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Allergy & Asthma Network CEO shares top takeaways for PCPs from AAAAI annual meeting
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New research on food allergy treatments, stewardship of oral corticosteroids, microbiome’s role in allergy development, and shared decision making were some of the highlights at the recent American Academy of Allergy, Asthma and Immunology annual meeting.
Allergy treatments
Recent data indicate 7.6% of children have some type of food allergy, with the most common allergen being peanut. Studies have also shown caring for these children costs U.S. families almost $25 billion annually.
Potential new treatments for food allergy were the focus of many presentations at the meeting, according to Tonya Winders, CEO of the Allergy & Asthma Network.
“There was lots of buzz about a presentation that discussed using bone marrow transplants as a treatment for food allergy in the future, once the procedure is made safer for the recipient,” Winders told Healio Primary Care Today.
“There were also multiple presentations about biologics treating food allergies. It was encouraging to see mostly positive trial results on both oral and epicutaneous immunotherapies presented,” she continued.
Presentations in these areas included:
- AR101 (an experimental treatment for peanut allergy) had an 85% increased probability vs. placebo to tolerate any dose in the exit challenge of less than 1000 mg in patients aged 4 to 17 years;
- AR101 was well-tolerated in patients aged 4 to 17 years that received 300 mg daily and most could tolerate higher challenge amounts (1,000 mg and 2,000 mg) of peanut protein after additional maintenance;
- Viaskin peanut patch (100 µg or 250 µg) was safe and well-tolerated in patients aged 1 to 3 years with a peanut allergy; and
- An eliciting dose of 300 mg or less of peanut protein in children aged between 4 and 11 years had a significant difference in treatment response rate vs. those who received placebo; however, a prespecified lower bound of the CI threshold was not met.
Microbiome’s role in allergy, asthma
Data indicate that 8.1% of adults, and 8.4% of those 18 years of age and younger, have asthma. In addition, asthma is the primary diagnosis in 1.7 million ED visits each year.
Thus, “many families want to know what they can do to prevent food allergy and asthma,” Winders said, adding presentations regarding how gut bacteria can prevent food allergy and asthma were “very insightful.”
Some of the abstracts in this area included:
- patients with persistent IgE-mediated food allergy had and a higher abundance of Firmicutes and Actinobacteria, and significantly reduced Bacteroidetes and Proteobacteria, which may be a specific microbiota signature;
- stool of farm infants contained higher amounts of Clostridiaceae, Akkermansia, and Blautia vs. the stool of nonfarm infants, which contained higher amounts of Veillonella, Bifidobacterium and Clostridium;
- integrative analyses discovered “significant interrelationships between the intestinal metabolome and the intestinal microbiome, plasma metabolome, and diet in association with childhood asthma;”
- carpet “likely alters” the indoor microbiome and human exposure to microbes;
- perturbations to fungal community composition in the guts of adults seem to be tied to atopy, with or without coincident asthma; and
- imbalance in both bacterial gut and fungal microbiota “is a signature of established atopic asthma, and features of these communities are associated with clinical markers of the disease.”
Oral corticosteroids to treat asthma
According to Winders, oral corticosteroid stewardship and nasal polyps “are a common concern” expressed by patients with asthma. She added that several abstracts detailed the latest research into medications that may eliminate these concerns: benralizumab (Fasenra, AstraZeneca) and dupilumab (Dupixent; Sanofi Genzyme; Regeneron).
Data presented on these treatments included:
- patients with atopic dermatitis who received dupilumab “experienced clinically and statistically significant improvement” in their asthma, chronic nasal/paranasal sinus conditions and atopic dermatitis;
- patients with difficult-to-control asthma who received dupilumab had significantly improved FEV1 and lower annual severe exacerbation rates;
- healthy volunteers who received benralizumab had similar pharmacokinetic exposure the medication whether they received it from an auto-injector or an accessorized pre-filled syringe; and
- most attempts to use single-use autoinjectors containing benralizumab at home were successful (10 unsuccessful uses among 595 tries).
“Researchers are hopeful these treatments will allow them to reduce if not eliminate the side effects of oral corticosteroids,” Winders said.
Communication between clinicians, patients
Winders also noted many of the conference’s presentations discussed the significant change in the conversation clinicians are having with their patients regarding allergy- and asthma-related conditions.
“Shared decision making — whether it be in treating patients who have asthma or atopic dermatitis, or discussing allergen immunotherapy and food allergies, was another hot topic at the meeting,” she said in the interview.
“More and more clinicians are realizing shared decision making is critical to patient empowerment. The presentations throughout AAAAI 2019 demonstrated a true shift in how physicians are engaging patients in a more effective manner to drive behavior change,” Winders said.
Other Healio Primary Care Today coverage from this and past years of the AAAAI annual meeting can be found by clicking here. Watch for coverage of the organization’s 2020 meeting in Philadelphia. – by Janel Miller
References:
CDC.gov. “Asthma.” https://www.cdc.gov/nchs/fastats/asthma.htm. Accessed March 4, 2019.
Foodallergy.org. “Facts and statistics.” https://www.foodallergy.org/life-with-food-allergies/food-allergy-101/facts-and-statistics. Accessed March 4, 2019.
Gupta RS, et al. Pediatrics. 2018;doi: 10.1542/peds.2018-1235.
The following abstracts were presented at the American Academy of Allergy, Asthma and Immunology Annual Scientific Meeting; Feb. 22-25, 2019; San Francisco:
Barker P, et al. “Single-use autoinjector functionality and reliability for at-home benralizumab administration: GRECO trial results.”
Boguniewicz M, et al. “Dupilumab improves outcomes of concurrent asthma and chronic sino-nasal conditions in patients with atopic dermatitis: a pooled analysis of four phase 3 studies (LIBERTY AD, SOLO 1 & 2, CHRONOS, and CAFE).”
Busse WW, et al. Dupilumab improves lung function and reduces severe exacerbation rate in patients with uncontrolled, moderate-to-severe asthma with or without comorbid allergic rhinitis: Results from the phase 3 LIBERTY ASTHMA QUEST Study.”
Carr W, et al. “Estimating the probability of tolerating each challenge dose of peanut protein at exit double-blind, placebo-controlled food challenge: Results from a phase 3, randomized, double-blind, placebo-controlled trial (PALISADE) of AR101.”
Carr TF, et al. “Longer-term safety and efficacy measures of AR101 oral immunotherapy for peanut allergy: Results from a phase 3 follow-on study.”
Dannemiller KC, et al. “The presence of carpet alters human exposure to microorganisms in the home.”
Durack J, et al. “Distinct enteric microbiota perturbations exist in atopic adults with or without asthma.”
Goldberg M, et al. “Distinctive gut microbiota signature in persistent IgE-mediated food allergy.”
Lee-Sarwar K, et al. Integrative analysis of the intestinal metabolome of childhood asthma.
Thorsen J, et al. Evaluating the effects of farm exposure on infant gut microbiome.”
Martin U, et al. “Comparison of accessorized pre-filled syringe with autoinjector for benralizumab pharmacokinetic exposure in healthy volunteers following administration of a single subcutaneous dose: AMES trial results.”
Disclosure s: Winders is CEO of the Allergy & Asthma Network. Healio Primary Care Today was unable to determine the other authors’ relevant financial disclosures prior to publication.