L. Borish

Pilot study of budesonide inhalant suspension irrigations for chronic eosinophilic sinusitis

nary function testing have been implemented to optimize asthma control. It has not been uncommon for a subject taking a daily OIT dose without eating a meal or snack in the 2 hours before dosing to have symptoms with a dose that had been previously tolerated; taking the same dose with a substantial meal or snack the next day and thereafter prevents further reactions. Additionally, several subjects have experienced allergic symptoms with exercise after OIT dosing, and we advise these subjects to avoid exertion for 2 hours after dosing. Finally, 1 subject had several systemic reactions when menses was coupled with exercise despite no symptoms with daily dosing in the interval between episodes and was eventually withdrawn from the study. She was not taking other medications (eg, nonsteroidal anti-inflammatory drugs). Of note, she did not have systemic reactions each time she exercised during menses. At this time, the role of menses is unclear, and further study is needed. In the studies to date, peanut and food OIT have a good safety profile, and home dosing is infrequently associated with adverse reactions. However, allergic symptoms should be expected, and subjects and their families should be counseled about circumstances associated with an increased possibility of reacting to previously tolerated OIT doses. As OIT for food allergy becomes increasingly studied in research settings, implementing these recommendations and modifications can improve the safety of these experimental protocols. Pooja Varshney, MD Pamela H. Steele, CPNP Brian P. Vickery, MD J. Andrew Bird, MD Ananth Thyagarajan, MD Amy M. Scurlock, MD Tamara T. Perry, MD Stacie M. Jones, MD A. Wesley Burks, MD From Pediatric Allergy and Immunology, Department of Pediatrics, Duke University Medical Center, Durham, NC, and Pediatric Allergy and Immunology, Department of Pediatrics, University of Arkansas for Medical Sciences, Arkansas Children’s Hospital, Little Rock, Ark. E-mail: wesley.burks@duke.edu. Disclosure of potential conflict of interest: P. Varshney received the National Institutes of Health T32 Training Grant. B. P. Vickery has received research support from the Thrasher Research Foundation. J. A. Bird has received research support from the Food Allergy Initiative. A. M. Scurlock has received research support from the National Institutes of Health. T. T. Perry has received research support from the National Institutes of Health and the Robert Wood Johnson Foundation. S. M. Jones is a consultant for and board member of the Food Allergy & Anaphylaxis Network and has received research support from the National Institutes of Health and DYAX Corporation. A. W. Burks is a Consultant for ActoGeniX NV, Intelliject, McNeil Nutritionals, and Novartis; is a minority stockholder of Allertein and MastCell, Inc; is on the Advisory Board for Dannon Co. Probiotics; is on the Expert Panel for Nutricia; has received research support from the National Institutes of Health, the Food Allergy & Anaphylaxis Network, and the Wallace Research Foundation; has served as an expert witness on the topic of food allergies; is on the Medical Board of Directors for the Food Allergy & Anaphylaxis Network and the Dermatological Allergy Committee for the American College of Allergy, Asthma & Immunology; is a member for the National Institutes of Health Hypersensitivity, Autoimmune and Immunemediated Disease Study Section; and is on the Journal of Allergy and Clinical Immunology reviewer board. The rest of the authors have declared they have no conflict of interest.