Kate Johnson

February 17, 2015

HOUSTON — Technological advances are transforming how many physicians think about allergy and asthma. Delegates attending this year's American Academy of Allergy, Asthma & Immunology (AAAAI) conference will hear how the microbiome could change disease management.

"They're now using DNA techniques, measuring certain types of RNA that only occur in bacterial or viral species," meeting program chair Paul Williams, MD, from the Northwest Allergy & Asthma Center in Mount Vernon, Washington, told Medscape Medical News.

"There are millions of organisms inhabiting the gastrointestinal tract that we didn't know about," he explained. "It's not only the species that is important; even the strain of bacteria and the collection are important because they interact with each other and they interact with diet. All of that plays a role in inflammation and immune response."

During the meeting, delegates will be guided through the hygiene hypothesis to the more murky details of the link between gut microflora and asthma and allergies.

A plenary will look at how the microbial environment influences the development of allergic diseases, an oral abstract session will highlight some of the links between infant and maternal microbiome and allergen exposure, and a translational symposium will examine how microbiome discoveries could guide future probiotic regimens for the treatment and prevention of food allergy and atopic dermatitis.

There are millions of organisms inhabiting the gastrointestinal tract that we didn't know about.

"The concept of the microbiome and the gut is getting another wave, if you will, because there's more science now. It's a very trendy topic," said Mary Beth Fasano, MD, from the University of Iowa Carver College of Medicine in Iowa City, who is vice chair of the annual meeting program subcommittee.

Gideon Lack, MD, from Guy's and St Thomas' NHS Foundation Trust in London, United Kingdom, will present much-anticipated results from the Learning Early About Peanut (LEAP) study.

LEAP Results

"The LEAP study was based on the hypothesis that early feeding of foods reduces the development of allergy," Dr Williams explained. "There have been smaller studies and epidemiologic studies that suggest this, but this is the first controlled study."

Immunotherapy will also be the subject of an oral abstract session. Newer epicutaneous and intralymphatic forms of delivery will be presented and discussed along with the more recognized oral and sublingual forms of immunotherapy.

And two debates on immunotherapy promise to stimulate some lively discussion.

In one, David Fitzhugh, MD, from Chapel Hill, North Carolina, will argue in favor of prescribing injectable epinephrine to all patients on subcutaneous allergen immunotherapy, and David Bernstein, MD, from Cincinnati, will argue against.

In the other, James Baker, MD, from Lake Oswego, Oregon, will argue that oral immunotherapy for food allergy is ready for prime time, and Robert Wood, MD, from Johns Hopkins Hospital in Baltimore, will argue against.

These debates, as well as about 40 other sessions at the meeting, will be incorporating "interactive learning strategies," a new initiative by the AAAAI to use educational innovation in the form of audience response systems using smartphones, flipped classroom learning techniques, Q&A workshops, and case-based discussions, Dr Williams explained.

Another focus at the meeting will be Ebola. Nancy Sullivan, PhD, from the National Institute of Allergy and Infectious Diseases, will talk about the Ebola vaccine, which went into human trials this month.

"Although the number of reported cases and deaths from Ebola virus are starting to wane, Dr Sullivan was absolutely instrumental in developing the vaccine and will discuss vaccine development for emerging infections," Dr Fasano told Medscape Medical News.

Asthma Type to Map Treatment

A presentation on the task of classifying heterogeneous forms of asthma into distinct phenotypes is designed to guide delegates "From Bench to Guidelines."

The identification of associations between biomarkers and ideal therapy will help patients, said Dr Williams.

To this end, Stanley Szefler, MD, from Denver, will address the use of therapies based on biomarkers, phenotypes, and endotypes, and Mario Castro, MD, from Washington University in St Louis, will discuss guideline recommendations and emerging treatments for severe asthma.

"I think that in the next couple of years, this science will translate into a doctor being able to tell patients what type of asthma they have and the best cocktail of medications to take," Dr Fasano said.

"People continue to identify certain biomarkers and patterns of cytokines that seem to better identify different types of asthma," she explained. "If we can classify or phenotype someone's asthma, we could really provide focused therapeutic care."

Dr Williams and Dr Fasano have disclosed no relevant financial relationships.


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