“Allergy shots have come in for criticism over the years because, well, they are shots and require repeat visits to the doctor’s office — two things children really don’t like.

And many parents may wonder — in some cases, rightfully, alas — whether the allergy doctor is overdiagnosing allergies and overtreating their children. Dr. Cox argues that allergists get to the root of the cause instead of just treating symptoms.

A new study published last month in the peer-reviewed Annals of Allergy, Asthma and Immunology found that allergy shots, also known as immunotherapy, could actually help eliminate allergy symptoms after only 18 months. What’s more, shots may help save you money in the long run. Among the children with allergic rhinitis studied, shots helped to reduce total health care costs by a third, and prescription drug costs by 16 percent, said Dr. Cox, who was a co-author of the study

The first year of allergy shots, which includes a three-month build-up period during which a child receives injections as often as twice a week until the proper dosage is found, would cost a bit less than $1,000 for the year, according to Dr. Cox. The next year, with twice-a-month injections, would total an estimated $350.”

References:A Child’s Allergies Are Serious but Can Be Treated Effectively. NYTimes, 2010.

Recent research presented at the 2010 Annual Meeting of the American Academy of Allergy, Asthma & Immunology (AAAAI) shows promising results for parents of egg allergic children.

In this first multi-center trial that involved Duke, Johns Hopkins, Mount Sinai, National Jewish and the University of Arkansas, 55 children between the ages of 5 and 18 were randomized to receive egg white solid oral immunotherapy or a placebo. The study spanned three dosing phases: initial escalation, build-up and maintenance. This was then followed by an oral food challenge at approximately 44 weeks to determine how many of the children became desensitized to egg.

Seven subjects withdrew before the oral food challenge took place. While 21 of the 40 who received the egg white oral immunotherapy passed the oral food challenge, none of the 15 who received the placebo did.

“Some of the most exciting research in allergy today focuses on possible treatments for patients with severe food allergy. This important study on the use of oral immunotherapy for children with egg allergy provides further evidence that a real treatment for food allergy will soon be possible,” commented Robert A. Wood, MD, FAAAAI, one of the study authors.

The mean cumulative dose consumed during the oral food challenge by those children who received the egg oral immunotherapy far surpassed that consumed by the placebo group. Symptoms reported during the dosing phases were mild to moderate with no symptoms reported in nearly 12,000 of the doses consumed by the oral immunotherapy group versus only 4,014 symptom-free doses consumed by the placebo group.

In the oral immunotherapy group, there were also significant decreases in egg IgE and egg-specific basophil and mast cell responses. The immune profiles and long-term tolerance of the children involved in the trial are being monitored.

This study was presented during the 2010 Annual Meeting of the American Academy of Allergy, Asthma & Immunology (AAAAI) on February 26-March 2 in New Orleans. This a reprint from an article located at AAAAI.org

This week the FDA announced their recommendations for label changes for products containing long-acting-beta-agonists (LABAs). Long-acting-beta-agonists are found in Advair and Symbicort, two of the most widely prescribed asthma medications in the US and Europe.

The specific label changes recommended by the FDA for Long-Acting Beta-Agonists (LABAs) include:

1. Contraindicate the use of LABAs for asthma in patients of all ages without concomitant use of an asthma-controller medication such as an inhaled corticosteroid.

2. Stop use of the LABA, if possible, once asthma control is achieved and maintain the use of an asthma-controller medication, such as an inhaled corticosteroid.

3. Recommend against LABA use in patients whose asthma is adequately controlled with a low- or medium-dose inhaled corticosteroid.

4. Recommend that a fixed-dose combination product containing a LABA and an inhaled corticosteroid be used to ensure compliance with concomitant therapy in pediatric and adolescent patients who require the addition of a LABA to an inhaled corticosteroid.

Some background and a few thoughts.

A number of large studies conducted over the past 20 years have suggested that there is an increased risk of severe asthma attacks associated with the use of the  long-acting-beta-agonists salmederol and fermoderal.  Salmederol is found in Advair and Fermoderal is found in Symbicort.

Unfortunately, it has not been possible to determine if the patients in the study who had severe attacks were also taking an inhaled corticosteroid at the time. This fact is very important.

Most asthma specialists would predict that, for patients with moderate to severe asthma, using a long-acting-bronchodilator alone  without using a daily anti-inflammatory medication, could cause  problem.    An analogy would be taking an antibiotic and Ibuprofen for pneumonia. Both medications are used to treat pneumonia.  However, if you were given both medications but only took the Ibuprofen, for a time you would feel better with less fever, body aches, and chest pain.  Without antibiotics, however the infection in the lungs could continue to worsen, even to the point were antibiotics would no longer save the patient. In asthma, steroids control the inflammation in the airways which is at the heart of asthma symptoms. Short and long-acting bronchodilators temporarily relieve the chest tightness, cough, shortness of breath and wheezing of asthma but have no effect on the inflammation.  This can lead to a serious, even fatal asthma attack. In the pneumonia analogy it would be short sighted to blame the use of Ibuprofen for a death caused by pneumonia: it has never been  good practice to treat the symptoms of pneumonia alone without addressing the infection, and a poor outcome would be expected. A poor outcome is also to be expected from an asthma treatment that masks the seriousness of the condition by providing temporary relief of symptoms without addressing the dangers of progressive inflammation.   It is possible that the results of the studies that have concerned the  FDA confirm what has always been assumed:  Daily symptom relief medications should not be used without the concurrent use of effective anti-inflammatory agents such as inhaled corticosteroids.   This is not a problem with Advair and Symbicort, both of which contain inhaled steroids.