Hot Topics in Allergy

Host: Matt Birnholz, MD Guest: Kevin Fussell, MD Up to one in 10 patients with asthma have severe disease, and of those patients, up to 1.3 million have severe uncontrolled asthma.1-3 Since severe asthma has been associated with reduced lung function and poor outcomes.4,5 Dr Kevin Fussell is here to talk about how a treatment option may help patients with severe eosinophilic asthma as well as how we can use telemedicine to help manage and diagnose them. Chung KF, Wenzel SE, Brozek JL, et al. International ERS/ATS guidelines on definition, evaluation and treatment of severe asthma. Eur Respir J. 2014;43(2):343-373. Hankin CS, Bronstone A, Wang Z, Small MB, Buck P. Estimated prevalence and economic burden of severe, uncontrolled asthma in the United States. J Allergy Clin Immunol. 2013;131(2):AB126. Global Initiative for Asthma. Global strategy for asthma management and prevention. Updated 2020. Available from: https://ginasthma.org/wp-content/uploads/2020/06/GINA-2020-report_20_06_04-1-wms.pdf. Accessed August 22, 2020. Newby C, Agbetile J, Hargadon, B, et al. Lung function decline and variable airway inflammatory pattern: longitudinal analysis of severe asthma. J Allergy Clin Immunol. 2014;134(2):287-294. Global Initiative for Asthma. Difficult-to-treat and severe asthma in adolescent and adult patients 2019. Available from:https://ginasthma.org/wp-content/uploads/2019/04/GINA-Severe-asthma-Pocket-Guide-v2.0-wms-1.pdf. Accessed November 1, 2020. ©2020 AstraZeneca. All rights reserved. US-34513 Last Updated 11/20 ...

Host: Jennifer Caudle, DO Guest: Maria Pasioti Food allergy trials help us stay on the cutting edge by studying the latest treatment advances, but are we consistent in the terminology we use and even in the way we apply these findings to clinical practice? To find out, Dr. Jennifer Caudle welcomes Dr. Maria Pasioti, who discusses the design, endpoints, and real-world implications of food allergy trials.

Guest: Maria Pasioti Here to give us a glimpse into the prevalence and impact of IgE-mediated food allergies in the EU is Dr. Maria Pasioti, an allergist at Laiko Hospital in Athens, Greece.

Host: Jennifer Caudle, DO Guest: Anne Ellis, MD Guest: George DuToit, MD Managing a food allergy can be difficult for both physicians and patients, which is why advocacy groups are working to advance the interests of this community and develop guidelines for healthcare professionals. To find out more, Dr. Jennifer Caudle is joined by Drs. Anne Ellis and George DuToit, who discuss their opinions and go into detail about how physicians can help patients living with a food allergy.

Host: Jennifer Caudle, DO Guest: Bruce Lanser, MD Guest: Drew Bird, MD Clinical trials are an important part of food allergy research, but there are some pretty big differences in the language that’s used to define primary endpoints and reported outcomes—not only here, but also abroad. Joining Dr. Jennifer Caudle to interpret the language that’s used in food allergy research and the implications of these different dialects are Drs. Drew Bird and Bruce Lanser.

Host: Mario R. Nacinovich, Jr., MSc Guest: Jonathan Spergel, MD, PhD Get a bird’s-eye view of how oral immunotherapy (OIT) is developing in different countries with Dr. Mario Nacinovich and Dr. Jonathan Spergel, who also discusses the reasoning behind this strategy and when we should use this treatment option for our patients with food allergies.

Host: Amy Mackey, MD Guest: Jay Lieberman, MD Guest: Alan Goldsobel, MD When it comes to managing patients with food allergy, what team members should contribute within your practice? To find out, Dr. Amy Mackey speaks with Drs. Jay Lieberman and Alan Goldsobel who discuss their food allergy care teams along with how they overcome common obstacles.

Guest: Jay Lieberman, MD Food challenges can be done in a few different ways, and here to walk us through two types that are commonly used in research and clinical settings is Dr. Jay Lieberman, Associate Professor in the Department of Pediatrics at the University of Tennessee Health Science Center.

Guest: Jay Lieberman, MD As oral immunotherapy for food allergy continues to gain traction in clinical trials, Dr. Jay Lieberman shares four key takeaways regarding its side effects, whether it should be viewed as a cure, how it could potentially change a patient’s lifestyle, and ultimately, if it’s the answer for every patient with a food allergy.

Host: Amy Mackey, MD Guest: Brian P. Vickery, MD In an effort to help physicians provide better care for those patients at risk of unpredictable—and potentially life-threatening—allergic reactions, the PALISADE group of clinical investigators explored oral immunotherapy as a potential treatment. Joining Dr. Amy Mackey to review these findings is the study’s lead author, Dr. Brian Vackey. He’s also an Associate Professor of Pediatrics and Director of the Food Allergy Center of Children’s Healthcare of Atlanta at Emory University.

Guest: Brian P. Vickery, MD To help address some common concerns, a recent study from the PALISADE group of clinical investigators looked at the safety and efficacy of peanut oral immunotherapy. So what exactly did the study find? Here to review the trial’s promising results is Dr. Brian Vickery. In addition to being the lead author of the study, he’s also an Associate Professor of Pediatrics and Director of the Food Allergy Center of Children’s Healthcare of Atlanta at Emory University.

Host: Amy Mackey, MD Guest: Ruchi Gupta, MD, MPH Before we are able to improve how we address, research, and treat food allergies, we must first better understand the true prevalence and severity of this health threat. To help close this knowledge gap, Professor of Pediatrics at Northwestern University’s Feinberg School of Medicine Dr. Ruchi Gupta reveals key findings from The Public Health Impact of Parent-Reported Childhood Food Allergies in the United States study.

Guest: Ruchi Gupta, MD, MPH Despite the increasing prevalence of food allergies in children nationwide, accurate and comprehensive statistics regarding its impacts didn’t exist, which is exactly why The Public Health Impact of Parent-Reported Childhood Food Allergies in the United States study was conducted. Here to walk us through its findings is Dr. Ruchi Gupta, Professor of Pediatrics at Northwestern University’s Feinberg School of Medicine and lead author of the study.

Guest: J. Wesley Sublett, MD, MPH With the prevalence of peanut allergy on the rise, there’s a lot physicians need to know about diagnosis, treatment barriers, and its impact on our healthcare system as a whole. Taking a look at each of these pieces in this problematic puzzle is Dr. Wesley Sublett from Family Allergy and Asthma in Louisville, Kentucky.

Guest: David Stukus, MD With the prevalence of peanut allergies increasing, it’s easy to get caught up in the numbers and forget that living with a peanut allergy comes with a significant burden for children and families alike, as Dr. David Stukus from Nationwide Children’s Hospital and the Ohio State College of Medicine explains.

Host: Todd Mahr, MD Guest: Warner Carr, MD What phases does the FDA use to approve a new medication, and why does this process take several years? Why must the active and excipient components of the medication, as well as the device, complete all of the testing phases? Dr. Warner Carr, allergist at Allergy and Asthma Associates in Mission Viejo, California, shares insight from his role as a new drug reviewer at the FDA. How do physicians play a vital role in the drug-approval process by providing clinical feedback to the FDA? Dr. Todd Mahr hosts.

Host: Todd Mahr, MD Guest: Warner Carr, MD What phases does the FDA use to approve a new medication, and why does this process take several years? Why must the active and excipient components of the medication, as well as the device, complete all of the testing phases? Dr. Warner Carr, allergist at Allergy and Asthma Associates in Mission Viejo, California, shares insight from his role as a new drug reviewer at the FDA. How do physicians play a vital role in the drug-approval process by providing clinical feedback to the FDA? Dr. Todd Mahr hosts.

Host: Ketan Sheth, MD, MBA Guest: Carlos Camargo, MD, DrPH, MPH What's the best strategy for managing patients with chronic asthma, and how can physicians create an action plan with their patients to treat an asthma exacerbation? Host Dr. Ketan Sheth reviews recent guideline recommendations for preventing asthma exacerbations with Dr. Carlos Camargo, associate professor of medicine and epidemiology at Harvard Medical School. How are acute and chronic management of asthma different?

Host: Ketan Sheth, MD, MBA Guest: William Lumry, MD Hereditary angioedema is relatively rare and is often misdiagnosed as an allergic reaction to medication or food. What symptoms are helpful differentiating points for making an accurate hereditary angioedema diagnosis? Dr. William Lumry, clinical professor of internal medicine at the University of Texas Southwestern Medical School, outlines the types of hereditary angioedema, factors which can contribute to an acute attack, and therapies to prevent or treat patients with this condition. Dr. Ketan Sheth hosts.

Host: Ketan Sheth, MD, MBA Guest: Carlos Camargo, MD, DrPH, MPH What's the best strategy for managing patients with chronic asthma, and how can physicians create an action plan with their patients to treat an asthma exacerbation? Host Dr. Ketan Sheth reviews recent guideline recommendations for preventing asthma exacerbations with Dr. Carlos Camargo, associate professor of medicine and epidemiology at Harvard Medical School. How are acute and chronic management of asthma different?

Host: Ketan Sheth, MD, MBA Guest: William Lumry, MD Hereditary angioedema is relatively rare and is often misdiagnosed as an allergic reaction to medication or food. What symptoms are helpful differentiating points for making an accurate hereditary angioedema diagnosis? Dr. William Lumry, clinical professor of internal medicine at the University of Texas Southwestern Medical School, outlines the types of hereditary angioedema, factors which can contribute to an acute attack, and therapies to prevent or treat patients with this condition. Dr. Ketan Sheth hosts.

Host: Todd Mahr, MD Guest: Sidney Braman, MD, FACP, FCCP Chronic obstructive pulmonary disease, or COPD, is often diagnosed in late stages, as it is a slowly progressing condition. How can physicians diagnose patients with this deadly disease in its earlier stages, to increase the success of reversing some of its symptoms? Dr. Sidney Braman, professor of medicine at the Warren Alpert Medical School of Brown University, describes who is affected by COPD, and how physicians can best treat these patients. Dr. Todd Mahr hosts.

Host: Todd Mahr, MD Guest: Sidney Braman, MD, FACP, FCCP Chronic obstructive pulmonary disease, or COPD, is often diagnosed in late stages, as it is a slowly progressing condition. How can physicians diagnose patients with this deadly disease in its earlier stages, to increase the success of reversing some of its symptoms? Dr. Sidney Braman, professor of medicine at the Warren Alpert Medical School of Brown University, describes who is affected by COPD, and how physicians can best treat these patients. Dr. Todd Mahr hosts.

Host: Ketan Sheth, MD, MBA Guest: William Silvers, MD Are the symptoms of exercise-induced asthma always apparent, and if not, how can physicians diagnose the condition? Can exercise-induced asthma exist independently, or does it always signify an underlying asthmatic condition? Host Dr. Ketan Sheth discusses the pathogenesis of and treatments for exercise-induced asthma with Dr. William Silvers, clinical professor of medicine at the University of Colorado School of Medicine. Dr. Silvers will explain the phenomenon that the seemily innocuous food celery can specifically cause exercise-induced allergic reactions.

Host: Ketan Sheth, MD, MBA Guest: William Silvers, MD Are the symptoms of exercise-induced asthma always apparent, and if not, how can physicians diagnose the condition? Can exercise-induced asthma exist independently, or does it always signify an underlying asthmatic condition? Host Dr. Ketan Sheth discusses the pathogenesis of and treatments for exercise-induced asthma with Dr. William Silvers, clinical professor of medicine at the University of Colorado School of Medicine. Dr. Silvers will explain the phenomenon that the seemily innocuous food celery can specifically cause exercise-induced allergic reactions.

Host: Todd Mahr, MD Guest: Steven Weinstein, MD Clinical trials are essential to the safe development of medications. How are clinical trials structured, and what are the features of the various clinical trial stages? Dr. Steven Weinstein, clinical professor in the department of pediatrics at the University of California at Irvine, provides an overview of clinical trials with host Dr. Todd Mahr. What are the ethical considerations taken into account during clinical trials?

Host: Todd Mahr, MD Guest: Bradley E. Chipps, MD, FAAP, FACAAI, FAAAAI, FCCP What criteria are included in the modified asthma predictive index, and how does this index help physicians diagnose young patients with wheezing and coughing? When is bronchoscopy recommended as an important diagnostic tool for evaluating pediatric lower respiratory symptoms? Dr. Bradley Chipps, medical director of respiratory therapy at Sutter Medical Center, reviews how physicians might work up a young patient with these respiratory symptoms, and suggests the most effective treatments. Dr. Todd Mahr hosts.

Host: Todd Mahr, MD Guest: Jason Knuffman, MD A cough that continues for more than a couple of months is considered chronic. What are the most likely causes of chronic cough in non-smoking adults, other than asthma? Dr. Jason Knuffman, allergist in the department of allergy at Gunderson Lutheran Health System in LaCrosse, Wisconsin, discusses how to avoid some common pitfalls that are often encountered when evaluating and treating adults with chronic cough. Dr. Todd Mahr hosts.

Host: Todd Mahr, MD Guest: Steven Weinstein, MD Clinical trials are essential to the safe development of medications. How are clinical trials structured, and what are the features of the various clinical trial stages? Dr. Steven Weinstein, clinical professor in the department of pediatrics at the University of California at Irvine, provides an overview of clinical trials with host Dr. Todd Mahr. What are the ethical considerations taken into account during clinical trials?

Host: Todd Mahr, MD Guest: Bradley E. Chipps, MD, FAAP, FACAAI, FAAAAI, FCCP What criteria are included in the modified asthma predictive index, and how does this index help physicians diagnose young patients with wheezing and coughing? When is bronchoscopy recommended as an important diagnostic tool for evaluating pediatric lower respiratory symptoms? Dr. Bradley Chipps, medical director of respiratory therapy at Sutter Medical Center, reviews how physicians might work up a young patient with these respiratory symptoms, and suggests the most effective treatments. Dr. Todd Mahr hosts.

Host: Todd Mahr, MD Guest: Jason Knuffman, MD A cough that continues for more than a couple of months is considered chronic. What are the most likely causes of chronic cough in non-smoking adults, other than asthma? Dr. Jason Knuffman, allergist in the department of allergy at Gunderson Lutheran Health System in LaCrosse, Wisconsin, discusses how to avoid some common pitfalls that are often encountered when evaluating and treating adults with chronic cough. Dr. Todd Mahr hosts.

Host: Ketan Sheth, MD, MBA Guest: Santiago Martinez, MD What is the relationship between immunity and autism? Do the immune systems of those with autism function differently than the rest of the population? Dr. Santiago Martinez, clinical assistant professor at Florida State University College of Medicine, joins host Dr. Ketan Sheth to discuss the immune systems of autism patients. Is there any evidence that might suggest that autoimmune disorders in mothers can somehow contribute to the development of autism in their children?

Host: Ketan Sheth, MD, MBA Guest: J. Allen Meadows, MD How are Medicare and health insurance companies affecting physicians and their patients' access to care? What can physicians do to influence policy at the local level? Dr. J. Allen Meadows, clinical instructor in the Montgomery Internal Medicine Residency Program at the University of Alabama at Birmingham, suggests ways allergists and other physicians can get involved with their communities and shape policies affecting how physicians care for their patients. Dr. Ketan Sheth hosts.

Host: Ketan Sheth, MD, MBA Guest: Renata Engler, MD How do insect allergies present challenges in emergency situations to first responders? What are the best ways to diagnose and treat anaphylaxis in patients away from a clinical setting? Host Dr. Ketan Sheth talks with Dr. Renata Engler, associate professor in the department of medicine at the Uniformed Services University of the Health Sciences, about treating insect allergy in the field. How is proper transport and storage of epinephrine particularly difficult for those in the military or others traveling to remote locations, and what can physicians do to ensure safety for patients in these situations?

Host: Ketan Sheth, MD, MBA Guest: Santiago Martinez, MD What is the relationship between immunity and autism? Do the immune systems of those with autism function differently than the rest of the population? Dr. Santiago Martinez, clinical assistant professor at Florida State University College of Medicine, joins host Dr. Ketan Sheth to discuss the immune systems of autism patients. Is there any evidence that might suggest that autoimmune disorders in mothers can somehow contribute to the development of autism in their children?

Host: Ketan Sheth, MD, MBA Guest: J. Allen Meadows, MD How are Medicare and health insurance companies affecting physicians and their patients' access to care? What can physicians do to influence policy at the local level? Dr. J. Allen Meadows, clinical instructor in the Montgomery Internal Medicine Residency Program at the University of Alabama at Birmingham, suggests ways allergists and other physicians can get involved with their communities and shape policies affecting how physicians care for their patients. Dr. Ketan Sheth hosts.

Host: Ketan Sheth, MD, MBA Guest: Renata Engler, MD How do insect allergies present challenges in emergency situations to first responders? What are the best ways to diagnose and treat anaphylaxis in patients away from a clinical setting? Host Dr. Ketan Sheth talks with Dr. Renata Engler, associate professor in the department of medicine at the Uniformed Services University of the Health Sciences, about treating insect allergy in the field. How is proper transport and storage of epinephrine particularly difficult for those in the military or others traveling to remote locations, and what can physicians do to ensure safety for patients in these situations?

Host: Ketan Sheth, MD, MBA Guest: I. Leonard Bernstein, MD The Joint Task Force on Practice Parameters for the Diagnosis and Treatment of Asthma has revised its allergy diagnostic testing parameters. What are the parameters trying to establish? What are the advantages of intracutaneous, skin prick, and in vitro testing for diagnosing allergies? Dr. I. Leonard Bernstein, co-director of the allergy research laboratory in the department of medicine at the University of Cincinnati Medical Center, and co-author of the parameters, explores allergy diagnostic testing options with host Dr. Ketan Sheth.

Host: Todd Mahr, MD Guest: Scott Sicherer, MD Because more children now live with food allergies than in decades past, at what point should a physician suspect that a patient might have a food allergy? What gastrointestinal symptoms are most common in children with food allergies? Dr. Scott Sicherer, associate professor of pediatrics at Mount Sinai School of Medicine in New York, reviews the most effective ways to diagnose and manage children with food allergies. Surprisingly, Dr. Sicherer says skin prick testing should not be the first diagnostic step. So what should physicians do when they suspect a child might have food allergies? Dr. Todd Mahr hosts.

Host: Todd Mahr, MD Guest: Stanley Fineman, MD, MBA Immunoglobulin replacement therapy has been used for treating various infections over the past 50 years. It has been traditionally administered intravenously, but now subcutaneous delivery of immunoglobulin is proving to be an attractive alternative. What disorders are immunoglobulin therapy used to treat, and what are the advantages to each type of preparation? Dr. Stanley Fineman, clinical associate professor in the department of pediatrics at Emory University School of Medicine, discusses novel approaches to immunoglobulin therapy with host Dr. Todd Mahr. Which patients are the best candidates for immunoglobulin therapy?

Host: Todd Mahr, MD Guest: Clifford Bassett, MD Gastroesophageal reflux disease (GERD) and laryngopharyngeal reflux (LPR) are both conditions stemming from acid reflux, but can manifest with different symptoms. What other health problems can be tied to LPR and GERD, and how can we determine the difference between the two? Dr. Clifford Bassett, assistant clinical professor of medicine and otolaryngology at the Long Island College Hospital and faculty member at the NYU School of Medicine, explains the characteristics of both conditions with host Dr. Todd Mahr.

Host: Todd Mahr, MD Guest: Alan Goldsobel, MD Cough is one of the most common symptoms but can develop as a symptom of various disorders, from asthma to bacterial infection to gastroesophogeal reflux disorder. How important is the character of a cough in determining the cause in children particularly? Host Dr. Todd Mahr explores cough guidelines and recommendations for children, alon with Dr. Alan Goldsobel, clinical professor in the department of medicine at the University of California San Francisco. At what point is a cough considered chronic, and when should a lingering cough be evaluated in children?