Allergy/Asthma Information Association

Highlights from the Canadian Society of Allergy and Clinical Immunology (CSACI)
Annual Meeting October 26-29, 2006 Montreal

Dr. Eric Leith, Chair, Canadian Allergy Asthma and Immunology Foundation (CAAIF)

The Royal College of Physicians and Surgeons of Canada have instituted a Maintenance of Certification (MOC) program. There are now many buzzwords including continuing professional development, CanMEDS and accredited learning activities. When one attends a scientific meeting credits may be awarded towards requirement hours to fulfill the MOC program.

However, after attending a scientific meeting with intensive information bombardment what does someone actually remember and incorporate into their practice and professional attitudes to enhance their standard of practice? After attending the recent CSACI annual meeting it is now time to reflect upon the knowledge transfer and how I may incorporate this in my practice. These are some of the outlines of the featured sessions.

The clinical and basic science trainees participated in the Thursday CSACI/AllerGen Trainee Day where the trainee oral presentation occurred and the “Immunology Platform of the Allergen Birth Cohort” was presented.

The Thursday CAAIF non-profit summit gave an opportunity for all the organizations related to allergic and immunologic diseases to share with the others their mission statements and activities over the past year. A joint project to develop answers to frequently asked questions (FAQ) document for patients and families with allergic and immunologic diseases was initiated. This will be made available to physicians' offices, support organizations and patients and families with allergic and immunologic diseases.

A Friday breakfast symposium on severe asthma discussed the indications for anti- IgE therapy in patients with difficult to control asthma who meet the criteria of atopy, positive skin tests, and measurement of elevated total IgE levels along with clinical criteria of moderate to severe asthma.

The Friday plenary session on food allergy discussed the importance of history of allergic reaction in conjunction with skin prick test size and level of specific IgE elevation in assessing peanut allergy and whether or not to consider a challenge. Challenge studies have shown that 0.1 mg seems to be the lowest subjective–symptom dose. Casual (skin, air) exposure is usually tolerated and challenge studies are reassuring. Studies have looked at measurement of peanut allergen after ingestion and different cleaning methods. There is still insufficient evidence to advise definitively about prevention of peanut allergy in relation to maternal diet during pregnancy and lactation and the young child. Potential treatments for peanut allergy include anti- IgE therapy, Chinese herbal remedies, vaccination strategies (such as modified proteins, addition of immunostimulatory sequences), oral immunotherapy and induction of high dose tolerance. It is important for physicians and health care workers to appreciate how patients and families living with anaphylaxis cope. Recommendations to help coping include reliable sources of information and meetings with families and health care providers to discuss these issues. Dietary history, dietary adequacy, use of vitamin and mineral supplements, alternate products and formulas, elimination diets, label reading and cross contamination are just some of the things that a registered dietician can offer food allergic patients and their families.

The Friday immunodeficiency plenary session reviewed the new Jeffrey Modell Canadian Immunodeficiency Network which promotes excellence in the investigation, treatment and research of immunodeficiency diseases. Wiskott- Aldridge Syndrome is a condition associated with thromboctopenia, eczema, bacterial infections, lymphomas, and autoimmune disease. There are mutations in the WASP gene resulting in cytoskeletal defects of haematopoetic stem cell derivatives. Molecular testing for primary immune deficiency can be utilized in combined T- and B- cell immunodeficiency including T- B+ SCID ( eg. JAK3 deficiency, CD 45 deficiency) and T-B- SCID (eg. RAG deficiency, CD 40 defiency, ADA deficiency). Immunoglobulin replacement therapy can be given in the outpatients intravenously or subcutaneously and now programs are looking at home administration of immunoglobulin via both intravenous and subcutaneous routes.

The Friday primary care/allied health symposium discussed sleep disorders in the pediatric population, snoring in adulthood and the public health and economic impact of sleep apnea.

The Friday lunch symposium reviewed the use of induced sputum and nitric oxide (NO) to guide treatment of airway inflammation.

The Friday plenary session on advances of autoimmune disease and immune regulation reviewed the role of tolerogenic dendritic cells as a therapeutic tool as well as the role of stem cells in allergic diseases. The genetic applications of patients with inflammatory bowel disease and the therapeutic intervention with biologics such as anti- TNF in spondyloarthritis were also reviewed.

The Saturday breakfast symposium reviewed the newer understanding of antihistamine pharmacology including Histamine 3 and Histamine 4 receptors.

The Saturday luncheon symposium was a pro/con debate on the timely escalation of maintenance therapy to achieve better asthma outcomes in relation to combination therapy and as needed add on therapy.

Saturday afternoon included the “Libation Amongst the Posters” where the abstracts that are printed in the CSACI journal were presented by the authors.

Sunday morning breakfast symposium discussed the role of rhinitis in asthma and the united airway whereby treatment of upper respiratory diseases improved the treatment of asthma.

The Sunday plenary symposium on occupational allergy reviewed occupational asthma in relation to research on induced sputum as well as the clinical applications of etiology, risk factors, diagnosis and treatment. Occupational skin diseases including irritant and allergic dermatitis and the role of patch testing these patients was discussed. The final presentation summarized the population health aspects of mould as well as the uncertainty and ongoing research in the area. Health Canada recommends to control humidity and diligently repair any water damage in residences to prevent mould growth and to clean thoroughly any mould growing in residential buildings.

It is now time to reflect on all this information and with each ongoing patient encounter reassess ongoing care in light of this knowledge transfer.

from Allergy & Asthma News, Issue 4 2006

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