people who suffer from asthma are regularly seen by PCPs, and we wanted to know if PCPs were familiar with biologics to treat asthma,” said Bijalben Patel, MD, lead author of the study. “We also wanted to explore at what point PCPs were referring asthma patients with uncontrolled symptoms to asthma specialists, and whether they were aware of eligibility requirements for a patient to start biologic treatment.”
The survey was sent via email to primary care, attending and resident physicians in the departments of Internal Medicine, Family Medicine and Pediatrics. Of the 85 PCPs surveyed, 77% referred to specialists after two or more exacerbations per year, 42% were unfamiliar with biologics, 82% do not get labs, and 90% do not use absolute eosinophil count (a test for levels of a certain type of white blood cell that is active in allergic conditions) to guide management.
“The results of the survey point to the need to improve the communication between primary care physicians and asthma care specialists, including regarding use of biologics,” said allergist Juan Carlos Cardet, MD, MPH, ACAAI member and senior author of the study. “Biologics have become an important tool in the treatment of asthma and other allergic diseases such as atopic dermatitis (eczema), chronic rhinosinusitis with nasal polyps and eosinophilic esophagitis, and can prevent substantial ill results from occurring in patients who are eligible for them.”
The researchers also found the frequency of PCP referrals to a specialist did not change familiarity with biologics or eligibility criteria. PCPs who saw asthma patients more frequently and those who referred patients to specialists were more likely to get lab work to manage asthma.
Abstract Title: Primary care physician referral patterns and awareness of biologic therapy for uncontrolled asthma
Presenter: Bijalben Patel, MD
For more information about asthma and allergies, or to find an allergist in your area, visit AllergyandAsthmaRelief.org. The ACAAI Annual Scientific Meeting is Nov. 9-13. For more news and research from the ACAAI Scientific Meeting, go to our newsroom and follow the conversation on X/Twitter #ACAAI23.
About ACAAI
The American College of Allergy, Asthma & Immunology (ACAAI) is a professional medical organization of more than 6,000 allergists-immunologists and allied health professionals, headquartered in Arlington Heights, Ill. Founded in 1942, the College fosters a culture of collaboration and congeniality in which its members work together and with others toward the common goals of patient care, education, advocacy, and research. ACAAI allergists are board-certified physicians trained to diagnose allergies and asthma, administer immunotherapy, and provide patients with the best treatment outcomes. For more information and to find relief, visit AllergyandAsthmaRelief.org. Join us on Facebook, Pinterest, Instagram and Twitter/X.
PRIMARY CARE PHYSICIAN REFERRAL PATTERNS AND AWARENESS OF BIOLOGIC THERAPY FOR UNCONTROLLED ASTHMA
B. Patel*1, P. Bradford2, J. Cardet2, D. Ledford2, L. Guerra2, R. Plant2, K. Trasmonte2, P. Sriaroon3, B. Flam2, 1. Riverview, FL; 2. Tampa, FL; 3. St Petersburg, FL.
Introduction: Asthma is a common chronic airway disease causing more than 10,000,000 exacerbations per year in the US. Most patients with uncontrolled asthma are seen by primary care clinicians (PCP) and not by asthma care specialists who are trained in biologic therapy that is proven to decrease asthma exacerbation rates. Here we describe PCP referral patterns, their familiarity with biologic therapy, and their use of lab work in asthma management.
Methods: A REDCap survey was administered by email to primary care attending and resident physicians in the Departments of Internal Medicine, Family Medicine, and Pediatrics. Responses were compared using Chi-square tests.
Results: Of the 85 PCPs surveyed, 77% referred to specialists after 2+ exacerbations per year, 42% were unfamiliar with biologics, 82% do not get labs, and 90% do not use absolute eosinophil count to guide management. The proportion of PCPs unfamiliar with biologics (p=0.185) and their eligibility criteria (p=0.383) did not vary based on the number of asthma patients seen per month. Also, the frequency of PCP referrals to a specialist did not change familiarity with biologics (p=0.260) or eligibility criteria (p=0.393). PCPs who saw asthma patients more frequently and those who referred patients to specialists were more likely to get lab work to manage asthma (p=0.020 and p=0.029, respectively).
Conclusion: Most PCPs are unfamiliar with asthma biologics, their initiation criteria, including lab work, and often wait until 2+ exacerbations per year before referral to an asthma specialist. PCP education could increase access to biologic therapy and thus decrease asthma exacerbations in the US.
JOURNAL
Annals of Allergy Asthma & Immunology
METHOD OF RESEARCH
Survey
SUBJECT OF RESEARCH
Not applicable
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