Thomas R. Collins

A new study points to bacteria commonly found in the human microbiome as possible culprits in the quest to identify the elusive triggers of autoantibodies present in patients with systemic lupus erythematosus (SLE).

Anti-Ro antibodies, including anti-Ro60 antibodies, are found in about half of SLE patients, and are the most common antinuclear antibodies that can be seen preclinically. They are also pathogenic.

In a proof-of-concept study, a Yale-led research team collected microbiome samples from eight SLE patients who were positive for anti-Ro60 autoantibodies, five SLE patients who were anti-Ro60-negative, and seven healthy controls. The researchers took samples from the mouth, sternum, and stool. They found that commensal bacteria containing orthologs to Ro60 were found commonly in all of the patient groups. These included Propionibacterium propionicus, Corynebacterium amycolatum, Actinomyces massiliensis, and Bacteroides thetaiotaomicron, reported Teri M. Greiling, MD, PhD, of Yale University, New Haven, Conn., and her associates.

They also found that CD4 memory T-cell clones from lupus patients that were specific to Ro60 autoantigen were stimulated by Ro60-containing bacteria.

Researchers also colonized two groups of mice with B. thetaiotaomicron – mice with a lupuslike syndrome induced with the immune-response modifier imiquimod and those without this syndrome induced. The levels of anti-Ro60 antibodies were increased in those with the syndrome. Plus, lupus nephritislike complex depositions were seen in 88% of the glomeruli of the imiquimod-treated mice and in just 8% of those not treated with imiquimod.

“These data,” the researchers said, “suggest that Ro60 orthologs from human commensal bacteria may initiate and drive lupus pathogenesis.”

The study authors reported they had nothing to disclose. The work was supported by various grants from the National Institutes of Health, Arthritis National Research Foundation, the Arthritis Foundation, and the Lupus Research Institute, as well as NIH Intramural Research Programs.

SOURCE: Greiling TM et al. Sci Transl Med. 2018;10(434). doi: 10.1126/scitranslmed.aan2306.

A new study points to bacteria commonly found in the human microbiome as possible culprits in the quest to identify the elusive triggers of autoantibodies present in patients with systemic lupus erythematosus (SLE).

Anti-Ro antibodies, including anti-Ro60 antibodies, are found in about half of SLE patients, and are the most common antinuclear antibodies that can be seen preclinically. They are also pathogenic.

In a proof-of-concept study, a Yale-led research team collected microbiome samples from eight SLE patients who were positive for anti-Ro60 autoantibodies, five SLE patients who were anti-Ro60-negative, and seven healthy controls. The researchers took samples from the mouth, sternum, and stool. They found that commensal bacteria containing orthologs to Ro60 were found commonly in all of the patient groups. These included Propionibacterium propionicus, Corynebacterium amycolatum, Actinomyces massiliensis, and Bacteroides thetaiotaomicron, reported Teri M. Greiling, MD, PhD, of Yale University, New Haven, Conn., and her associates.

They also found that CD4 memory T-cell clones from lupus patients that were specific to Ro60 autoantigen were stimulated by Ro60-containing bacteria.

Researchers also colonized two groups of mice with B. thetaiotaomicron – mice with a lupuslike syndrome induced with the immune-response modifier imiquimod and those without this syndrome induced. The levels of anti-Ro60 antibodies were increased in those with the syndrome. Plus, lupus nephritislike complex depositions were seen in 88% of the glomeruli of the imiquimod-treated mice and in just 8% of those not treated with imiquimod.

“These data,” the researchers said, “suggest that Ro60 orthologs from human commensal bacteria may initiate and drive lupus pathogenesis.”

The study authors reported they had nothing to disclose. The work was supported by various grants from the National Institutes of Health, Arthritis National Research Foundation, the Arthritis Foundation, and the Lupus Research Institute, as well as NIH Intramural Research Programs.

SOURCE: Greiling TM et al. Sci Transl Med. 2018;10(434). doi: 10.1126/scitranslmed.aan2306.

A new study points to bacteria commonly found in the human microbiome as possible culprits in the quest to identify the elusive triggers of autoantibodies present in patients with systemic lupus erythematosus (SLE).

Anti-Ro antibodies, including anti-Ro60 antibodies, are found in about half of SLE patients, and are the most common antinuclear antibodies that can be seen preclinically. They are also pathogenic.

In a proof-of-concept study, a Yale-led research team collected microbiome samples from eight SLE patients who were positive for anti-Ro60 autoantibodies, five SLE patients who were anti-Ro60-negative, and seven healthy controls. The researchers took samples from the mouth, sternum, and stool. They found that commensal bacteria containing orthologs to Ro60 were found commonly in all of the patient groups. These included Propionibacterium propionicus, Corynebacterium amycolatum, Actinomyces massiliensis, and Bacteroides thetaiotaomicron, reported Teri M. Greiling, MD, PhD, of Yale University, New Haven, Conn., and her associates.

They also found that CD4 memory T-cell clones from lupus patients that were specific to Ro60 autoantigen were stimulated by Ro60-containing bacteria.

Researchers also colonized two groups of mice with B. thetaiotaomicron – mice with a lupuslike syndrome induced with the immune-response modifier imiquimod and those without this syndrome induced. The levels of anti-Ro60 antibodies were increased in those with the syndrome. Plus, lupus nephritislike complex depositions were seen in 88% of the glomeruli of the imiquimod-treated mice and in just 8% of those not treated with imiquimod.

“These data,” the researchers said, “suggest that Ro60 orthologs from human commensal bacteria may initiate and drive lupus pathogenesis.”

The study authors reported they had nothing to disclose. The work was supported by various grants from the National Institutes of Health, Arthritis National Research Foundation, the Arthritis Foundation, and the Lupus Research Institute, as well as NIH Intramural Research Programs.

SOURCE: Greiling TM et al. Sci Transl Med. 2018;10(434). doi: 10.1126/scitranslmed.aan2306.

About 6 years ago, members of the Society of Hospital Medicine’s Academic Hospitalist Committee got together to try to answer a question: How do we meet the mentoring needs of junior hospitalists?

One answer was inspired by the singles social scene. “Speed mentoring,” modeled after speed dating, became a thing at the Society of Hospital Medicine’s annual meeting in 2013, and it has remained popular going into this year, its 6th appearance.

Joanna Bonsall, MD, PhD, SFHM, assistant professor of medicine at Emory University, Atlanta, has been a part of coordinating the event since the beginning.

“We tried it out for the first year, and it was wildly successful,” she said. “The feedback was enormous, so we’ve continued it ever since.”

Hospitalists looking for mentoring time with senior hospitalists submit their curriculum vitae and a question they’d like to have answered. Then they’re paired with three mentors who have expertise in that field, meeting with each for 15 minutes.

For instance, someone asking – How can I improve my teaching skills with medical students? – would be paired with veteran hospitalists known for their education skills. In its first year, there were 12 slots available. It has since expanded, and this year, there are 20 slots. Registration closed a month before the annual conference.

About 6 years ago, members of the Society of Hospital Medicine’s Academic Hospitalist Committee got together to try to answer a question: How do we meet the mentoring needs of junior hospitalists?

One answer was inspired by the singles social scene. “Speed mentoring,” modeled after speed dating, became a thing at the Society of Hospital Medicine’s annual meeting in 2013, and it has remained popular going into this year, its 6th appearance.

Joanna Bonsall, MD, PhD, SFHM, assistant professor of medicine at Emory University, Atlanta, has been a part of coordinating the event since the beginning.

“We tried it out for the first year, and it was wildly successful,” she said. “The feedback was enormous, so we’ve continued it ever since.”

Hospitalists looking for mentoring time with senior hospitalists submit their curriculum vitae and a question they’d like to have answered. Then they’re paired with three mentors who have expertise in that field, meeting with each for 15 minutes.

For instance, someone asking – How can I improve my teaching skills with medical students? – would be paired with veteran hospitalists known for their education skills. In its first year, there were 12 slots available. It has since expanded, and this year, there are 20 slots. Registration closed a month before the annual conference.

About 6 years ago, members of the Society of Hospital Medicine’s Academic Hospitalist Committee got together to try to answer a question: How do we meet the mentoring needs of junior hospitalists?

One answer was inspired by the singles social scene. “Speed mentoring,” modeled after speed dating, became a thing at the Society of Hospital Medicine’s annual meeting in 2013, and it has remained popular going into this year, its 6th appearance.

Joanna Bonsall, MD, PhD, SFHM, assistant professor of medicine at Emory University, Atlanta, has been a part of coordinating the event since the beginning.

“We tried it out for the first year, and it was wildly successful,” she said. “The feedback was enormous, so we’ve continued it ever since.”

Hospitalists looking for mentoring time with senior hospitalists submit their curriculum vitae and a question they’d like to have answered. Then they’re paired with three mentors who have expertise in that field, meeting with each for 15 minutes.

For instance, someone asking – How can I improve my teaching skills with medical students? – would be paired with veteran hospitalists known for their education skills. In its first year, there were 12 slots available. It has since expanded, and this year, there are 20 slots. Registration closed a month before the annual conference.

The theme for HM18 could well be “in with the new, and in with the new.”

Conference planners have managed to pack HM18 with five new tracks: Great Debate, Nurse Practitioner/Physician Assistant (NP/PA), Palliative Care, Seasoning Your Career, and a new Career Development workshop track. And they did this while eliminating only one track that was on the schedule last year – Technology – and without adding any extra days to the meeting.

The trick was including more half-day tracks. With more tracks in smaller time chunks, the schedule provides more flexibility, and attendees have more choices to find what they’re looking for, said Kathleen Finn, MD, MPhil, SFHM, an assistant professor of medicine at Harvard Medical School, Boston, and the HM18 course director.

“We decided, since there were a bunch of themes that we really wanted to cover, we would do half-day tracks. The shorter tracks also are a way to gauge interest in a topic without making a big commitment to it,” Dr. Finn said. “The grouping of topics in smaller tracks in the Day-at-a-Glance helps people easily see a collection of lectures or a theme they might want to attend.”

While choosing themes for the conference, the planners were trying to stay true to their own theme: timeliness.

Assistant course director Dustin Smith, MD, SFHM, an associate professor of medicine at Emory University, Atlanta, said much of the information for this year’s conference came from the 2017 annual meeting, including attendance at sessions, speaker reviews, and session ratings.

“It’s building on momentum from the previous meeting,” he said. “Sometimes we choose things to offer that we know are going to go well, and sometimes we choose things that we hope go well, and all of a sudden we see [that they] go very, very well.” For instance, he said, the topic of sepsis was so popular last year that it has its own pre-course this year.

Great Debate

The annual meeting has traditionally had a “Great Debate” on perioperative medicine, but the format – with carefully chosen speakers who are dynamic and entertaining – will be used to cover pulmonary medicine and infectious diseases this year as well.

“It’s a hugely successful talk,” Dr. Finn said. “We can tell by our numbers that lots of people go, and it’s always funny, and it’s a very clever way of discussing the latest literature – by having two very dynamic speakers present a case and then debate the two options of the case and then use the literature to support the answer.”

NP/PA

This track includes topics that are chosen by the committee for advanced practice professionals.

“There are many hospitalist programs that include NP/PAs, and everybody is struggling with how best to incorporate NPs and PAs into the group practice and have everybody work at the top of their license and work well together,” Dr. Finn said.

“The idea, too, is to be very inclusive of all providers and offering a track that focuses on NP/PAs but also includes physicians, physician leaders, and physician administrators,” Dr. Smith said. “It’s not designed for one type of practicing professional; it should be a good educational track for all.”
 

Palliative Care

This was a topic that had been sprinkled throughout programs in previous years, but Dr. Finn and Dr. Smith said it was considered too important not to have its own track this year.

“I think hospitalists often are the doctors caring for patients at the end of their lives since many Americans die in the hospital,” Dr. Finn said. “As a result, this is a skill set that as hospitalists we need to be very good at.”

Seasoning Your Career

This is a track geared toward one of this year’s themes: With “hospital medicine” now a concept that’s more than 2 decades old, how do hospitalists keep up the momentum in their careers, how do they take stock, how do they make the important decisions they face as they move ahead in their jobs?

“Hospital medicine is now more than 20 years old – many hospitalists are now mid-career,” Dr. Finn said. “This track can help people reflect on and rethink their career. Do you want to expand what you’re doing? Do you want to change it? How do you make this a lifelong career?”
 

Career Development

There have always been workshops with a career-development focus, but this year, six of them were chosen to be placed under the heading of an official “Career Development” workshop track.

“Are there other skills you want to take on for the second half of your career?” Dr. Finn said. “Do you want to take on leadership? Do you want to learn how to better give your peers feedback? Do you want to promote women in your group? Do you want to prevent burnout or use emotional intelligence to improve your career?”

The theme for HM18 could well be “in with the new, and in with the new.”

Conference planners have managed to pack HM18 with five new tracks: Great Debate, Nurse Practitioner/Physician Assistant (NP/PA), Palliative Care, Seasoning Your Career, and a new Career Development workshop track. And they did this while eliminating only one track that was on the schedule last year – Technology – and without adding any extra days to the meeting.

The trick was including more half-day tracks. With more tracks in smaller time chunks, the schedule provides more flexibility, and attendees have more choices to find what they’re looking for, said Kathleen Finn, MD, MPhil, SFHM, an assistant professor of medicine at Harvard Medical School, Boston, and the HM18 course director.

“We decided, since there were a bunch of themes that we really wanted to cover, we would do half-day tracks. The shorter tracks also are a way to gauge interest in a topic without making a big commitment to it,” Dr. Finn said. “The grouping of topics in smaller tracks in the Day-at-a-Glance helps people easily see a collection of lectures or a theme they might want to attend.”

While choosing themes for the conference, the planners were trying to stay true to their own theme: timeliness.

Assistant course director Dustin Smith, MD, SFHM, an associate professor of medicine at Emory University, Atlanta, said much of the information for this year’s conference came from the 2017 annual meeting, including attendance at sessions, speaker reviews, and session ratings.

“It’s building on momentum from the previous meeting,” he said. “Sometimes we choose things to offer that we know are going to go well, and sometimes we choose things that we hope go well, and all of a sudden we see [that they] go very, very well.” For instance, he said, the topic of sepsis was so popular last year that it has its own pre-course this year.

Great Debate

The annual meeting has traditionally had a “Great Debate” on perioperative medicine, but the format – with carefully chosen speakers who are dynamic and entertaining – will be used to cover pulmonary medicine and infectious diseases this year as well.

“It’s a hugely successful talk,” Dr. Finn said. “We can tell by our numbers that lots of people go, and it’s always funny, and it’s a very clever way of discussing the latest literature – by having two very dynamic speakers present a case and then debate the two options of the case and then use the literature to support the answer.”

NP/PA

This track includes topics that are chosen by the committee for advanced practice professionals.

“There are many hospitalist programs that include NP/PAs, and everybody is struggling with how best to incorporate NPs and PAs into the group practice and have everybody work at the top of their license and work well together,” Dr. Finn said.

“The idea, too, is to be very inclusive of all providers and offering a track that focuses on NP/PAs but also includes physicians, physician leaders, and physician administrators,” Dr. Smith said. “It’s not designed for one type of practicing professional; it should be a good educational track for all.”
 

Palliative Care

This was a topic that had been sprinkled throughout programs in previous years, but Dr. Finn and Dr. Smith said it was considered too important not to have its own track this year.

“I think hospitalists often are the doctors caring for patients at the end of their lives since many Americans die in the hospital,” Dr. Finn said. “As a result, this is a skill set that as hospitalists we need to be very good at.”

Seasoning Your Career

This is a track geared toward one of this year’s themes: With “hospital medicine” now a concept that’s more than 2 decades old, how do hospitalists keep up the momentum in their careers, how do they take stock, how do they make the important decisions they face as they move ahead in their jobs?

“Hospital medicine is now more than 20 years old – many hospitalists are now mid-career,” Dr. Finn said. “This track can help people reflect on and rethink their career. Do you want to expand what you’re doing? Do you want to change it? How do you make this a lifelong career?”
 

Career Development

There have always been workshops with a career-development focus, but this year, six of them were chosen to be placed under the heading of an official “Career Development” workshop track.

“Are there other skills you want to take on for the second half of your career?” Dr. Finn said. “Do you want to take on leadership? Do you want to learn how to better give your peers feedback? Do you want to promote women in your group? Do you want to prevent burnout or use emotional intelligence to improve your career?”

The theme for HM18 could well be “in with the new, and in with the new.”

Conference planners have managed to pack HM18 with five new tracks: Great Debate, Nurse Practitioner/Physician Assistant (NP/PA), Palliative Care, Seasoning Your Career, and a new Career Development workshop track. And they did this while eliminating only one track that was on the schedule last year – Technology – and without adding any extra days to the meeting.

The trick was including more half-day tracks. With more tracks in smaller time chunks, the schedule provides more flexibility, and attendees have more choices to find what they’re looking for, said Kathleen Finn, MD, MPhil, SFHM, an assistant professor of medicine at Harvard Medical School, Boston, and the HM18 course director.

“We decided, since there were a bunch of themes that we really wanted to cover, we would do half-day tracks. The shorter tracks also are a way to gauge interest in a topic without making a big commitment to it,” Dr. Finn said. “The grouping of topics in smaller tracks in the Day-at-a-Glance helps people easily see a collection of lectures or a theme they might want to attend.”

While choosing themes for the conference, the planners were trying to stay true to their own theme: timeliness.

Assistant course director Dustin Smith, MD, SFHM, an associate professor of medicine at Emory University, Atlanta, said much of the information for this year’s conference came from the 2017 annual meeting, including attendance at sessions, speaker reviews, and session ratings.

“It’s building on momentum from the previous meeting,” he said. “Sometimes we choose things to offer that we know are going to go well, and sometimes we choose things that we hope go well, and all of a sudden we see [that they] go very, very well.” For instance, he said, the topic of sepsis was so popular last year that it has its own pre-course this year.

Great Debate

The annual meeting has traditionally had a “Great Debate” on perioperative medicine, but the format – with carefully chosen speakers who are dynamic and entertaining – will be used to cover pulmonary medicine and infectious diseases this year as well.

“It’s a hugely successful talk,” Dr. Finn said. “We can tell by our numbers that lots of people go, and it’s always funny, and it’s a very clever way of discussing the latest literature – by having two very dynamic speakers present a case and then debate the two options of the case and then use the literature to support the answer.”

NP/PA

This track includes topics that are chosen by the committee for advanced practice professionals.

“There are many hospitalist programs that include NP/PAs, and everybody is struggling with how best to incorporate NPs and PAs into the group practice and have everybody work at the top of their license and work well together,” Dr. Finn said.

“The idea, too, is to be very inclusive of all providers and offering a track that focuses on NP/PAs but also includes physicians, physician leaders, and physician administrators,” Dr. Smith said. “It’s not designed for one type of practicing professional; it should be a good educational track for all.”
 

Palliative Care

This was a topic that had been sprinkled throughout programs in previous years, but Dr. Finn and Dr. Smith said it was considered too important not to have its own track this year.

“I think hospitalists often are the doctors caring for patients at the end of their lives since many Americans die in the hospital,” Dr. Finn said. “As a result, this is a skill set that as hospitalists we need to be very good at.”

Seasoning Your Career

This is a track geared toward one of this year’s themes: With “hospital medicine” now a concept that’s more than 2 decades old, how do hospitalists keep up the momentum in their careers, how do they take stock, how do they make the important decisions they face as they move ahead in their jobs?

“Hospital medicine is now more than 20 years old – many hospitalists are now mid-career,” Dr. Finn said. “This track can help people reflect on and rethink their career. Do you want to expand what you’re doing? Do you want to change it? How do you make this a lifelong career?”
 

Career Development

There have always been workshops with a career-development focus, but this year, six of them were chosen to be placed under the heading of an official “Career Development” workshop track.

“Are there other skills you want to take on for the second half of your career?” Dr. Finn said. “Do you want to take on leadership? Do you want to learn how to better give your peers feedback? Do you want to promote women in your group? Do you want to prevent burnout or use emotional intelligence to improve your career?”

ORLANDO – Experts agreed that asthma and chronic obstructive pulmonary disease (COPD) overlap syndrome, referred to as ACOS, is an area in dire need of more careful study to give clinicians data they can actually use.

The topic is even more pressing given the growing interest and research into biological treatments for asthma and consideration of their possible use in COPD, experts said at the joint congress of the American Academy of Allergy, Asthma, and Immunology and the World Asthma Organization. Their remarks came in what was ostensibly a “debate” on whether ACOS is a distinct entity requiring special treatment but largely turned into a discussion about gaps in knowledge on the topic.

There is disagreement in published definitions: One set of definitions includes a criterion of fractional exhaled nitric oxide not seen in any other definitions, whereas some other definitions require a history of smoking while others don’t, he said.

“How does one manage a disease without a definition and without clinical studies? It’s impossible for me to know,” Dr. Peebles said.

“We all treat patients in the middle, everybody does, all the time – and we would love more guidance,” he said. “One of the reasons the number of articles has gone up is that there have been lots of case definitions. But we can’t get consensus. So who do we have to bring to the table to get a consensus definition so we can get the funding we need from the drug companies or governmental bodies to do the research that we all want?”

Dr. Tashkin said the way forward could be to draw on the points of consensus that do exist on certain criteria.

Dr. Peebles said an international panel is needed to draw up a consensus guideline, with the panel including both pulmonologists and allergists – “people experienced with clinical trials, who take care of a lot of patients.”

ORLANDO – Experts agreed that asthma and chronic obstructive pulmonary disease (COPD) overlap syndrome, referred to as ACOS, is an area in dire need of more careful study to give clinicians data they can actually use.

The topic is even more pressing given the growing interest and research into biological treatments for asthma and consideration of their possible use in COPD, experts said at the joint congress of the American Academy of Allergy, Asthma, and Immunology and the World Asthma Organization. Their remarks came in what was ostensibly a “debate” on whether ACOS is a distinct entity requiring special treatment but largely turned into a discussion about gaps in knowledge on the topic.

There is disagreement in published definitions: One set of definitions includes a criterion of fractional exhaled nitric oxide not seen in any other definitions, whereas some other definitions require a history of smoking while others don’t, he said.

“How does one manage a disease without a definition and without clinical studies? It’s impossible for me to know,” Dr. Peebles said.

“We all treat patients in the middle, everybody does, all the time – and we would love more guidance,” he said. “One of the reasons the number of articles has gone up is that there have been lots of case definitions. But we can’t get consensus. So who do we have to bring to the table to get a consensus definition so we can get the funding we need from the drug companies or governmental bodies to do the research that we all want?”

Dr. Tashkin said the way forward could be to draw on the points of consensus that do exist on certain criteria.

Dr. Peebles said an international panel is needed to draw up a consensus guideline, with the panel including both pulmonologists and allergists – “people experienced with clinical trials, who take care of a lot of patients.”

ORLANDO – Experts agreed that asthma and chronic obstructive pulmonary disease (COPD) overlap syndrome, referred to as ACOS, is an area in dire need of more careful study to give clinicians data they can actually use.

The topic is even more pressing given the growing interest and research into biological treatments for asthma and consideration of their possible use in COPD, experts said at the joint congress of the American Academy of Allergy, Asthma, and Immunology and the World Asthma Organization. Their remarks came in what was ostensibly a “debate” on whether ACOS is a distinct entity requiring special treatment but largely turned into a discussion about gaps in knowledge on the topic.

There is disagreement in published definitions: One set of definitions includes a criterion of fractional exhaled nitric oxide not seen in any other definitions, whereas some other definitions require a history of smoking while others don’t, he said.

“How does one manage a disease without a definition and without clinical studies? It’s impossible for me to know,” Dr. Peebles said.

“We all treat patients in the middle, everybody does, all the time – and we would love more guidance,” he said. “One of the reasons the number of articles has gone up is that there have been lots of case definitions. But we can’t get consensus. So who do we have to bring to the table to get a consensus definition so we can get the funding we need from the drug companies or governmental bodies to do the research that we all want?”

Dr. Tashkin said the way forward could be to draw on the points of consensus that do exist on certain criteria.

Dr. Peebles said an international panel is needed to draw up a consensus guideline, with the panel including both pulmonologists and allergists – “people experienced with clinical trials, who take care of a lot of patients.”

ORLANDO – Programs tailored according to culture and socioeconomic background can overcome food allergies that are worse in African American and Hispanic children, compared with their white counterparts, an expert said.

These ethnic groups have higher odds of food sensitization compared with whites, and an analysis of the U.S. National Mortality Database found a higher rate of food-related anaphylaxis that turned fatal more often among African-Americans than among whites, Mahboobeh Mahdavinia, MD, PhD, an allergist and immunologist at Rush University Medical Center, Chicago, said at the joint congress of the American Academy of Asthma, Allergy, and Immunology and the World Asthma Organization.

©piotr_malczyk/Thinkstock

“There has been a lot of research and increasing awareness about food allergy, but this has certainly not affected minorities, and they’re even dying more from these diseases,” Dr. Mahdavinia said.

Studies also have shown that African-American and Hispanic children have a higher rate of emergency department visits for food allergy, compared with white children. Dr. Mahdavinia said this might be because the severity of their allergies is worse, because they have less access to primary care, they have inferior practices at home to manage the allergies, and that higher asthma rates in these children is likely leading to worse food allergy incidents.

Children from low-income backgrounds, she noted, spend less on specialty outpatient care.

The difference in food allergy rates is likely linked, in part, to familial and cultural differences in childrearing, she said. African-American and Hispanic parents tend to introduce solid foods earlier, and breastfeed children at lower rates than those of white families.

Dr. Mahdavinia noted that while more affluent families are able to sidestep allergies by making a simple stop at a high-end grocer to get an allergen-free version of a food, poorer families are less able to buy these more expensive alternatives.

“The higher rate of asthma anaphylaxis observed in these minority children is concerning, especially when it’s considered in the context of the reported higher rate of fatal anaphylaxis associated food allergy in African Americans,” she said. “So there’s a tremendous need for future studies.”

ORLANDO – Programs tailored according to culture and socioeconomic background can overcome food allergies that are worse in African American and Hispanic children, compared with their white counterparts, an expert said.

These ethnic groups have higher odds of food sensitization compared with whites, and an analysis of the U.S. National Mortality Database found a higher rate of food-related anaphylaxis that turned fatal more often among African-Americans than among whites, Mahboobeh Mahdavinia, MD, PhD, an allergist and immunologist at Rush University Medical Center, Chicago, said at the joint congress of the American Academy of Asthma, Allergy, and Immunology and the World Asthma Organization.

©piotr_malczyk/Thinkstock

“There has been a lot of research and increasing awareness about food allergy, but this has certainly not affected minorities, and they’re even dying more from these diseases,” Dr. Mahdavinia said.

Studies also have shown that African-American and Hispanic children have a higher rate of emergency department visits for food allergy, compared with white children. Dr. Mahdavinia said this might be because the severity of their allergies is worse, because they have less access to primary care, they have inferior practices at home to manage the allergies, and that higher asthma rates in these children is likely leading to worse food allergy incidents.

Children from low-income backgrounds, she noted, spend less on specialty outpatient care.

The difference in food allergy rates is likely linked, in part, to familial and cultural differences in childrearing, she said. African-American and Hispanic parents tend to introduce solid foods earlier, and breastfeed children at lower rates than those of white families.

Dr. Mahdavinia noted that while more affluent families are able to sidestep allergies by making a simple stop at a high-end grocer to get an allergen-free version of a food, poorer families are less able to buy these more expensive alternatives.

“The higher rate of asthma anaphylaxis observed in these minority children is concerning, especially when it’s considered in the context of the reported higher rate of fatal anaphylaxis associated food allergy in African Americans,” she said. “So there’s a tremendous need for future studies.”

ORLANDO – Programs tailored according to culture and socioeconomic background can overcome food allergies that are worse in African American and Hispanic children, compared with their white counterparts, an expert said.

These ethnic groups have higher odds of food sensitization compared with whites, and an analysis of the U.S. National Mortality Database found a higher rate of food-related anaphylaxis that turned fatal more often among African-Americans than among whites, Mahboobeh Mahdavinia, MD, PhD, an allergist and immunologist at Rush University Medical Center, Chicago, said at the joint congress of the American Academy of Asthma, Allergy, and Immunology and the World Asthma Organization.

©piotr_malczyk/Thinkstock

“There has been a lot of research and increasing awareness about food allergy, but this has certainly not affected minorities, and they’re even dying more from these diseases,” Dr. Mahdavinia said.

Studies also have shown that African-American and Hispanic children have a higher rate of emergency department visits for food allergy, compared with white children. Dr. Mahdavinia said this might be because the severity of their allergies is worse, because they have less access to primary care, they have inferior practices at home to manage the allergies, and that higher asthma rates in these children is likely leading to worse food allergy incidents.

Children from low-income backgrounds, she noted, spend less on specialty outpatient care.

The difference in food allergy rates is likely linked, in part, to familial and cultural differences in childrearing, she said. African-American and Hispanic parents tend to introduce solid foods earlier, and breastfeed children at lower rates than those of white families.

Dr. Mahdavinia noted that while more affluent families are able to sidestep allergies by making a simple stop at a high-end grocer to get an allergen-free version of a food, poorer families are less able to buy these more expensive alternatives.

“The higher rate of asthma anaphylaxis observed in these minority children is concerning, especially when it’s considered in the context of the reported higher rate of fatal anaphylaxis associated food allergy in African Americans,” she said. “So there’s a tremendous need for future studies.”

ORLANDO – Swamp coolers – a low-cost alternative to air-conditioning in dry regions – weren’t found to increase sensitization to house dust mites or mold in atopic pediatric patients, researchers reported.

Neema Izadi, MD, and his associates say the findings, seen in a pediatric Colorado population in a study evaluating data over 10 years, could mean that not everyone at risk of dust mite and mold sensitization needs to avoid these cooling systems.

fpnews@frontlinemedcom.com

SOURCE: Izadi N et al. AAAAI/WAO Joint Congress, Abstract 586

ORLANDO – Swamp coolers – a low-cost alternative to air-conditioning in dry regions – weren’t found to increase sensitization to house dust mites or mold in atopic pediatric patients, researchers reported.

Neema Izadi, MD, and his associates say the findings, seen in a pediatric Colorado population in a study evaluating data over 10 years, could mean that not everyone at risk of dust mite and mold sensitization needs to avoid these cooling systems.

fpnews@frontlinemedcom.com

SOURCE: Izadi N et al. AAAAI/WAO Joint Congress, Abstract 586

ORLANDO – Swamp coolers – a low-cost alternative to air-conditioning in dry regions – weren’t found to increase sensitization to house dust mites or mold in atopic pediatric patients, researchers reported.

Neema Izadi, MD, and his associates say the findings, seen in a pediatric Colorado population in a study evaluating data over 10 years, could mean that not everyone at risk of dust mite and mold sensitization needs to avoid these cooling systems.

fpnews@frontlinemedcom.com

SOURCE: Izadi N et al. AAAAI/WAO Joint Congress, Abstract 586

ORLANDO – Using videoconferencing to assess patients for a reported penicillin allergy saved more than 2 hours of physician time for every patient, and resulted in almost every patient having their allergy label removed, researchers reported.

In what the researchers said was the first study showing the utility of telemedicine in evaluating patient-reported penicillin allergies, allergy and immunology physicians did a secure telemedicine consultation with patients after they underwent penicillin skin testing with a physician assistant; an approach which, on average, took 123 minutes fewer each time than if the physician had done the consultation face-to-face. The teleconference can be done on a laptop or smartphone.

Thomas R. Collins/Frontline Medical Communications

“This is so overlabeled,” Dr. Ramsey said. “Ten percent of the population thinks they’re allergic to penicillin, and 90% of them are not.”

A stark difference was found in the types of medicines administered before and after the evaluations, with aminopenicillin therapy jumping from 0 days of use to 188 days, and vancomycin – a more potent, but more costly alternative – dropping from 130 days of use to 16 days (P less than .05 for both).

Dr. Ramsey noted that, in part because of the time-consuming nature of the penicillin skin tests, they often are simply not done, so the false allergy labels are not caught, leading to pointless costs and exposure to more potent and potentially harmful forms of antibiotic therapy.

“Some hospitals don’t have allergists who will come in to do testing,” she said. “Sometimes patients are on medications that may interfere. And then a lot of times it’s just underrecognized – the implications of a penicillin allergy label. That is a very hot topic in our field and also in infectious disease.”

She hopes the telemedicine approach catches on more widely, which would help minimize the multitude of problems linked to penicillin allergy labels.

“Patients that avoid penicillin, they’re on more costly second-line antibiotics that are, in general, less effective, depending on which infection you’re talking about,” Dr. Ramsey said. “The [second-line antibiotics] have more side effects. And there’s data to show that patients with [a] penicillin allergy label have longer hospital stays, more costly hospital stays, are at risk for more resistant infections. And it breeds antimicrobial resistance in the long-term.”

Dr. Ramsey had no relevant financial disclosures.

SOURCE: Ramsey AC et al. AAAAI/WAO Joint Congress, Abstract 104.

ORLANDO – Using videoconferencing to assess patients for a reported penicillin allergy saved more than 2 hours of physician time for every patient, and resulted in almost every patient having their allergy label removed, researchers reported.

In what the researchers said was the first study showing the utility of telemedicine in evaluating patient-reported penicillin allergies, allergy and immunology physicians did a secure telemedicine consultation with patients after they underwent penicillin skin testing with a physician assistant; an approach which, on average, took 123 minutes fewer each time than if the physician had done the consultation face-to-face. The teleconference can be done on a laptop or smartphone.

Thomas R. Collins/Frontline Medical Communications

“This is so overlabeled,” Dr. Ramsey said. “Ten percent of the population thinks they’re allergic to penicillin, and 90% of them are not.”

A stark difference was found in the types of medicines administered before and after the evaluations, with aminopenicillin therapy jumping from 0 days of use to 188 days, and vancomycin – a more potent, but more costly alternative – dropping from 130 days of use to 16 days (P less than .05 for both).

Dr. Ramsey noted that, in part because of the time-consuming nature of the penicillin skin tests, they often are simply not done, so the false allergy labels are not caught, leading to pointless costs and exposure to more potent and potentially harmful forms of antibiotic therapy.

“Some hospitals don’t have allergists who will come in to do testing,” she said. “Sometimes patients are on medications that may interfere. And then a lot of times it’s just underrecognized – the implications of a penicillin allergy label. That is a very hot topic in our field and also in infectious disease.”

She hopes the telemedicine approach catches on more widely, which would help minimize the multitude of problems linked to penicillin allergy labels.

“Patients that avoid penicillin, they’re on more costly second-line antibiotics that are, in general, less effective, depending on which infection you’re talking about,” Dr. Ramsey said. “The [second-line antibiotics] have more side effects. And there’s data to show that patients with [a] penicillin allergy label have longer hospital stays, more costly hospital stays, are at risk for more resistant infections. And it breeds antimicrobial resistance in the long-term.”

Dr. Ramsey had no relevant financial disclosures.

SOURCE: Ramsey AC et al. AAAAI/WAO Joint Congress, Abstract 104.

ORLANDO – Using videoconferencing to assess patients for a reported penicillin allergy saved more than 2 hours of physician time for every patient, and resulted in almost every patient having their allergy label removed, researchers reported.

In what the researchers said was the first study showing the utility of telemedicine in evaluating patient-reported penicillin allergies, allergy and immunology physicians did a secure telemedicine consultation with patients after they underwent penicillin skin testing with a physician assistant; an approach which, on average, took 123 minutes fewer each time than if the physician had done the consultation face-to-face. The teleconference can be done on a laptop or smartphone.

Thomas R. Collins/Frontline Medical Communications

“This is so overlabeled,” Dr. Ramsey said. “Ten percent of the population thinks they’re allergic to penicillin, and 90% of them are not.”

A stark difference was found in the types of medicines administered before and after the evaluations, with aminopenicillin therapy jumping from 0 days of use to 188 days, and vancomycin – a more potent, but more costly alternative – dropping from 130 days of use to 16 days (P less than .05 for both).

Dr. Ramsey noted that, in part because of the time-consuming nature of the penicillin skin tests, they often are simply not done, so the false allergy labels are not caught, leading to pointless costs and exposure to more potent and potentially harmful forms of antibiotic therapy.

“Some hospitals don’t have allergists who will come in to do testing,” she said. “Sometimes patients are on medications that may interfere. And then a lot of times it’s just underrecognized – the implications of a penicillin allergy label. That is a very hot topic in our field and also in infectious disease.”

She hopes the telemedicine approach catches on more widely, which would help minimize the multitude of problems linked to penicillin allergy labels.

“Patients that avoid penicillin, they’re on more costly second-line antibiotics that are, in general, less effective, depending on which infection you’re talking about,” Dr. Ramsey said. “The [second-line antibiotics] have more side effects. And there’s data to show that patients with [a] penicillin allergy label have longer hospital stays, more costly hospital stays, are at risk for more resistant infections. And it breeds antimicrobial resistance in the long-term.”

Dr. Ramsey had no relevant financial disclosures.

SOURCE: Ramsey AC et al. AAAAI/WAO Joint Congress, Abstract 104.

ORLANDO – Reviewing patient charts for asthma risk factors using natural language processing can be done 8 times faster than reviewing the charts by hand, and with high levels of accuracy, researchers reported here.

Thomas R. Collins/Frontline Medical News

Natural language processing (NLP) is a kind of artificial intelligence in which computers are “trained” through a reiterative process to understand human language.

Researchers at Mayo Clinic previously have shown that a program created in-house can successfully and quickly determine patients’ asthma status. In this study, they turned to assessment of asthma risk factors, Chung-Il Wi, MD, assistant professor of pediatrics at Mayo said in a presentation at the joint congress of the American Academy of Allergy, Asthma and Immunology and the World Asthma Organization.

They used a convenience sample of 177 patient charts to train the NLP system. The system extracted – from key terms and sentences in the electronic health record (EHR) – data such as breastfeeding history and history of atopic conditions such as allergic rhinitis, eczema, and food allergy. From parent charts, the system extracted terms related to family history of asthma and other atopic conditions. The performance of the NLP algorithm was assessed by comparison with results of a manual chart review in a test cohort of 220 patient charts.

SOURCE: Wi C AAAAI/WAO Joint Congress 2018 abstract 637.

ORLANDO – Reviewing patient charts for asthma risk factors using natural language processing can be done 8 times faster than reviewing the charts by hand, and with high levels of accuracy, researchers reported here.

Thomas R. Collins/Frontline Medical News

Natural language processing (NLP) is a kind of artificial intelligence in which computers are “trained” through a reiterative process to understand human language.

Researchers at Mayo Clinic previously have shown that a program created in-house can successfully and quickly determine patients’ asthma status. In this study, they turned to assessment of asthma risk factors, Chung-Il Wi, MD, assistant professor of pediatrics at Mayo said in a presentation at the joint congress of the American Academy of Allergy, Asthma and Immunology and the World Asthma Organization.

They used a convenience sample of 177 patient charts to train the NLP system. The system extracted – from key terms and sentences in the electronic health record (EHR) – data such as breastfeeding history and history of atopic conditions such as allergic rhinitis, eczema, and food allergy. From parent charts, the system extracted terms related to family history of asthma and other atopic conditions. The performance of the NLP algorithm was assessed by comparison with results of a manual chart review in a test cohort of 220 patient charts.

SOURCE: Wi C AAAAI/WAO Joint Congress 2018 abstract 637.

ORLANDO – Reviewing patient charts for asthma risk factors using natural language processing can be done 8 times faster than reviewing the charts by hand, and with high levels of accuracy, researchers reported here.

Thomas R. Collins/Frontline Medical News

Natural language processing (NLP) is a kind of artificial intelligence in which computers are “trained” through a reiterative process to understand human language.

Researchers at Mayo Clinic previously have shown that a program created in-house can successfully and quickly determine patients’ asthma status. In this study, they turned to assessment of asthma risk factors, Chung-Il Wi, MD, assistant professor of pediatrics at Mayo said in a presentation at the joint congress of the American Academy of Allergy, Asthma and Immunology and the World Asthma Organization.

They used a convenience sample of 177 patient charts to train the NLP system. The system extracted – from key terms and sentences in the electronic health record (EHR) – data such as breastfeeding history and history of atopic conditions such as allergic rhinitis, eczema, and food allergy. From parent charts, the system extracted terms related to family history of asthma and other atopic conditions. The performance of the NLP algorithm was assessed by comparison with results of a manual chart review in a test cohort of 220 patient charts.

SOURCE: Wi C AAAAI/WAO Joint Congress 2018 abstract 637.

ORLANDO – At schools in a Texas district, unassigned epinephrine injectors were used more often than assigned ones were, according to results of an analysis.

In the 2015-2016 and 2016-2017 school years, epinephrine was administered to students 31 times at schools in the Austin Independent School District, which began to stock unassigned epinephrine in its schools after state legislators approved a law in 2015 allowing, but not requiring, school districts to do so. In 21 of those cases, or 68% of the time, it was the unassigned stockpile that was used, Kathryn Neupert, MD, said at the joint congress of the American Academy of Allergy, Asthma, and Immunology and the World Asthma Organization.

Thomas R. Collins/Frontline Medical News

“It kind of argues that, for those people that we don’t know have anaphylaxis to anything, it’s definitely important to have it available to them,” reported Dr. Neupert, a resident at the University of Texas, Austin.

In 45% of the cases, epinephrine was administered to children who had a known history of allergic reactions but, for whatever reason, did not have an epinephrine injector assigned to them.

Food was the most common trigger for use of epinephrine, accounting for 48% of the injections, with fragrance at 16%, insect stings at 10%, and exercise and overheating at 7%.

Dr. Neupert and her associates said the frequency with which epinephrine was administered after exposure to a fragrance – seen in about the same amount for unassigned and assigned epinephrine – might signal a need for greater education.

She emphasized the importance of follow-up after the use of unassigned injectors. If children get epinephrine that was unassigned and they have known allergies, “be sure that they subsequently get back in with their pediatrician or their allergist [and] that they’re getting their up-to-date epinephrine pens renewed,” she noted.

Carla Davis, MD, a pediatrician at Baylor College of Medicine, Houston, said she hopes more school districts adopt the stock epinephrine policy, despite barriers of cost and education. “I do think that it’s important for these schools to have these, because 20% of children will have their first episode of food allergic reaction – and in some of those cases it will be anaphylaxis – in schools.”

Dr. Neupert had no relevant financial disclosures.

SOURCE: AAAAI/WAO Joint Congress Abstract 465.

ORLANDO – At schools in a Texas district, unassigned epinephrine injectors were used more often than assigned ones were, according to results of an analysis.

In the 2015-2016 and 2016-2017 school years, epinephrine was administered to students 31 times at schools in the Austin Independent School District, which began to stock unassigned epinephrine in its schools after state legislators approved a law in 2015 allowing, but not requiring, school districts to do so. In 21 of those cases, or 68% of the time, it was the unassigned stockpile that was used, Kathryn Neupert, MD, said at the joint congress of the American Academy of Allergy, Asthma, and Immunology and the World Asthma Organization.

Thomas R. Collins/Frontline Medical News

“It kind of argues that, for those people that we don’t know have anaphylaxis to anything, it’s definitely important to have it available to them,” reported Dr. Neupert, a resident at the University of Texas, Austin.

In 45% of the cases, epinephrine was administered to children who had a known history of allergic reactions but, for whatever reason, did not have an epinephrine injector assigned to them.

Food was the most common trigger for use of epinephrine, accounting for 48% of the injections, with fragrance at 16%, insect stings at 10%, and exercise and overheating at 7%.

Dr. Neupert and her associates said the frequency with which epinephrine was administered after exposure to a fragrance – seen in about the same amount for unassigned and assigned epinephrine – might signal a need for greater education.

She emphasized the importance of follow-up after the use of unassigned injectors. If children get epinephrine that was unassigned and they have known allergies, “be sure that they subsequently get back in with their pediatrician or their allergist [and] that they’re getting their up-to-date epinephrine pens renewed,” she noted.

Carla Davis, MD, a pediatrician at Baylor College of Medicine, Houston, said she hopes more school districts adopt the stock epinephrine policy, despite barriers of cost and education. “I do think that it’s important for these schools to have these, because 20% of children will have their first episode of food allergic reaction – and in some of those cases it will be anaphylaxis – in schools.”

Dr. Neupert had no relevant financial disclosures.

SOURCE: AAAAI/WAO Joint Congress Abstract 465.

ORLANDO – At schools in a Texas district, unassigned epinephrine injectors were used more often than assigned ones were, according to results of an analysis.

In the 2015-2016 and 2016-2017 school years, epinephrine was administered to students 31 times at schools in the Austin Independent School District, which began to stock unassigned epinephrine in its schools after state legislators approved a law in 2015 allowing, but not requiring, school districts to do so. In 21 of those cases, or 68% of the time, it was the unassigned stockpile that was used, Kathryn Neupert, MD, said at the joint congress of the American Academy of Allergy, Asthma, and Immunology and the World Asthma Organization.

Thomas R. Collins/Frontline Medical News

“It kind of argues that, for those people that we don’t know have anaphylaxis to anything, it’s definitely important to have it available to them,” reported Dr. Neupert, a resident at the University of Texas, Austin.

In 45% of the cases, epinephrine was administered to children who had a known history of allergic reactions but, for whatever reason, did not have an epinephrine injector assigned to them.

Food was the most common trigger for use of epinephrine, accounting for 48% of the injections, with fragrance at 16%, insect stings at 10%, and exercise and overheating at 7%.

Dr. Neupert and her associates said the frequency with which epinephrine was administered after exposure to a fragrance – seen in about the same amount for unassigned and assigned epinephrine – might signal a need for greater education.

She emphasized the importance of follow-up after the use of unassigned injectors. If children get epinephrine that was unassigned and they have known allergies, “be sure that they subsequently get back in with their pediatrician or their allergist [and] that they’re getting their up-to-date epinephrine pens renewed,” she noted.

Carla Davis, MD, a pediatrician at Baylor College of Medicine, Houston, said she hopes more school districts adopt the stock epinephrine policy, despite barriers of cost and education. “I do think that it’s important for these schools to have these, because 20% of children will have their first episode of food allergic reaction – and in some of those cases it will be anaphylaxis – in schools.”

Dr. Neupert had no relevant financial disclosures.

SOURCE: AAAAI/WAO Joint Congress Abstract 465.

ORLANDO – Food was found to be the most commonly identified trigger, with peanuts the most prevalent food cause, in what researchers say is the largest comprehensive review of anaphylaxis episodes in North America that led to pediatric intensive-care unit stays.

Researchers examined the Virtual Pediatrics Systems database, an international database of pediatric intensive care unit (PICU) information, said Carla M. Davis, MD, a pediatrician at Baylor College of Medicine, Houston. During 2010-2015, there were 1,989 pediatric anaphylaxis admissions to these units in North America, she reported at the joint congress of the American Academy of Allergy, Asthma and Immunology and the World Asthma Organization.

Thomas R. Collins/Frontline Medical Communications

pdnews@frontlinemedcom.com

SOURCE: Davis CM et al. 2018 AAAAI/WAO Joint Congress Abstract 775.

ORLANDO – Food was found to be the most commonly identified trigger, with peanuts the most prevalent food cause, in what researchers say is the largest comprehensive review of anaphylaxis episodes in North America that led to pediatric intensive-care unit stays.

Researchers examined the Virtual Pediatrics Systems database, an international database of pediatric intensive care unit (PICU) information, said Carla M. Davis, MD, a pediatrician at Baylor College of Medicine, Houston. During 2010-2015, there were 1,989 pediatric anaphylaxis admissions to these units in North America, she reported at the joint congress of the American Academy of Allergy, Asthma and Immunology and the World Asthma Organization.

Thomas R. Collins/Frontline Medical Communications

pdnews@frontlinemedcom.com

SOURCE: Davis CM et al. 2018 AAAAI/WAO Joint Congress Abstract 775.

ORLANDO – Food was found to be the most commonly identified trigger, with peanuts the most prevalent food cause, in what researchers say is the largest comprehensive review of anaphylaxis episodes in North America that led to pediatric intensive-care unit stays.

Researchers examined the Virtual Pediatrics Systems database, an international database of pediatric intensive care unit (PICU) information, said Carla M. Davis, MD, a pediatrician at Baylor College of Medicine, Houston. During 2010-2015, there were 1,989 pediatric anaphylaxis admissions to these units in North America, she reported at the joint congress of the American Academy of Allergy, Asthma and Immunology and the World Asthma Organization.

Thomas R. Collins/Frontline Medical Communications

pdnews@frontlinemedcom.com

SOURCE: Davis CM et al. 2018 AAAAI/WAO Joint Congress Abstract 775.