Laird Harrison

February 20, 2014

SAN DIEGO — As sublingual immunotherapy nears regulatory approval by the US Food and Drug Administration (FDA), experts presenting at the American Academy of Allergy, Asthma & Immunology 2014 meeting will offer insight into the new approach.

After an FDA panel recommended approval in December, organizers of the meeting, which will run from February 28 to March 4, added a March 1 workshop on implementing, in practice, sublingual immunotherapy of under the tongue allergen extracts of grass (Grastek, Merck Sharp & Dohme; Oralair, Stallergenes) for people with allergies to specific pollens.

"This is evidence-based medicine," Stuart Abramson, MD, chair of the meeting program committee, told Medscape Medical News. "These have been used in Europe for some time."

One of the conference plenary sessions will take a broad look at the fast-moving field of immunotherapy and will offer an overview of mechanisms and present data on safety and efficacy. The field will also figure prominently in the abstracts being presented in oral and poster sessions.

The approach is showing promise, not only as a sublingual desensitization for pollen, but through the oral route for food allergies, said Dr. Abramson, who is head of allergy and immunology at the Shannon Medical Center in San Angelo, Texas.

Desensitizing Approach

"We have always said to avoid foods that you might be allergic to, but there may be a way we can desensitize individuals with oral immunotherapy using a particular regimen," he said. "This is still in clinical trials, so it's not a commonly accepted process yet, but once you reach a high level, there appears to be maintenance of desensitization that lasts for years."

The meeting will feature multiple presentations on vitamin D, with 5 seminars providing an overview of the nutrient's role in allergies and asthma. In addition, results will be presented from 12 studies that explore correlations between vitamin D and asthma in children, the elderly, and various ethnic groups; dust-induced bone loss; urticaria; atopic dermatitis; and outdoor allergens.

"There is growing evidence to suggest that low vitamin D is associated with asthma prevalence and severity," Reynold Panettieri Jr., MD, told Medscape Medical News.

Dr. Panettieri, who is director of the comprehensive asthma program at the University of Pennsylvania Health System in Philadelphia, will talk about vitamin D in a symposium on treatment alternatives for refractory severe asthma.

Role of Vitamin D

He acknowledged that most of the evidence for the vitamin's benefits comes from epidemiologic studies and a few randomized controlled trials of supplementation, but he said he believes there is enough information for clinicians to act.

"We routinely check all our asthma patients' levels of vitamin D," he said. "It's our hypothesis that improving vitamin D levels, and even bringing them up to top levels, could have an anti-inflammatory effect on the airways, and might make steroids work better."

Vitamin D is not the only nutritional strategy to be explored at the meeting. Other researchers will present studies on the potential benefits of phytoestrogens and omega-3 fatty acids.

Analyzing patients' nutritional deficiencies fits into a larger theme at the meeting — personalized medicine.

In the March 1 plenary session, Sally Wenzel, MD, director of the Asthma Institute at the University of Pittsburgh, will talk about her proposal to classify asthma into endotypes with different causes.

Other researchers will present findings from the field of genetics. The first of 2 keynote speakers is Eric Topol, MD, from the Scripps Research Institute in La Jolla, California, and editor-in-chief of Medscape. Dr. Topol will speak about the role of genomic and wireless digital innovations in reshaping the future of medicine.

The second keynoter will be James Baker Jr., MD, director of the Michigan Nanotechnology Institute for Medicine and Biological Sciences in Ann Arbor. He will speak on nanotechnology applications in immunology and allergy.

Organizers report that they are also ramping up efforts to help participants meet certification requirements. This year, for the first time, some sessions will help physicians meet their requirements for practice assessment and quality improvement activity as part of the maintenance of certification program of the American Board of Allergy and Immunology.

The pilot programs won't count for certification at this meeting, but they will give organizers an idea of how to design more interactive workshops at future meetings. For example, participants might meet in a group to discuss plans for collecting and analyzing data about their practices. As Dr. Abramson explained, "programs that can adapt to more active learning is where we're headed."

Dr. Abramson and Dr. Panettieri have disclosed no relevant financial relationships.

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