Immunotherapy Tablet Gives Fast, Durable Relief From Grass Allergens

From Reuters Health Information

By Scott Baltic

NEW YORK (Reuters Health) Sep 29 - A high-dose sublingual tablet containing allergens produced by the pollen of five grass species significantly decreases common allergy symptoms compared with placebo, from the first month of treatment forward, according to a report in the September issue of the Journal of Allergy and Clinical Immunology.

The immunotherapy tablet, Oralair Grasses, includes allergen extracts from five grasses: orchard, meadow, perennial rye, sweet vernal and timothy grasses. Oralair Grasses is manufactured by Stallergenes, Antony, France and marketed in Europe. It is not yet approved for use in the United States.

The tablet is safe and easy for patients to use, Dr. Friedrich Horak of the Medical University of Vienna, Austria told Reuters Health by e-mail, and is potent over a short treatment period, though only for grass pollen allergies. The once-daily treatment, he added, gives the advantage of good patient compliance.

The study is reportedly the first to evaluate the efficacy and onset of action of this desensitization tablet in an allergy challenge chamber. The chamber provides controlled conditions for measuring individuals' responses to a specific allergen concentration for a set period of time.

The randomized, placebo-controlled, double-blind trial recruited 89 participants between 18 and 50 years of age with histories of seasonal grass-pollen allergies. The 45 subjects in the treatment group received one immunotherapy tablet daily for the four month trial period.

Each participant underwent a two-hour baseline grass-pollen allergen challenge in the chamber before treatment began, and then again at one week and one, two and four months after starting treatment.

The primary outcome was the participants' average rhinoconjunctivitis total symptom score, which measures sneezing, runny nose, itchy nose, nasal congestion, itchy eyes and tearing.

A statistically significant improvement was seen in the treatment group after the first month, which was maintained at two and four months. Further, the total symptom score in the treatment group decreased at each successive challenge. In the patients showing the best clinical response to treatment, specific IgG (but not IgE) values were higher.

There were no serious adverse events.

J Allergy Clin Immunol 2009;124:471-477.

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Updated September Schedule for Allergy Shots

We will not be giving allergy injections on these dates.

September 7, 2009, Closed

September 16, 2009, Closed after 12 Noon

Nasal Provocation Test Useful in Diagnosing Latex Allergy

Latex allergies affects many workers(especially health workers), and has a significant impact on productivity and loss of work. There is no commercially available diagnostic method to confirm IgE-mediated latex hypersensitivity. Allergy specialist in the community have tried the latex glove test but has poor validity, and serum IgE titers to latex can be ordered but has poor sensitivity. A latex allergen skin prick test has been used for investigational purposes but is not commercially available. The nasal provocation test is interesting but requires further studies.

From Reuters Health Information

NEW YORK (Reuters Health) Jul 21 - The nasal provocation test is more sensitive than the glove test for diagnosing natural rubber latex allergy, according to a report in the June issue of Allergy.

However, a standard nasal provocation method has yet to be established, according to Dr. Mehmet Unsel and researchers from Ege University Medical Faculty, Izmir, Turkey.

The nasal provocation test was positive in 84.6% and negative in 15.4% of patients with positive skin prick test to natural rubber latex, the authors report, compared with 50% positive and 50% negative glove responses.

Nasal provocation test results were negative in patients with positive skin prick tests to other inhaler allergens and in a control group with no allergic diseases.

Using skin prick test positivity to natural rubber latex and a history of natural rubber latex-associated rhinitis as the gold standard for diagnosing natural rubber latex allergy, nasal provocation test had a sensitivity of 96%, specificity of 100%, negative predictive value of 98%, and positive predicative value of 100%, the investigators note.

In comparison, the glove use test had a sensitivity of 81%, specificity of 90%, negative predictive value of 75%, and positive predictive value of 93%.

"Nasal provocation test was successfully used for the first time in the diagnosis of natural rubber latex allergy," the authors conclude.

Allergy 2009;64:862-867.

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Allergy Control Products

A reader asked where one can obtain the dust mite pillow and mattress encasings. There are several vendors that sell their products in the internet. Most of my patients have obtained their allergy control supplies from these sites.

Allergy Control Products

National Allergy

These encasings have evolved over the past decades. In the past, recommendations were made to wrap one's mattress and pillow with plastic. Now, who can sleep with plastic wrapped on your bed and pillow? The newer encasings are tightly woven sheets that breathe just like regular fabric, and serve as an excellent barrier to getting exposed to the dust mite allergen(excretions).

As a disclaimer, I do not have any financial relationship with these companies and have nothing to gain financially from this posting. Just glad that I can help

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Dust Mite Allergen Avoidance

A lot of times after allergy skin testing, when a patient finds out one is allergic to dust mite allergen the usual reaction is eeek! And then the patient asks if these microscopic insects bite. So, here is the low down on the dust mite allergen.

When we are told that we are allergic to the dust mite allergen it means that we are allergic to the dust mite excretions. Dust mites feed on our skin flakes. They do not bite. We spend at least 8 hours a day in our beds. Thus, the highest concentration of human skin flakes are in our beds, and therefore, the highest concentration of dust mites and their excretions will be in our beds. That is why when we give environmental control recommendation for dust mites we focus on the premise of minimizing exposure to the dust mites and their excretions.

Avoidance measures that have been shown to be effective in dust mite allergen control.

• Pillow, mattress and box-spring allergen proof covers. These tightly woven dust mite encassements serve as a barrier method to prevent exposure to the allergen. Getting a new mattress is not a viable method since it will be repopulated with dust mites an a few months.
• Wash beddings frequently in hot water(130 degrees F) or use special detergents that remove allergens(eg. Allersearch allergen wash)
  
• Choose wood or tiled floors instead of carpeting
• Use vacuum cleaners with a HEPA filtration system or one with double-lining bags. Vacuum at least twice a week
• Use a dehumidifier in conjunction with your air-conditioner. Maintain humidity levels between 30-50% year round.

A link to the AAAAI is available on indoor allergen control. Ask your allergist for more information on dust mite control.

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Australian Army Fined $200K over Teen's Peanut Allergy Death

We need to be constant advocates for those who suffer from food allergies. One death is too many. Read the article below taken from the Fairfax Digital Network

Army fined over teen's peanut allergy death
Fairfax Digital Network
By Selma Milovanovic
June 30, 2009

The Australian Army has been fined more than $200,000 over the death of a teenager from a peanut allergy at a cadets' school camp in May 2007.

Nathan Francis, 13, was a year nine student at Scotch College.

Regardless of his mother writing to the camp organisers that Nathan suffered from a severe peanut allergy he was given a lunch of beef satay on the first day of the camp and died shortly after.

In the Federal Court this morning, Justice Tony North ordered that the Commonwealth should pay $210,100 to the public purse.

The case came about when Comcare, a government workplace safety agency, sued the Commonwealth for a breach of the Occupational Health and Safety Act.

The Commonwealth, through the Chief of Army, was responsible for running the camp.

Justice North urged that the Victorian Coroner hold an inquest into Nathan's death to examine the role of Scotch College and its staff who manned the camp.

The school has promised to take steps to prevent the recurrence of another incident on the same camp in which six boys were lost in the forest for hours without radio contact.

Justice North adjourned that undertaking for one year.

The court heard WorkSafe Victoria had decided not to prosecute the school.

Justice North described the case as "every parent's worst nightmare" and commended Nathan's parents, Brian and Jessica, for their bravery during the proceedings.

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