J ALLERGY CLIN IMMUNOL

VOLUME 125, NUMBER 2

Abstracts AB67

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262 ASHMI (Anti-Asthma Herbal Medicine Intervention) PreventsMaternal Transmission of Early Onset of Allergic AirwayInflammation and Mucus Cell Development in Offspring

I. Lopez Exposito, N. Birmingham, A. Castillo, X. M. Li; Mount Sinai

School of Medicine, New York, NY.

RATIONALE: Maternal asthma has been described as a risk factor for

asthma development in children. ASHMI has shown effectiveness in asth-

matics in a control clinical trial. We hypothesized treating asthmatic

mothers with ASHMI before pregnancy would reduce the risk of allergic

airway disease in mice.

METHODS: Female BALB/c mice were sensitized intraperitoneally

twice with ovalbumin (OVA) and alum followed by 3 weekly intra tracheal

challenges with OVA. Allergic airway responses were determined. These

asthmatic mothers (AS-M) were treated with ASHMI (AS-M/ASHMI)

for 6 weeks. Controls were untreated (AS-M/None). Naı̈ve mothers

(Naive-M) were used as additional controls. Mice were then mated with

normal males. Twelve day old offspring from each group received 3 con-

secutive daily intranasal (i.n.) OVA challenges. Two days later offspring

were sacrificed and bronchoalveolar lavage (BAL) and lung histology

were performed. Serum OVA antibodies and cytokine profiles were also

determined.

RESULTS: Two days following the third i.n. challenge, total numbers of

BAL macrophages, eosinophils, lymphocytes, and neutrophils in AS-M/

none offspring were significantly higher than in BAL of Naive-M off-

spring. AS-M/none offspring also contained many airway mucus cells.

In contrast, BAL cells from AS-M/ASHMI offspring were essentially the

same as Naı̈ve-M offspring, and no mucus cells were present.

Furthermore, AS-M/ASHMI offspring showed higher ratios of OVA-spe-

cific IgG2a vs IgG1 and Con A stimulated splenocyte production of

IFN-g vs IL-4, IL5 and IL13.

CONCLUSIONS: Offspring from asthmatic mothers developed allergic

airway responses in response to OVA challenge without prior systemic sen-

sitization. This predisposition can be reduced by a maternal treatment with

ASHMI before conception.

263 Physician Knowledge & Compliance with Updated AsthmaGuidelines

S. Fitzpatrick1, B. Silverman2, R. Joks1, A. Schneider2; 1SUNY Down-

state/Long Island College Hospital, Brooklyn, NY, 2Long Island College

Hospital, Brooklyn, NY.

RATIONALE: The Expert Panel 3 asthma guidelines were updated in

2007. The revised paradigm for asthma management emphasizes control

and achieving that control by reducing both impairment and risk. This

study focuses on primary physician awareness of and compliance with

these changes.

METHODS: Physicians completed an online, anonymous survey consist-

ing of 16 questions. The data was compiled & analyzed using the online

Survey Monkey website.

RESULTS: A total of 85 surveys were collected (43 pediatric, 28 internal

medicine and 14 family practice). 54% of responding physicians reported

awareness that the asthma guidelines had been updated in 2007. Of the 5

domains used to assess patient impairment, the percentage of physicians

using each of these domains in practice ranged from 42% to 95%. Of the

3 domains used to assess patient risk, the percentage of physicians using

each of these domains ranged from 32% to 96%. 66% of physicians would

consider allergen immunotherapy for patients with mild/moderate persis-

tent allergic asthma. Only 26% of physicians were aware that omalizumab

is the only adjunctive therapy with demonstrated efficacy for severe persis-

tent allergic asthmatics. 66% of physicians schedule regular asthma spe-

cific office visits with the most frequent interval being every 3 months.

CONCLUSION: Primary care physicians play an important role in the

treatment of asthmatic patients. Adherence and knowledge of the asthma

guidelines, as assessed by the online questionnaire, needs improvement.

As such, better educational programs are needed to reinforce the current

guidelines in order to improve asthma outcomes.

264 Two Year Follow-Up of Patients with Chronic AutoimmuneUrticaria Treated with Omalizumab

A. P. Kaplan1, K. Joseph1, T. Murphy2, J. Ramey2, R. J. Maykut3, R. K.

Zeldin4; 1Medical university of South Carolina, Charleston, SC, 2National

Allergy, Asthma, and Urticaria Centers of Charleston, Charleston, SC,3Novartis Pharma AG, Basel, SWITZERLAND, 4Novartis Pharmaceuti-

cals Corporation, East Hanover, NJ.

RATIONALE: In our proof of concept study, after 4 months of omalizu-

mab therapy for chronic autoimmune urticaria, seven patients responded

completely, four improved but required antihistamine therapy, and one

did not respond. We investigated the post-treatment clinical course over

the 2 years following discontinuation of omalizumab.

METHODS: Telephone interviews and/or out-patient office visits.

RESULTS: Of the 7 complete responders, 5 had no recurrence, one expe-

rienced a mild exacerbation 6 months later that spontaneously resolved,

and one experienced intermittent urticaria treated with as-needed hydrox-

yzine. Of the 4 patients with a partial response, one had mild urticaria for 6

months which then worsened requiring prednisone and diphenhydramine

for 1 year and is now treated with cetirizine; two have had continuous

mild urticaria for 2 years treated with cetirizine, and hydroxyzine respec-

tively; and one worsened immediately after omalizumab was stopped. This

patient required cyclosporine therapy for 1 ½ years and is now treated with

cetirizine. The non-responder received a 6-month tapering course of oral

corticosteroids and has been maintained on hydroxyzine.

CONCLUSIONS: Our results suggest sustained improvement in symp-

toms of chronic autoimmune urticaria after discontinuation of omalizumab

therapy in most of the patients who responded to a 4-month treatment

protocol.

265 Self-Administration of Asthma Medication in Children andAsthma Control

B. Safier, L. Green, M. Ballow; SUNY at Buffalo School of Medicine and

Biomedical Sciences, Buffalo, NY.

RATIONALE: In the pediatric asthmatic population, the impact of place

of residence and who administers asthma medication on asthma compli-

ance and control is unclear. However, some may assume that inner city

children who self-administer asthma medication would fare poorly in com-

parison with suburban patients whose parents administer medication.

METHODS: Parent and patient questionnaires were completed for 31

children (ages 4 to 18 years old) with moderate- to severe-persistent

asthma. Suburban asthmatic patients were managed by pediatricians.

Inner city asthmatic patients were managed in our allergy clinic.

Medication compliance was determined based upon reported number of

missed doses. Asthma control was based upon night symptoms, rescue in-

haler use, interference with activity, oral steroid use, ED visits, and hospital

admissions.

RESULTS: Comparison of suburban asthmatics managed by pediatricians

and inner city asthmatics managed by allergists yielded no significant dif-

ferences in medication compliance or asthma control. There was also no

significant difference in these parameters when comparing parent medica-

tion administration with patient medication self-administration in either

the suburban or inner city subjects.

CONCLUSIONS: Effective asthma control is attainable in inner city chil-

dren with moderate to severe asthma; and the medication administrator

does not impact this control.