Marcia Frellick

October 18, 2017

BOSTON — With the recent sea change in the timeline of when to introduce potentially allergenic foods to children, the upcoming American College of Allergy, Asthma & Immunology (ACAAI) 2017 Annual Scientific Meeting will focus on making sure that allergists are prepared to explain the new guidelines to families.

Dr Todd Mahr

"We've done a 180. Parents used to be told, 'don't give your baby eggs or tree nuts or peanuts until they are 3 to 5 years of age'," said ACAAI Vice President Todd Mahr, MD, from the Gundersen Health System–La Crosse in Wisconsin. "Now, it's breast-feed until 4 to 6 months of age, and between 4 and 11 months of age, you should be introducing everything."

"Allergists are going to be looked upon to be experts in this field," he told Medscape Medical News.

In one study to be presented at the meeting, which will celebrate the seventy-fifth anniversary of the college, physicians were scored on their understanding of and adherence to the guidelines, and demographic and practice variations were calculated.

For those who need more information, a plenary session — moderated by Matthew Greenhawt, MD, director of the food challenge and research unit at Children's Hospital Colorado in Aurora — will be devoted to "demystifying" the early introduction of food to prevent allergy. Dr Greenhawt is "one of the leading experts in food allergy in the United States," said Dr Mahr.

These sessions are particularly important, Dr Mahr added, because at least one company is already marketing a peanut powder product that has qualified approval from the US Food and Drug Administration (FDA) to make the claim that it might reduce peanut allergies when given to infants.

The FDA still recommends that parents consult their child's healthcare provider first in some cases, so allergy specialists might find themselves fielding inquiries as such products hit the market, he explained.

Another national expert — Ruchi Gupta, MD, from Northwestern Medicine in Chicago — will report on the prevalence of food allergy in adults and present findings from a study of more than 50,000 adults looking at age of onset and type of allergies.

Asthma and Chronic Cough

Dr Bradley Chipps

Asthma is also a major focus of this year's meeting, and one highlight is a session on a proposed shift in the way adults are diagnosed and treated for chronic cough, said Bradley Chipps, MD, ACAAI president.

The proposal moves away from the anatomic approach and looks instead at cough reflex hypersensitivity and its triggers, Dr Chipps explained.

In addition, the controversial use of fractional exhaled nitric oxide as an indicator of inflammation in patients with asthma will be tackled at the meeting. The test results open up a window on what is happening in the lungs, but physicians disagree on their usefulness, said Dr Mahr.

A presentation on the effect of marijuana on patients with asthma or allergy is timely, as more states legalize recreational and medical use. There will also be presentations on the effects of e-cigarettes and hookah smoking on asthma.

Several sessions will focus on atopic dermatitis, and will examine infectious complications, the role of contact allergy, epidemiology, and cutting-edge treatments.

And two studies will be presented on the preventive effects of pet ownership on atopic dermatitis and asthma. One, a longitudinal birth cohort study, looks at the effects of prenatal dog exposure on eczema in children 2 and 10 years of age, and the other looks at the effects of animal exposure on inner-city children with asthma.

We need to be able to clear the sinuses with nonantibiotic and nonsteroidal medications, and keep them healthy.

Experts will also discuss alternative treatments for sinus disease, especially nonallergic sinus disease.

"Multiple courses of antibiotics are not the answer," said Dr Chipps. "We need to be able to clear the sinuses with nonantibiotic and nonsteroidal medications, and keep them healthy," he told Medscape Medical News.

Biologics for Difficult Cases

The use of biologics to help with difficult-to-treat cases of asthma — one of the hottest topics in the field — will be explored by speakers discussing the patient profiles that have the best response to the multiple biologics that have been approved, the latest clinical trials, and the way these drugs can change practice.

There will also be an exploration of biologics for the treatment of severe atopic dermatitis for patients who do not respond to current therapies, such as moisturization, topical corticosteroids, and topical calcineurin inhibitors.

Experts will share ways that clinicians can incorporate new targeted, systemic biologic therapies into treatment, and offer advice on ways to assess the severity of conditions.

Dr Mahr and Dr Chipps have disclosed no relevant financial relationships.

Follow Medscape on Twitter @Medscape and Marcia Frellick @mfrellick


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