A look back at PAAM 2017

Over 1000 international researchers, clinicians and allied health professionals converged on London last week to attend the 5th Paediatric Allergy and Asthma Meeting (PAAM), organised by the European Academy of Allergy and Clinical Immunology (EAACI).

PAAM took place between 26^th–28^th October bringing together world leading experts to discuss the newest research outcomes, disease management and how to improve the lives of patients.

Building on the success of PAAM 2015 which took place in Berlin, the 2017 meeting brought together paediatricians and primary care physicians to challenge the latest scientific and clinical issues, with the aim of bringing cutting-edge science to a wider audience.

Lead of the local organising committee, Dr Lauri-Ann Van der Poel, an expert in the field of paediatric allergy, commented on the success of the event:

'PAAM is the flagship of the EAACI paediatric section and it offers a mix of scientific and social interaction that keeps delegates coming back. Held every 2 years, it is gratifying that it is increasingly adding to its number, general paediatricians, GP’s with a special interest in allergy or asthma, immunologist, dermatologists and allied health, including dietitians and psychologists.  In addition to being the largest EAACI allergy meeting after the annual congress, at well over a thousand delegates both in Berlin and London, PAAM has a stellar scientific programme and offers plenty of opportunities for interaction. Attendees were predominately from Europe but top speakers from the US and Australia joined us and colleagues from 99 countries were present. PAAM2019 will mean the 10 year anniversary of these popular paediatric meetings. Looking forward to seeing you in Florence in 2019!'

We’ve collated a small report on some of the key outcomes from the congress:

AIT Guidelines – open access guidelines will actively improve clinical practice

A highlight from the meetings was the release of new EAACI Allergen Immunotherapy (AIT) Guidelines Part 2: Recommendations which received an official launch at PAAM.

EAACI has a long history and strong ethos in developing and implementing the latest research findings as guidelines and recommendations in order to deliver better healthcare for patients with allergies. This is no different for the newest and most up to date resource, the EAACI Allergen Immunotherapy (AIT) Guidelines Part 2: Recommendations. Part 1 (Systematic Reviews) was published during the EAACI Annual Congress in Helsinki in June this year. Although AIT has been used for a century, it has also been subject of considerable controversy in terms of safety and efficacy, that hampered the relevant dissemination of knowledge and the availability of products.

Prof. Antonella Muraro, EAACI AIT Guidelines Chair and EAACI Past President commented:

“We are tremendously proud and pleased that the EAACI AIT Guidelines Part 1 and Part 2 are now available online as open access, providing a guide for the clinical practice that aims to serve as a strong basis for operational recommendations and to help the allergists advocate for AIT, practitioners to refer patients onto appropriate management and the patient to request the best standard of care for their disease and quality of life”.

Early introduction of peanut does not influence the onset or resolution of co-existent food allergies and/or other atopic diseases according to Novel LEAP Study data

New data was presented by Prof. Gideon Lack, adding to the Learning Early About Peanut allergy (LEAP) study. Professor Lack’s findings demonstrated that oral tolerance induction to peanut is specific for both allergen and allergic disease, i.e. early consumption of peanut had no preventative effect on development of asthma, allergic rhino conjunctivitis or surrogate markers of co-existent food allergies (SPT, specific IgE and reported tree nut and sesame reactions).

This did not hasten the resolution of the eczema or egg allergy that were key inclusion criteria for participation in LEAP. The noted similarities in allergic disease burden between LEAP intervention groups is in contrast with the marked reduction in peanut allergy observed in the consumption group. There was no evidence that peanut consumption protected against tree nut and sesame sensitization. This study therefore demonstrated that oral tolerance induction to peanut in the LEAP Study is specific for both allergen and allergic disease. The underlying immune mechanisms associated with tolerance to peanut do not alter the natural history of allergic disease.

Prof. George Du Toit, Study Co-Investigator comments on this study: “Since the publication of the LEAP Study, we have known that the consumption of peanut during infancy protects against the development of peanut allergy. This study adds important information to this field, as we now know that the early introduction of peanut does not influence the onset or resolution of co-existent food allergies and/or other atopic diseases. Given that infants with eczema are at risk of developing additional food allergies and other allergic diseases, these findings will help guide future studies that aim to prevent the overall burden of allergic disease.”

Identifying a cause of the food allergy epidemic…

Australian allergy expert Prof. Pete Smith discussed glycation end products (AGEs) as causing the food allergy epidemic, examining whether AGEs are driving factors. Prof. Smith discussed whether food allergy appears to be increasing in both western countries and those countries that adopt western lifestyles.

“There are many plausible attributions to explain this, but not one factor totally explains things”, Smith said. When looking at the way the body responds to threats, it is apparent that a group of compounds called advanced glycation end-products can mimic the signals given off from damaged body tissues. AGEs are formed by heating proteins and oils at high temperature with sugars (such as microwaving, frying or using processed foods that have been dehydrated and then re-hydrated). Higher sugar diets and particularly those with more fructose seem to promote inflammatory AGEs. The increase in this pattern of eating has epidemiological and sociological associations with a rise in food allergies in young children. Smith elaborated that, “AGEs are important in generating allergic responses and some animal studies which modify AGEs appear to reduce food allergy responses. They can also be made by the wrong microbiota (gut bacteria) and bad diet is a substrate for bad bacteria and their products. There is the possibility that AGEs are part of this answer by healthy lifestyle choices, including having slow cooked meats that have been marinated with fresh herbs, reducing sugar intake and exercising.”

… But is a food allergy treatment on the horizon?

Prof. Wesley Burks from the UNC School of Medicines presented on oral immunotherapy (OIT), sublingual immunotherapy (SLIT), and epicutaneous immunotherapy (EPIT) depicting major differences in clinical outcomes, adverse reactions and immune studies. Prof. Burks is convinced: “A treatment for food allergy will be available soon, it is important now to begin to understand the possible options for patients and the profile of a patient that would be best served by each treatment.”

Practical advice for parents preferred

Dr Rosan Meyer discussed the need for dietary management of the complex food allergic patient, suggesting that some of the most prevalent questions of allergic patients are how to best manage their diet and cope with the challenges of daily life. Dr. Meyer, specialist paediatric dietitian from the Kings College London, presented a lecture about allergy prevention and how parents can be best supported. One of her take home messages is that collaboration with parents’ associations is key to ensure optimal advice and dissemination of the messages. “Parents need practical advice. For example, when they are advised to give peanuts early, they have to know exactly how peanuts are best introduced in their baby’s diet. And there is still some confusion for parents about the role of partially hydrolysed formula for allergy prevention. Furthermore, the message that breast feeding is the best for allergy prevention should be promoted by all healthcare professionals.”