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Cultural background can affect parents' asthma attitudes
The cultural background of a parent can affect his or her attitude about a child’s asthma, including medication use, according to a study in the Archives of Disease in Childhood. Researchers at King's College London surveyed parents of 150 children who were treated at three London hospitals that serve multicultural communities. Of those surveyed, 41 were of South Asian decent, 42 were other ethnic groups, and 67 were Caucasian. Researchers found that South Asian parents were less likely than Caucasian parents to give their children preventive asthma drugs. They also were three to four times more likely to believe that most asthma drugs are addictive and more harmful than good. The other ethnic groups also were more likely than Caucasian parents to have concerns about asthma drugs. And parents in both minority groups were less likely to tell friends and family about their child's asthma.  

Family history ups asthma death risk
Being overweight or obese may increase the likelihood of being hospitalized for a severe asthma attack, according to a study in Chest. Scientists at the Hospital Central de las FF.AA in Montevideo, Uruguay, studied 426 patients who were seen in the emergency department for a severe asthma exacerbation during a two-year period. They found that overweight patients tended to have longer emergency department stays and were more likely to be admitted to the hospital. After emergency department treatment, 14 percent of overweight patients were admitted versus 7 percent of normal or underweight patients. All patients received albuterol and intravenous hydrocortisone, and those whose blood oxygen levels dropped more than 8 percent also received oxygen. In general, both groups responded similarly to those treatments, based on lung function measures. However, symptoms, such as wheezing, persisted longer among overweight patients. 

Study: Shots hurt less if rapid injection technique used
Immunizing infants using rapid injection is less painful and takes less time than the standard technique, according to a study published in the Archives of Diseases in Childhood. Researchers at the University of Toronto, Ontario, Canada, studied 113 healthy 4- to 6-month-old infants, receiving their second and third DPTaP-Hib immunizations at an urban pediatric primary care practice. They compared the acute pain response — as measured by the Modified Behavior Pain Scale (MBPS), crying, and parent/pediatrician visual analog scale (VAS) — among two randomized groups. The standard care group received slow aspiration prior to injection, slow injection and slow withdrawal. The pragmatic group received no aspiration, rapid injection and rapid withdrawal. Infants in the standard care group were more likely to cry (82 percent vs. 43 percent) and cried longer than those in the pragmatic group. The median VAS scores by parents and pediatricians also were higher for infants in the standard care group. 

A Message from Dr. Linda Cox, Chair, Immunotherapy and Diagnostics Committee

As U.S. allergists watch the rapid growth of sublingual immunotherapy taking place across the Atlantic Ocean and some of their U.S. colleagues begin to prescribe SLIT off-label, there are many questions that have arisen. Why aren’t U.S. allergists embracing this treatment that seems so much more convenient than subcutaneous immunotherapy? What are the roadblocks preventing its use in the United States? Sublingual immunotherapy (SLIT) talking points, which were approved by the ACAAI Board of Regents, have been posted on the College Web site.

Why SLIT talking points? These talking points were developed in response to the U.S. allergy community’s growing interest in SLIT. This interest has spawned a number of frequently asked questions. At the request of the ACAAI Public Relations Committee at the ACAAI’s 2006 Annual Meeting, the ACAAI and AAAAI Immunotherapy and Diagnostics Committees developed an informational document that is intended to address some of the commonly asked questions on sublingual immunotherapy.

The talking points are intended to help U.S. allergists answer questions regarding SLIT that they may encounter from patients, other laypersons or the media. The questions cover topics such as: the efficacy and safety in the published literature, effectiveness in polysensitized patients, and off-label use of SLIT in the United States.

The SLIT talking points were reviewed by both the ACAAI and AAAAI Immunotherapy and Diagnostics Committees. Desiree E. Larenas-Linnemann, Harold S. Nelson and I made revisions based on these comments. This document will be revised periodically by the ACAAI/AAAAI SLIT Joint Task Force (SJTF) as new information on SLIT materializes. Other members of SJTF are Drs. Jay M. Portnoy (co-chair), John J. Oppenheimer, Ira Finegold, and J. Spencer Atwater.

An update on SLIT. Presently, subcutaneous immunotherapy (SCIT) is the only form of specific allergen immunotherapy that has an FDA-approved formulation, but SLIT is currently under investigation in the United States. However, only a small percentage (less than 5 percent) of allergic individuals receive SCIT, which, unlike medications, has the potential to modify the allergic disease and produce sustained clinical remission of allergic symptoms after discontinuation. Inconvenience due to the time involved in receiving allergen immunotherapy injections in a medically supervised setting is likely the reason for the low utilization of SCIT. SLIT appears to have a more favorable safety profile, allowing for home administration, and this may expand the population of allergic patients who receive specific allergen immunotherapy (e.g., young children, over-scheduled adults who find it difficult to comply with the weekly visits during a SCIT build-up).

There are several investigator-initiated and extract manufacturer-sponsored clinical SLIT trials in some stage of development or progress in the United States. Some of the allergens being studied in these ongoing or planned trials include: grass pollen, dust mite, short ragweed, cat, German cockroach, Alternaria and peanut. If the clinical trials are successful, an FDA-approved formulation for sublingual immunotherapy may be available in the near future.

I think SLIT may expand the menu of treatment choices for allergists. Right now we are very limited in only having SCIT for immunotherapy.

The SLIT Joint Task Force report. The SJTF was formed at the 2005 Immunotherapy and Diagnostics Committee meeting at the ACAAI’s 2005 meeting with the purpose of performing a comprehensive review of the sublingual immunotherapy. The SJTF’s report was based on the review of 104 articles identified through a Medline search and review articles’ references dating through October of 2005. The report was published in the May 2006 issue of the Journal of Allergy and Clinical Immunology. The SLIT talking points’ primary focus is on literature published after the SJTF report (i.e., after October 2005). In addition to Drs. Larenas-Linnemann, Nelson and me (co-chair), other members of SJTF are Drs. Jay M. Portnoy (co-chair), John J. Oppenheimer, Ira Finegold, and J. Spencer Atwater.

If you any questions or comments on SLIT talking points or have additional questions, please contact lindaswolfcox@msn.com.

I hope you’ll take a moment to answer the three poll questions regarding SLIT.

ClinicalConnect offers you a direct line to abstract authors
As an added feature of the 2007 ACAAI Annual Scientific Meeting in Dallas, the College, with support by an educational grant from Merck & Co. Inc., introduced ClinicalConnect – an innovative approach to the scientific poster viewing experience.

Through ClinicalConnect you can engage in dynamic, two-way dialogue with authors of 20 key abstracts selected by the ACAAI Abstract Review Committee.

Visit the College Web site for the identification tag numbers of the posters that have been selected for participation in this program, as well as the abstracts in PDF files. Then simply use your phone to dial into 888.57.ACAAI and punch in the identification tag number to retrieve key talking points presented by the lead author about the scientific research featured on his/her poster.

You may also send a recorded message or question to the author, who will respond to you by e-mail.

College invites its Fellows to apply for leadership roles
The College invites applications for the positions of Vice President for 2008-09, President-Elect for 2008-09, Treasurer for 2008-09, and for a position on its Board of Regents for 2008-2011.

All interested Fellows are encouraged to complete a questionnaire and submit it with a cover letter and curriculum vitae to the College office no later than Feb. 15, 2008.

“The application process lets the Nominating Committee know of your desire for a leadership role in the College,” said ACAAI Past President and Nominating Committee Chair Dr. William K. Dolen. “The questionnaire allows the Nominating Committee to evaluate each candidate’s potential fairly, giving everyone an opportunity to express his or her interest in being an officer or on the Board of Regents.”

“Priority is given to Fellows with a track record of excellent service on College committees or who are substantially involved in other College activities. Applicants for the position of vice president must have previously served a three-year term on the ACAAI Board of Regents. We strongly encourage qualified individuals who previously applied to consider applying again,” Dr. Dolen said.

Applications are available on the College Web site.

In Memoriam: Dr. John Moffitt
Dr. John Ellis Moffitt, former member of the ACAAI Board of Regents (1999-2002), and beloved physician and teacher, died Dec. 6, 2007.

He was an active member of many College committees and served as chair of the Professional A/I Education Committee, the Joint Task Force on GME, and the Workshop Committee. He was associate editor of Annals of Allergy, Asthma & Immunology.

Dr. Moffitt was professor of pediatrics and senior associate dean in the School of Medicine at the University of Mississippi Medical Center. He was director of the Division of Allergy and Immunology in the Department of Pediatrics from 1987-2002.

“John E. Moffitt was one of the most upbeat people I have had the pleasure of knowing,” said ACAAI Past President Dr. Don Q. Mitchell, Jackson, Miss. “Not only was he a caring physician, but also an outstanding teacher. His legacy to the University of Mississippi Medical School and to the community will endure.”

Donations may be made to Galloway United Methodist Church, 305 North Congress Street, Jackson, Miss. 39201; or to Blair Batson Children’s Hospital, Public Affairs, The University of Mississippi Medical Center, 2500 N. State St., Jackson, Miss. 39216.

Board Review Corner
Welcome to the Board Review Corner prepared by Drs. Bret R. Haymore and Dr. Jennifer W. Mbuthia, Senior and Junior Representatives of ACAAI’s fellows-in-training (FITs) to the Board of Regents. The Board Review Corner is an opportunity to help hone your Board preparedness.

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

Review Questions: Chapter 16 of Pediatric Allergy: Principles & Practices, edited by Donald Y.M. Leung, et al. Review questions were written by Drs. Jennifer W. Mbuthia, Walter Reed Army Medical Center, and Thomas G. Sternberg, Le Bonheur Children’s Hospital.

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Do you have news, responses or opinions to share with us? Please e-mail the association office at enews@acaai.org