On a personal note, the AAAAI annual meeting at Phoenix, Arizona, from February 24–28, 2022, was a special experience for my wife, Mrs. Kamala, and myself. Around this time of the year, we are normally in India, busy with academic, cultural, and charitable activities, mainly through our medical charity, namely International Asthma Services (IAS).
IAS has been active in India for the past three decades and other low and low-middle income countries (LMIC) in educational outreach activities (CMEs, allergy awareness camps, formal courses, and training of health professionals).
Due to the COVID-19 pandemic, we had to cancel our travel plans for the winter, and we thus had the opportunity to attend the AAAAI convention after several years. The other special event in our lives was the special recognition award bestowed on me by the AAAAI in recognition of our work as outlined above.
AAAAI’s theme was the aptest and appropriate topic of Difficult to Control Asthma. This is an issue around the globe faced by clinicians and researchers involved in the care of asthma patients. Due to multiple causes, 50-65% of pediatric patients in LMIC suffer from severe asthma. The diagnosis and management of asthma have changed significantly in the past decade through the clustering of patients based on phenotype, genotype, and endotype. Several biologicals have been introduced in the market to address these challenging cases, and this conference was filled with the latest innovations in the field of severe asthma management. There were many webinars, breakfast sessions, small group sessions as well as plenary sessions addressing this issue.
One of the topics discussed during the plenary session on severe asthma was the discussion regarding remote monitoring, utilizing digital health and remote patient monitoring to include an electronic medication monitor, mobile phone app, health cloud, and clinician dashboard with abilities to measure PM2.5, ozone, SO2 in our indoor and outdoor environments. It also opened the caveat of the present care with periodic follow-up of such patients. I was shocked to find that the care we provide through the 15–30-minute office visit is just an eyewash. Specifically, a three-month period translates into 2,160 hours, and our time spent in the care of studying disease processes translates to mere 0.007 minutes. This has to change, and it will, by ‘remote monitoring’ where we have access to the disease throughout the 2,160 hours. This surely will potentially change the way we will manage asthma as well as other medical issues too.
Another session I attended was the diversity issue in asthma: in patients and clinicians. The presentations were excellent and, at the same time, quite disturbing to find that poor, Black neighborhoods suffer from the vicious cycle of disease-poverty-disease. I did not realize the population living in those areas cannot obtain mortgages since the banks consider them high risk. Hence the properties are poorly maintained to start with and undergo dilapidation over the years. Such conditions increase the allergenic and pollution load and surely worsen the disease progression. And, due to poor socio-economics, there is poor access to quality care and recent effective medications like biologics. Hence this is a vicious pathway going one-way: into the gutter!
The last session I attended was the Component Resolved Diagnosis (CRD) in food allergy, insect allergy, and inhalant allergy. The presentations were fascinating, as well as highly applicable. In food allergy, history is the most important part of the diagnosis. No test can replace a good history. Considering a good history, the values of allergy skin testing, and the determination of specific Immunoglobulin E (IgE) (in vitro), are useful but limited in pinpointing the issue. The CRD provides the determination of specific IgE against the individual allergenic molecule, and this information will surely improve the diagnostic accuracy and management. This method, although a major improvement, still needs to be worked out for cut-off levels, and hence oral food challenges remain the gold standard for diagnosing food allergy. The application of CRD in diagnosing pet allergy (cat and dog) is also very useful, especially in situations where there is a discrepancy between history, aspartate aminotransferase, and IgE. CRD can also help in elucidating cross-reactivity and establishing predictive risk markers.
Dr. Vedanthan has no conflicts of interest to report.
Illustration by April Brust
