New Research Results from American Academy of Allergy, Asthma, and Immunology (AAAAI) Annual Meeting

FAACT President and CEO, Eleanor Garrow-Holding attended the American Academy of Allergy, Asthma, & Immunology (AAAAI) Virtual Annual Meeting from February 25-28, 2022, in Phoenix, Arizona, as well as meeting with many of FAACT’s corporate partners, medical advisors, and colleagues.

Here are a few highlights of research discussed at the meeting.

Quick Check:

• Anxiety or Anaphylaxis? Many symptoms of anxiety/panic disorder – including breathing problems, nausea, dizziness, and numbness or tingling sensations – may be seen in allergic reactions to food.
• Unnecessary Food Allergy Tests: IgE food panels are often incorrectly ordered and over-ordered by non-allergists, leading to incorrect food allergy diagnoses, unnecessary food avoidance, and increased healthcare costs.
• Early Peanut Introduction: For infants with moderate to severe eczema, the odds of developing a peanut allergy increase 30% every month that parents delay introducing peanut into their baby’s diet after age 6 months. Despite evidence favoring early introduction, most parents introduce peanut at age 12 months. There are also racial disparities in understanding when it’s safe to introduce peanuts (white parents were more likely to believe early introduction was safe compared with other groups).
• Pediatric Knowledge Gap on Epinephrine: There is a knowledge gap in pediatricians’ use of epinephrine for management of anaphylaxis in both emergency department and outpatient care.
• Food Allergies and Food Insecurity: Households with a dual burden of food allergy and food insecurity may opt out of national food assistance programs due to fears/problems associated with food allergies.
• Delayed Reaction to Egg and Milk: Reactions that happen during baked egg and baked milk challenges are often more delayed than in other food challenges – 60 minutes or more after the product is eaten.
• Less Need for ER Visit: Patients have been told for years to head straight to the emergency room after using an epinephrine auto-injector. New evidence shows this might not be necessary. Researchers say post-reaction care can be done at home if risk factors for biphasic anaphylaxis (severe initial symptoms, wide pulse pressure, less than one epinephrine dose for initial management) and barriers to home observation (adult not trained in post-reaction care, no additional doses of epinephrine, and no access to emergency care) are absent.
• Eczema and Food Allergies: A recent study showed that changes in the skin barrier from atopic dermatitis (the most common cause of eczema) were associated with an increased risk for peanut and egg allergies – but not milk or soy allergies.
• Wheat Variables: Wheat allergy reactions in adults vary with the amount of wheat eaten, recent exercise, and the specific amount of exercise. Reactions to wheat may be more delayed than other foods.
• FPIES and Food Allergies: Infants with food protein-induced enterocolitis syndrome (FPIES) – a rare food allergy that affects the gastrointestinal tract – often also have IgE-mediated food allergies. Early introduction of solids is important for prevention.
• Dust Mite Allergy Mimics Food Allergy: Researchers traced a case of anaphylaxis after eating a funnel cake to dust mites in the flour. “One way hypersensitivity to mites can manifest is oral mite anaphylaxis, also called ‘pancake syndrome,’ which is an anaphylactic reaction that develops after ingesting foods contaminated with mites that is mediated by mite-specific IgEs.”
• No Headache: More than 80% of people with reported aspirin or NSAID allergy do not have reactions consistent with hypersensitivity.
• Fresh Is Best: Commercially available products intended for early introduction to food allergens often contain allergens at much lower levels than fresh foods and may not help develop a tolerance to that food.

Detailed Review:

New Peanut Therapy Predictors: New predictors of safety for peanut oral immunotherapy (OIT) in preschoolers will help physicians develop a personalized approach to OIT safety. Predictors analyzed included sex, age, reaction before OIT, atopic conditions, skin prick test size, time spent on OIT, the OIT starting dose, and minimum dose eliciting symptoms during OIT.

Oral Epinephrine Option: A phase 1 study showed that epinephrine can reach therapeutic concentrations in the bloodstream through sublingual (under the tongue) administration. The oral dose was quickly absorbed, in some cases even faster than through epinephrine auto-injectors, and was well tolerated. Aquestive Therapeutics is going into phase two testing of its EPIPHAST oral film.

Penicillin Challenge Safe for Children: Pediatric patients with traditionally “high-risk” reaction histories should not be excluded from penicillin allergy evaluation. Penicillin is the safest and most effective antibiotic for many infections, and 9 out of 10 patients who report being allergic to penicillin were not truly allergic when formally evaluated.

Covid-19 Vaccine Safe for Patients with Mast Cell Syndrome: Patients with suspected or confirmed mast cell activation syndrome (MCAS) – a medical condition that causes mast cells to release too many chemicals into the patient’s body, causing repeated episodes of anaphylaxis symptoms such as hives, swelling, low blood pressure, difficulty breathing, and severe diarrhea – can tolerate Covid-19 vaccination. Side effects were similar to people without MCAS.

Next year's annual meeting will be held in San Antonio, Texas. Visit AAAAI to learn more.