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Babies’ exposure to farm animals may reduce bowel disease risk
Children who had regular contact with farm animals during the first year of their lives were about half as likely as other children to develop inflammatory bowel diseases (IBDs), Crohn's disease and ulcerative colitis, according to a German study in Pediatrics. Scientists at Ludwig-Maximilians-University in Munich compared IBD rates with infant exposure to farm environments, questioning parents of more than 2,200 German-born 6- to-18-year-olds. Of those, 304 had ulcerative colitis, 444 had Crohn's disease, and 1481 were healthy control subjects. Regular contact with farm animals during the first year of life was inversely associated with Crohn disease and ulcerative colitis. Early exposure to cattle specifically reduced risk of Crohn’s disease by 60 percent and ulcerative colitis by 70 percent.

Women more likely to have penicillin allergy
Female gender is an independent risk factor for penicillin allergy, according to a study in Annals of Allergy, Asthma, and Immunology. Researchers at Mayo Clinic, Rochester, Minn., determined rates of positive penicillin skin test (PST) results, according to gender, in patients with a history of penicillin allergy undergoing evaluation. They included 1,921 subjects. Of these, 1,759 underwent PST and 157 did not (five medical records were not available for review). The mean subject age was 60 years. The PST was positive in 64 patients. Of these, 53 were females and 11 males.

Direct-to-consumer drug ads continue to increase
Ten years after the U.S. Food and Drug Administration (FDA) began allowing direct-to-consumer advertising of prescription drugs on TV, spending on direct-to-consumer advertising continues to climb, despite criticisms against it. A moratorium on such ads, rather than restrictions, may be in order, according to the authors of a study in the New England Journal of Medicine. Researchers at the University of Pittsburgh Graduate School of Public Health looked at industry-wide trends in spending on direct-to-consumer advertising and promotion to physicians during the past decade. They also characterized types of drugs and timing after a drug is introduced, as well as the FDA’s trend in regulating pharmaceutical advertising. They found spending on direct-to-consumer advertising increased by 330 percent from 1996 to 2005, but this type of advertising made up only 14 percent of total promotional spending in 2005. Direct-to-consumer campaigns, on average, started within a year after product approval.

A message from ACAAI President Dr. Daniel Ein

You all, by now, should have received the Allergy Report, dealing with workforce issues in allergy/immunology. I hope you have read it, or at least glanced at it and its conclusions. The report highlights the growing discrepancy between demand for allergists and their supply and is meant to raise awareness that our specialty is in long-term potential trouble.

The report shows that the increased need for allergy services is due to growing population and increasing incidence of allergic diseases. The reduced availability of allergists can be traced to aging of the current practicing allergy community, retirement, and falling numbers of new allergists entering the system.

Some of the comments we have received have challenged the conclusions of the report. We are hearing about places in the United States where there seem to be too many allergists. Individuals are seeing fewer new patients, their schedules have more gaps and their incomes are falling. We acknowledge that the problems described in the report are not distributed homogeneously across the country, but vary depending on the location. There are a number of explanations why some allergists are seeing a declining patient base, including competition from ENT physicians and technological advances that have improved pharmacologic treatment of respiratory disease, allowing more patients to be cared for by primary care physicians. And the move of second-generation antihistamines to OTC status (cetirizine is to become OTC by the end of the year) will continue to erode the demand for our usual services.

So, are there solutions to the demand problems? I believe there are, but it will take work by us, the individual practitioners, and also by our specialty organizations. The quote below is from a reply I sent to Dr. James Kammermeyer, who worried about the future of the specialty. It identifies what I consider some, but not all, of the opportunities for our specialty, as well as outlines the plans the College has for addressing the issues raised by members and the Allergy Report.

“I also agree that we need to find new areas to call our own. We should pay more attention to contact dermatitis as the dermatologists lose interest. Jay Portnoy correctly intends to try to convince allergists to become the environmental doctors, during his Presidency. There are some encouraging possibilities in the eosinophilic disorders with new treatments (anti-IL5) due to become available and data is starting to come out about oral desensitization for food allergies (A. Wesley Burks, for example). Which brings me to something I believe you dismissed out of hand — SLIT. I believe we need to keep an open mind about SLIT. Studies are under way that should help establish its safety and efficacy. If it works, we must not let other specialties claim it as their own — which they are doing. You correctly pointed out the decreasing acceptability of SCIT to our patients, especially the younger ones. One solution is SLIT, if it meets our criteria for incorporation into our therapeutic arsenal. I personally think that, in principle, it is very attractive for patients who are phobic about injections, whose disease may be too mild for SCIT, for people for whom coming to the doctor is a hardship, possibly to treat food allergies, etc. We’ll see what the data shows.

We do need to do a better job letting the public and other physicians know what we do and how well we do it. We are therefore initiating an extensive (and expensive) public relations campaign that will last for a number of years and will hopefully have a positive result in our practices. I believe that people with allergic disease deserve our services, but first they need to know about them.”

You will be hearing more about our PR campaign as it evolves. We hope we can count on you to support it and to use it in the years ahead.

Hear from the experts: attend the ACAAI Annual Meeting named lectures
The ACAAI Annual Meeting in Dallas, Nov. 8-14, is chock full of practical scientific programs you and your patients can implement immediately. Hear what the experts have to say about hot topics in allergic diseases at the College’s named lectures, which include:

• Edward J. O’Connell Lecture
Saturday, Nov. 10: “Improving Safety in Allergy Practice” – Donald W. Aaronson, M.D., J.D.

• Bernard Berman Memorial Lecture
Saturday, Nov. 10: “Abnormal Antibody Responses: When to Intervene?” – Mark Ballow, M.D.

• John P. McGovern Lecture
Sunday, Nov. 11: “Allergy Skin Testing” –John J. Oppenheimer, M.D.

• Stanislaus Jaros Lecture
Monday, Nov. 12: “Drug Allergy – What Should We Do Without Pre-Pen?” – David A. Khan, M.D.

• Bela Schick Lecture
Tuesday, Nov. 13: “Mixing Science, Medicine and Politics” – Representative Steven L. Kagen, M.D. (D-Wis.-8th District)

Online registration for the ACAAI Annual Meeting is fast and easy. You can also view the preliminary program online and select from a variety of Workshops and Meet the Professor Breakfasts tailored to your needs.

Remember to register for the Annual Meeting Fundraising Dinner and performance by world-renowned vocalist and entertainer Wynonna Judd on Sunday evening, Nov. 11. Net proceeds from the event will be donated to the ACAAI Foundation to support the Consortium on Children’s Asthma Camps, Scholars Return Programs and Young Faculty Support Awards. The event is supported in part by grants from Alcon Laboratories Inc., AstraZeneca LP, Sepracor Inc., and Teva Specialty Pharmaceuticals.

View the new Literature Review Course vodcasts
Presentations from the popular Literature Review Course, Everything You Should Have Read Last Year, But Didn’t, at the 2006 ACAAI Annual Meeting, are vodcast weekly.

The new vodcasts include:
• Rhinitis and Sinusitis – Dr. Dana V. Wallace (Aug. 29 – Sept. 4)
• The Ten Best Articles in the Specialty of Allergy – Dr. Mark T. O’Hollaren (Sept. 5-11)

Previous vodcasts from the Literature Review Course, the International Food Allergy Symposium and the “Asthma Control: How Are We Doing?” symposium are archived for continued viewing.

Each vodcast contains the original audio and presentation slides and can be viewed from a computer or downloaded to a portable media player (such as an iPod). The ACAAI vodcast program is sponsored by an unrestricted educational grant from GlaxoSmithKline.

The U.S. Hereditary Angioedema Association educates patients and physicians
The U.S. Hereditary Angioedema Association (HAEA), a non-profit patient advocacy organization, provides a wide range of services for patients and physicians, including education, clinical trial placement, physician referrals and individualized patient case management.

The HAEA is dedicated to expediting U.S. approval of safer and more effective HAE therapies. The organization also sponsors an annual conference and an e-mail support group.

A joint ACAAI/AAAAI Hereditary Angioedema Task Force was recently established, consisting of Dr. Bruce L. Zuraw (chair) and Drs. Timothy J. Craig, Michael M. Frank, Allen P. Kaplan and David A. Khan.

Tithe-a-Talk a win-win program
The “Tithe-a-Talk” program benefiting the ACAAI Foundation makes it easy for you to donate honoraria from an upcoming speaking engagement, including the ACAAI Annual Meeting in Dallas. This win-win program allows:

• Allergists to make a donation of time that turns into help for others without getting the honoraria reported as taxable income to them
• Companies to demonstrate their good will with a charitable contribution or matching gift to the Foundation of the ACAAI in partnership with College members

Simply complete the form available on the College Web site and present it to the association/company that is sponsoring your talk.

Donated items needed for Silent Auction
The Alliance, the College and the Foundation will again host a Silent Auction at the ACAAI Annual Meeting in Dallas. The proceeds will help support clinical research and education through Young Faculty Awards, Scholars Return Awards and the projects of the Consortium on Children’s Asthma Camps.

We need your support for this worthwhile cause by donating and soliciting quality items, including artwork, trips, services, gift items, jewelry, tickets to major events or hand-crafted items. Cash donations are also welcome for purchasing auctioned items — an excellent way to add value to your contribution. The auction items will be available for viewing in the Alliance Hospitality Suite Friday and Saturday morning. The Auction will be held Saturday night, Nov. 10, at the Welcome Reception.

For more details or to make a donation, please call Marcee Claflin at (405) 340-1274 or e-mail marceeh519@aol.com.

Welcome to the AMA Corner prepared by Dr. Alnoor A. Malick, ACAAI Delegate to the AMA House of Delegates, to keep you abreast of important AMA news and developments impacting allergy-immunology.

Dr. Gary Gross reappointed to the AMA CPT Advisory Committee
Dr. Gary N. Gross, Dallas, was reappointed to the AMA CPT Advisory Committee at the recent AMA Board of Trustees meeting. Dr. Gross and ACAAI Past President Dr. Donald W. Aaronson review and comment on all CPT codes submitted before they go to the CPT Committee. They also present information to the AMA CPT Board on new codes that represent the coding perspectives of allergist-immunologists.

AMA to unveil campaign to expand health coverage for the uninsured
At an Aug. 23 news conference in Washington, D.C., the AMA unveiled its Voice for the Uninsured campaign, which will include new television ads, print ads, and other campaign activities. The three-year campaign is an effort to spur action to cover more of the nearly 45 million people in the United States who go without health insurance. The initial phases of the campaign are timed in conjunction with the 2008 election cycle and will bring a human face to this problem that affects millions of patients.

Physicians and Regence BlueShield reach settlement
Regence BlueShield and the Washington State Medical Association (WSMA), the AMA and six physician plaintiffs are pleased to announce resolution of their dispute and lawsuit over Regence’s creation of the Select Network program. Regence previously announced that it had voluntarily withdrawn the Select Network program and had apologized to the physicians and members for any misunderstanding that may have been caused by its initial communications about the Select Network program.

In an effort to better understand physician concerns, Regence met with the WSMA to discuss performance measurement. WSMA appreciates Regence’s efforts to collaborate on these issues and acknowledges that Regence has agreed to make a financial contribution to the WSMA Education and Research Foundation to support the Foundation’s work to educate providers on performance measurement issues and to promote quality improvement programs in physicians’ offices. In addition, the WSMA and Regence have agreed on a process to work together for a period of two years.

Board Review Corner
Welcome to the Board Review Corner prepared by Soo Kim-Delio, M.D., Senior Representative of ACAAI’s fellows-in-training (FITs) to the Board of Regents. The Board Review Corner is your chance to test your Board preparedness.

To refer to a previous Board Review Corner, click the “FIT Archive” link in the left column.

Review Questions:Chapter 8 of Pediatric Allergy: Principles & Practices, edited by Donald Y.M. Leung, et al. Review questions were written by Drs. Bret Haymore and Jiun Joon, Walter Reed Army Medical Center.