Kate Johnson

February 13, 2013

SAN ANTONIO, Texas — The mystery of allergic sensitization and the elusive inducement of tolerance will be the twin topics of the presidential plenary here at the American Academy of Allergy, Asthma & Immunology (AAAAI) 2013 Annual Meeting.

Immunotherapy, both oral and sublingual, has taken central stage in the field, said Stuart Abramson, MD, PhD, chair of the AAAAI Scientific Program Committee.

"This is a really hot area. We want to know how we can prevent, potentially, the development of allergic disease and then how we can induce tolerance," he told Medscape Medical News. "At the moment, our best management of food allergy is avoidance, but we're looking for new approaches that could involve the induction of tolerance," he explained.

During the presidential plenary, A. Wesley Burks, MD, will tackle that notion in an address entitled "Immune Tolerance and Allergy: Can We Produce True Tolerance?"

Dr. Stuart Abramson

Dr. Burks provided a sneak peek at his answer to this question, acknowledging that the possibility of inducing tolerance is real. "It may be possible, but we have a lot to learn," he told Medscape Medical News. "Tolerance may be different for different diseases," such as allergic rhinitis and food allergy.

Dr. Burks and others will be presenting data on food allergy immunotherapy, both oral and sublingual, during an oral abstract session.

Dr. Wesley Burks

"The studies continue to remain positive. It gives us even more promise that something is going to change pretty soon," he said, adding that the debate continues over whether sublingual or oral immunotherapy is better. "It depends who you talk to — everyone has a personal opinion on that right now," Dr. Burks explained.

The role of air pollutants in the potential induction of allergy and asthma will be the subject of another plenary address. The talk will explore epigenetics — how the environment affects gene expression and the development of asthma and allergic disease. The effects of exposure to polycyclic aromatic hydrocarbons (abstract 197) and dichlorophenol (abstract 705) will be investigated in oral abstract sessions.

"There's been some work before this on diesel exhaust particles and how they can actually induce allergic antibodies in nasal secretions. When you add an allergen, you get a much more robust sensitization and allergic reaction," said Dr. Abramson. "Now we're following that same line, but with other substances, such as polycyclic aromatic hydrocarbons and chlorophenols in herbicides and pesticides."

Making its debut in the AAAAI scientific program this year is the term "microbiome," with a keynote address entitled "Dining in with Trillions of Fascinating Friends: The Microbiome in Health and Disease." Dr. Abramson explained that "this is a really hot area that overlaps with infectious disease.... The bacteria that normally inhabit our bodies may not be pathogenic, but if you're missing some of them, that may have a role in a variety of disease processes. You might be more prone to developing severe eczema, atopic dermatitis, or autoimmune gut diseases (such as Crohn's disease or ulcerative colitis), and there may be a role for probiotics."

Indeed, the microbiome link between antibiotic exposure and the risk for food allergy will be explored in a late-breaking oral abstract (abstract L14).

"There have been no previous studies looking solely at the association between antibiotic exposure and development of food allergy that we are aware of," lead investigator Bryan Love, PharmD, from the South Carolina College of Pharmacy in Columbia, told Medscape Medical News. "We believe it may be related to a disruption of normal gut flora."

Late-Breakers

In another late-breaking oral abstract session, phase 3 data will be presented that shed light on the safety and efficacy of omalizumab for the treatment of chronic idiopathic or spontaneous urticaria. Omalizumab is an alternative to antihistamine therapy, which many patients are refractory to (abstract L3).

"The late-breaking abstracts undergo a little more scrutiny.... We don't want them to be just abstracts that are submitted late," said Dr. Abramson. "They have to be something that we feel is of importance to the academy and, for whatever reason, the data were not fully analyzed at the time of the original abstract deadline."

Penicillin Allergy

Investigators at the meeting will also explore penicillin allergy. "Approximately 85% of patients who have been penicillin-allergic lose that allergy over a 10-year period, so it is not a lifelong hypersensitivity," Dr. Abramson explained.

For clinicians and patients, testing the boundaries of penicillin sensitivity can be risky, but research will be presented that describes how to safely confirm or rule out penicillin allergy with skin testing (abstract 829).

"Allergists have been concerned because the minor determinants — penicilloate, penilloate, and amoxicillin — are not available in the United States in commercial form for skin testing," study coauthor Eric Macy, MD, from the Southern California Permanente Medical Group in San Diego, told Medscape Medical News. "This is an important large real-world confirmatory study that explores whether penicillin skin testing can be safely done using only materials commercially available in the United States," he explained.

This is an original study with a large number of subjects; to date, studies on this topic have involved very few patients, Dr. Abramson pointed out.

Cancer Vaccines

The Cutting-Edge Research Keynote will touch on another brand new area for the AAAAI meeting, Dr. Abramson said.

Dr. Larry Kwak

Larry Kwak, MD, PhD, from the University of Texas M.D. Anderson Cancer Center in Houston, will deliver an address entitled "Personalized Vaccine Therapy as a Strategy for Prevention of Cancer Relapse."

Dr. Kwak was named one of Time Magazine's 100 most influential people in 2010 for his development of a personalized vaccine for follicular lymphoma. The vaccine, known as BiovaxID (BioVest International), was granted orphan drug status in 2010 by the US Food and Drug Administration.

The vaccine induces cellular immunity and is personalized for each patient. In a study presented at the 2009 annual meeting of the American Society of Clinical Oncology (ASCO), as reported at that time by Medscape Medical News, median disease-free survival was significantly better in patients randomized to receive the vaccine than in those who were not (44.2 vs 30.6 months; hazard ratio, 0.62; = .047).

In addition to the keynotes, plenaries, oral abstracts, and poster sessions, this year's program involves symposia, hands-on workshops, seminars, question and answer sessions, and case-report discussions, said Dr. Abramson. "There are a lot of different venues, which will make this a very rich and rewarding meeting."

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