Monday March 19, 11:12 am Eastern Time
Press Release
SOURCE: American Academy of Allergy, Asthma and Immunology
New Asthma, Allergy Treatments Unveiled at AAAAI
Annual Meeting
Inhaled Corticosteroids Do Not Contribute to Osteoporosis in
Post-Menopausal Women
NEW ORLEANS, March 19 /PRNewswire/ -- Inhaled corticosteroids were not found to
decrease bone density in post-menopausal women, researchers announced today at the
American Academy of Allergy, Asthma and Immunology (AAAAI) Annual Meeting.
Corticosteroids are anti-inflammatory medications frequently used to treat asthma and other
respiratory disorders. Long-term use of corticosteroids in oral form has been linked to
adverse effects, including osteoporosis. Researchers in Sweden at Lund University and
Goteborg University, led by Solve Elmstahl, MD, PhD, sought to understand if inhaled
corticosteroids also produced a decrease in bone density.
Among the sample group of post-menopausal women, 106 had been using inhaled
corticosteroids; 49 had been using oral, inhaled and intra-articular injections; and 674 had
not been using any form of corticosteroids. Researchers collected health, dietary and
medication information, and performed forearm bone density scans on the women.
No difference in bone density measurements was found between the group of women using
inhaled corticosteroids and the group that had no usage. In the former group, no relationship
was found between inhaled corticosteroid dose levels and bone density further underscoring
the relative safety of this form of corticosteroid. As suspected, bone density was found to be
lower among the women using oral corticosteroids.
Youth asthma management program decreases ER visits and absenteeism, raises grades
The frequency of asthma symptoms, reliance on ``rescue'' medications and absenteeism all
decreased at a public middle school in Detroit after asthmatic students participated in a
year-long program teaching them how to better manage their condition. These results were
released today at the Annual Meeting of the AAAAI.
Of the 1,100 students in the school, 100 were identified as asthmatic. Poorly managed
asthma can result in increased absences and an inability to fully participate in school. Drs. S.E. Chatman and T.H. Joos at St.
John's Hospital in Detroit, worked with the school to design a program to enhance asthma education and management among
students and their parents.
A five-part plan was created consisting of: identifying of potentially asthmatic students; evaluating their physical health and lung
function; prevention/education whereby a student asthma club met monthly for one hour to discuss issues such as the definition
of asthma, triggers, proper use of medication and peak flow meters and when to seek help; providing students with appropriate
management tools and medications; and parental education.
The results of this program, analyzed after one academic year, were very favorable. A total of 89.7% of students had increased
their average peak flow readings (a measure of lung function) by 15%, weekly ``as needed'' use of rescue inhalers decreased
by 17% and emergency room visits decreased by 6%. More than 80% of students who received nebulizer treatments at school
for acute asthma attacks were able to return to the classroom. Grade point averages among this group increased from an
average of 1.85 to 2.52 (36%). The program enhanced student compliance, heightened their awareness of the disease and
enhanced their ability to fully participate in school.
Incentive program improves spirometry/medication compliance among asthmatic youth from low socioeconomic backgrounds
Medication compliance among asthmatic youth from low socioeconomic status (SES) backgrounds increased when usage was
coupled with an incentive program at school, according to a study presented today at the AAAAI Annual Meeting. Trends
show that asthma morbidity and mortality rates have increased in inner city populations and that children from low SES
backgrounds have been shown to have lower rates of compliance with asthma medications, a fact that may contribute to these
increasing rates.
In an earlier study, researchers at National Jewish Medical and Research Center in Denver, CO, set up a school-based
medication compliance program with a group of 40 primarily minority asthmatic children from low SES families. The children
were instructed to perform a pulmonary function test using a spirometer twice daily, once during school hours under staff
supervision and once at home. Points toward prizes (puzzles, books, gift certificates) and positive reinforcement at school were
used to encourage home compliance. Researchers found that at-home compliance was higher when school was in session
(51% compliance vs. 44%).
Twelve of the 40 participants were then recruited for this medication compliance study. Six of the 12 children were given points
for home inhaled steroid use and positive reinforcement at school. The other six served as the control group and received no
reinforcement. Electronic counters were placed on the inhalers to measure daily dosage. The compliance of the control group
dropped from 72% in week one of the study to 51% in week 5 of the study. The compliance of the group receiving
reinforcement remained unchanged at 67%.
The researchers concluded that in asthmatic children from low SES backgrounds, school interventions consisting of small
incentives and positive reinforcement can significantly increase compliance over a five-week period. Daily interaction is required
to optimize this effect.
Floating an inhaler to determine medication remaining can be deceiving
Patients using inhaled medications often will attempt to determine the amount of medication remaining in a canister by floating it
in water. Depending on the orientation of the canister, the patient then estimates the amount of medication left. Researchers
speaking at the Annual Meeting of the AAAAI today unveiled the results of a study which showed that floating is not an
accurate means to identify how much medication a patient has remaining. W. Travis Cain, MD, of Overlook Hospital in
Summit, NJ and John J. Oppenheimer, MD, of Pulmonary and Allergy Associates in Springfield, N.J. floated 45 metered dose
inhalers (MDI), both CFC and non-CFC propelled, prior to use. They actuated each device into free air at 2-minute intervals.
Each device was then floated in tap water following 25%, 50%, 75% and 100% of the prescribed number of actuations. The
canisters were actuated until no visible spray was produced.
Each of the three brands of MDIs tested had a unique floating pattern both prior to actuation and at each of the testing levels.
The researchers concluded that floating is not an accurate means by which patients can identify the amount of medication
contained within an inhaler device. Inhaled medications are critical in providing long-term control and rescue relief during an
attack. Relying on the float test to determine the amount of medication remaining is an inaccurate and potentially dangerous
proposition for asthmatics.
Mouse Allergen in Low-Income New York City Apartments Increases Asthma Risk
Mouse allergen is prevalent in inner-city apartments. Children living in these homes are exposed to mouse allergens from
infancy, thus increasing their risk for developing allergic sensitivity to mice, according to researchers at the AAAAI Annual
Meeting.
Although mouse allergen is associated with asthma in laboratory workers who handle animals, very little information is available
about mouse allergen in inner-city homes. Ginger L. Chew, ScD and colleagues from the Mailman School of Public Health at
Columbia University collected dust samples from the kitchens and beds of 122 homes of pregnant women, finding that
one-third (40) of the kitchen samples and 12% (15) of the bed samples had significant levels of mouse allergen. Close to 80%
of the households in the study reported an income below $20,000. The most predictive variables of mouse allergen levels in the
kitchen were whether the women had seen rodents and how many times they had seen them. The prevalence of mouse allergen
in the homes of pregnant women indicates that infants born into these homes will have long durations of exposure to the
allergens, researchers concluded.
Antihistamines take the bite out of mosquito allergy
Individuals sensitive to mosquitoes may find relief from skin reactions by taking antihistamines as a preventive measure,
according to a study by Finnish researchers presented today at the AAAAI Annual Meeting.
Researchers from the University Hospital of Tampere and National Public Health Institute led by Ari Tapani Karppinen, MD,
have previously shown that symptoms can be alleviated in adults with the drugs ceterizine and ebastine and in children with
loratadine. In this study, 27 mosquito bite allergic individuals received ceterizine, ebastine or loratadine each for four days on
consecutive weeks. Subjects were then exposed to mosquitoes to induce a bite. Researchers observed the size of the bite
lesion and pruritus (itching). Ceterizine and ebastine had the most significant effect on bite lesions and pruritus. Ceterizine had
the most marked effect on pruritus compared to other antihistamines, but also caused sedation in eight subjects.
Immunotherapy improves quality of life
Venom immunotherapy results in an improvement in the health-related quality of life in individuals allergic to insect stings,
researchers from the Netherlands and Canada said at the AAAAI Annual Meeting today.
Venom immunotherapy has been proven to be one of the most effective methods of prevention for anaphylactic reactions to
insect stings. (Anaphylaxis is a systemic allergic reaction that, in some cases, can be fatal.) The goal of venom immunotherapy is
to reduce symptoms from subsequent insect stings, and thus, prevent anaphylactic reactions. Researchers from University
Hospital of Groningen and McMaster University, led by Hanneke Oude Elberink, MD, compared the effects of immunotherapy
to patients carrying an Epipen® (injectable epinephrine, the treatment of choice for anaphylaxis) on health-related quality of life.
Patients who were sensitized to yellow jacket venom and had experienced an anaphylactic reaction following a yellow jacket
sting were given standardized information about the severity of their condition. Patients were asked whether they consented to
be randomized to treatment with venom immunotherapy or an Epipen®. Of the 101 patients, 50 received immunotherapy and
51 received Epipens®. Health-related quality of life scores were compared before treatment and after one year. After one year
of treatment the quality of life scores improved in the immunotherapy group and deteriorated in the Epipen® group.
Researchers found that for every three patients treated with immunotherapy, two experienced an improvement in health-related
quality of life. Treatment with an Epipen® in the absence of immunotherapy is not sufficient to prevent deterioration of
health-related quality of life.
Treatment attacks psoriasis on a molecular level
Psoriasis symptoms can be alleviated with Xanelim(TM) (efalizumab), one of a new class of targeted monoclonal antibody
drugs, researchers said at the AAAAI Annual Meeting. Additionally, Xanelim, also known as anti-CD11a, has demonstrated
the potential for treating other inflammatory diseases.
In prior studies, Craig Leonardi, MD, Radiant Research, St. Louis, and colleagues from throughout the United States, have
found that Xanelim injected intravenously reduced lymphocyte infiltration, epidermal hyperplasia and keratin 16 expression,
which are associated with the genesis of psoriasis. In this study, researchers sought to illustrate the safety and efficacy of
Xanelim. Patients received an initial dose of 0.7 mg/kg of Xanelim, followed by either 1 mg/kg (20 patients), 2 mg/kg (20
patients) or 4 mg/kg (21 patients) for 12 weeks. Seventy-five percent of psoriasis symptoms resolved in 30% of patients in the
1 mg/kg group, in 25% of those in the 2 mg/kg group and in 38% of the 4 mg/kg group. Xanelim was well tolerated in a
majority of patients in the study. The most commonly observed adverse events were headache, flu-like symptoms, and
psoriasis symptoms after completion of the treatment. No serious adverse events were reported in the study. Researchers
concluded that weekly injections of Xanelim for 12 weeks are convenient, well tolerated and provide marked improvement in
the signs and symptoms of moderate-to-severe plaque psoriasis.
Xanelim is currently in Phase III development for the treatment of moderate-to-severe plaque psoriasis, the most common form
of this chronic skin disease, characterized by inflamed patches of skin (``lesions'') topped with silvery white scales. Xanelim is
designed to inhibit the binding of T-cells to other cell types and target three key processes in the cascade of events that lead to
psoriasis symptoms. These processes include: T-cell binding through interactions with adhesion molecules on the endothelial cell
surface; trafficking of T-cells into the skin; and activation of T-cells, all which may be linked to the abnormal growth of skin
cells and the painful, elevated scaly patches of skin (lesions) typical among psoriasis sufferers. Psoriasis affects more than seven
million Americans in the United States.
These studies were presented at the 57th Annual Meeting of the AAAAI. The AAAAI is the largest professional medical
specialty organization in the United States representing allergists, asthma specialists, clinical immunologists, allied health
professionals and others with a special interest in the research and treatment of allergic disease. Allergy/immunology specialists
are pediatric or internal medicine physicians who have elected an additional two years of training to become specialized in the
treatment of asthma, allergy and immunologic disease. Established in 1943, the Academy has more than 6,000 members in the
United States, Canada and 60 other countries. The Academy serves as an advocate to the public by providing educational
information through its Web site at aaaai.org
SOURCE: American Academy of Allergy, Asthma and Immunology |
