Gerald Lee, MD: Hello everyone, and welcome to another episode of Allergy Talk, a roundup of the latest in the field of allergy and immunology from the American College of Allergy, Asthma and Immunology. For today's episode, we're reviewing more articles from Allergy Watch, a bi-monthly publication, which reviews the latest research from the latest journals of allergy and immunology.

And by listening to this podcast or watching it on YouTube, you can earn CME credit. For information about CME credit, go to education.acaai.org/allergytalk. And also please join us on the doc matter community where we can continue the discussion about the articles review today. Hello everyone. My name is Gerry Lee. I'm an allergist, immunologist, and Associate Professor at Emory University School of Medicine and an Assistant Editor of Allergy Watch.

And today I am joined by the editor-in-chief of Allergy Watch, Dr. Stan Fineman.

Stanley M. Fineman, MD, MBA: Thanks, Gerry, and it's great to be here. I've been in practice for over 45 years. I'm currently an adjunct faculty at Emory, and I'm going to be stepping down as editor-in-chief and turning the reins over to Dr. Joshi, next month as a matter of fact. So, I'm glad to be doing this.

Gerald Lee, MD: And so in the third chair, we have the new editor-in-chief of Allergy Watch, Dr. Shayam Joshi, an Associate Professor and Section Chief at Oregon Health and Science University. Welcome back to Allergy Talk.

Shayam Joshi, MD: Thank you so much for having me. I think we have some really, really great articles here to talk about.

Gerald Lee, MD: Okay, well, let's let her rip. Stan, I think you are always interested in allergen immunotherapy and any data that sort of helps inform that practice. What do you want to tell us about this time?

Stanley M. Fineman, MD, MBA: Well, this article is from the uh, Annals of Allergy, and it was reviewed by Dr. Otani in Allergy Watch. And it's entitled Allergen Immunotherapy Induced Anaphylaxis, and it's data from the European Anaphylaxis Registry and, so what they did is basically they looked at 54 allergy centers across 10 European countries.

And the timeline was from 2007 to 2023, and they defined anaphylaxis as involving at least two organ systems. Then they went forward from that looking to see how many were due to allergen immunotherapy and really immunotherapy, allergen immunotherapy accounted for 1.1% of cases in the anaphylaxis registry. That's 173 out of the 15,000 plus that they uh reviewed.

This was about 1.8% were pediatric and 0.7% were adults. So twice as many kids as adults and respiratory symptoms were more frequent. In the children 90 something percent. In adults, it was lower, only 66%, whereas cardiovascular and GI symptoms were more frequent in adults versus kids. And only a few sublingual immunotherapy related cases were documented.

And those mostly included two grade III reactions, but mostly grade II. And there were no fatalities. So that was eight cases in the uh, sublingual immunotherapy. But in the SCIT category, the subcutaneous immunotherapy, there were 153 cases and even had one fatality, and that was to grass pollen allergen.

They analyzed the onset of the uh symptoms. The onset of the reactions were most of them were within 30 minutes. There were a few that were delayed. In 22 cases and all the delayed grade III reactions occurred except that some of the reactions occurred in children even after couple of hours, which is very, very unusual, I think.

Adrenaline was underused in the emergency management. It was only administered in 30% of the grade II reactions and 50% of the grade III reactions. And, you know, just to follow-up on the article Dr. Joshi presented at the last podcast, which was the um, consensus statement on the definition and treatment for anaphylaxis.

I thought it was interesting that in these patient's that who had anaphylaxis II to immunIIotherapy, 80% received antihistamines. Only between 30 and 50% received adrenaline and over 80% received corticosteroids. There was a few that did receive beta agonist as well, because, I guess they had respiratory symptoms. But you could see steroids, antihistamines still frequently used for patient's who are being treated for anaphylaxis, for immunotherapy.

The other thing they did talk about was the fact that asthma and it was a predisposing risk criteria. We all know that. Asthma, you know, needs to be well-controlled before you get your immunotherapy dose because that can certainly predispose to having a risk for an anaphylactic reaction to immunotherapy.

But I thought it was interesting in terms of limitation. I felt this was a very limited study because what they did, these were patient's who were diagnosed with anaphylaxis, and then they went back to see was it sublingual immunotherapy or you know, subcutaneous. What I think is more useful is taking a group of patients who are on immunotherapy and then seeing the incidence of anaphylactic type reactions.

But I think, their report is uh, useful. I think it's helpful, again, a lot of data, over 15,000 patients and I think it is good that it was reported in the annals.

Gerald Lee, MD: So Stan, in terms of the report and entry into the registry, does that mean all of these cases, the anaphylaxis occurred in the office or we're not actually even sure of the location?

Stanley M. Fineman, MD, MBA: No, it did not clarify the location. In fact, I would think most of them were not in the office because sounded to me like some of the uh, subcutaneous immunotherapy was not in a allergist office like we know here in the United States. As we know in Europe, and in some of those areas it's hard to find allergists and a lot of times general family docs would be administering their immunotherapy too.

So definitely not just an allergist office, not the same practice type technique that we use here in the US.

Gerald Lee, MD: Yeah I think, my response to that is we often partner with local offices to administer allergy immunotherapy or even patients request if they can do home immunotherapy. And I think this is just a good reminder of, even though it is rare, right? You're mentioning of all the anaphylaxis reported in the registry, it is a vast minority.

It still can cause pretty significant reactions, especially those delayed reactions. I think like that's something that always concerns me when they are having reactions leaving the office. So, I think just really good partnership with our partners who are administering shots, especially if they're not in an allergist office. I think it's just a good reminder to, to make sure you have that relationship and are communicating well with pretty clear instructions and protocols.

Shayam Joshi, MD: And speaking of that, what do you all do specifically in when you are partnering with an outside, let's say primary care or student health services for college students? Do you require them to sign any documents that they understand how to treat anaphylaxis or how to give shots. I just curious to see how, what people do for in different parts of the country.

Gerald Lee, MD: Oh yeah, we absolutely have a signed consent. So, we give them a piece of paper that has our protocol, that they understand how to treat anaphylaxis and again, agree to do the monitoring. I think it's because we just want to ensure that they are going to a office that's going to take this seriously.

And so if they're willing to sign it, then they know that at least someone has read this document. Understood that this is not going to be something, oh, we didn't know, right? Like they, they knew what our expectations are.

Shayam Joshi, MD: Yeah, we do the same thing. That's great.

Stanley M. Fineman, MD, MBA: Yeah, we had signed forms. The other thing I did years ago when I had a number of patient's who were from a remote area. I mean, remote meaning, it took them an hour to drive and they had a, a good pediatrician in their neighborhood. This was a little more rural type area.

I went to visit the pediatrician office and I talked to them and it really gave them a little you know, update on what immunotherapy is, what do you have to look for for anaphylaxis, and treat it. And I think they felt a lot better about giving the injections. The other thing I think you could use this type of study for is to tell your patients, you really need to wait 30 minutes.

I mean, that was a big problem for a lot of times. Patient's will, you know, they'll get their allergy shot and then they go run off to soccer practice. I mean, you don't want them doing that. That's just asking for trouble. So you need to reinforce, this is just another more data that reinforces the fact that you need to wait 30 minutes.

Shayam Joshi, MD: And I think this is a great callback to the last episode when we talked about the consensus statement. I wonder if we could start utilizing that figure when we are talking to these pediatricians and primary care providers that are giving shots and being like, here, everything you need to know about anaphylaxis is right here.

What you need to look for, what kind of specific symptoms you're looking for, and only treatment here is epinephrine. So I think combining that with what we're talking about here is a no brainer.

Stanley M. Fineman, MD, MBA: More teachable opportunities.

Gerald Lee, MD: Oh, absolutely. And especially something important like allergen immunotherapy. So, completely agree. Thanks for bringing this article forward, Stan. So, let's talk about the next article. I'm going to review more data that just keeps on coming out from the famous OUTMATCH study, right? As you recall, OUTMATCH was the FDA phase three trial that led to the FDA approval of omalizumab as a protection against food allergic reactions for those with IG mediated food allergy.

It was three stages. Stage one was the double blind placebo controlled trial that got the medicine approved where children and a few adults had to have more than one food allergy, three food allergens that they all had challenges pre and post the treatment, showing that, again, increase in threshold, that protective threshold with two-thirds reaching 600 milligrams of peanut as well as variable response to other allergens.

So, you may recall, there's two other stages. We reviewed that in a previous podcast with Bob Wood and Sharon Chinthrajah. Definitely check that out. But just to review, stage two compared multi allergen OIT to omalizumab and stage three is what I'm going to be reviewing today, which is the asking the question, once you complete omalizumab, is there a way to continue consumption of the food even after discontinuation of Omalizumab?

And so that's the question. Essentially, this is taking the first 60 participants who again, completed 24 weeks of omalizumab treatment. They had their exit food challenges to their three foods, and based on the results, they were given three different strategies to each food. One is deliberate consumption, so they were asked in the dietary consumption group to get to eat approximately 300 milligrams at least of that food.

Is it like a maintenance? Number two was a rescue or immunotherapy, right? So again, they were desensitized again to that food, in an attempt to try to get them to be able to consume the food. Or number three the avoidance. And so again, this study is sort of reporting on the experience of these six C individuals and the success in achieving dietary consumption after discontinuation of omalizumab.

And what we did find is that less than half of the individuals were able to consume their foods that they were avoiding, all three of those foods. There were some successes more for milk, egg, and wheat. About 61 to 74% were able to get dietary consumption. Peanut and tree nuts were less, that was more like 38 to 56%.

And the only predictor of someone who's able to achieve dietary consumption was the initial reaction threshold. So if you had a higher threshold in your initial challenge during screening, then you were able to be more likely to achieve dietary consumption. Though things like duration of treatment and age did not seem to have an effect.

Now the thing that's very important about this study is, as you can imagine adverse reactions because again, they're withdrawing omalizumab therapy and now they're still consuming their allergens. So what are we expecting? Well we're expecting more reactions. They absolutely did see that. They had about 28 reactions requiring epinephrine, 16 of the participants experienced anaphylaxis starting consumption.

So we're thinking about approximately a third of the individuals who had some sort of anaphylaxis, requiring epinephrine, in this phase of the trial. I think there was also four individuals who developed eosinophillic esophagitis during this consumption phase. So again, there is some adverse events when we do this strategy.

So overall, the paper concluded that most participants could introduce their food allergen after omalizumab. But again, there was a lot of avoidance. There was reduction of intake, there was reactions. So it's not very clean. Right. And it's not clear to me how many allergists would take the strategy. Right?

How many allergists would just sort of gave omalizumab, and just stop it. Iknow that some allergists do use omalizumab to reduce the chance of a reaction and achieving maintenance, which sort of models this strategy. Especially if the intent is long-term dietary consumption, I think we are really going to need more data to decide who would be the individuals we would attempt that and who probably should stay on the drug if we are going to say dietary consumption, reintroduction of the food is the goal of the therapy.

Shayam Joshi, MD: Yeah, when they first announced the kind of phase two, phase three of OUTMATCH, I think we all thought this was going to be a little bit messy. It, in theory it is really important questions that we need to answer. But when all of us that take care of food allergy kids, like there's so much heterogeneity in those patients and really understanding, there's so many nuances that it's going to be really hard to categorize these patients as this group of patients you can do this for.

And I think this is going to exactly what you were saying is it really depends on what the goal of the family is. And if the goal really is free eating while on OIT, I think it's going to be a hard sell to really take them off omalizumab to allow them to do that.

But I think there's food challenges. There's still opportunities to give maybe some hope that this is very possible and really targeting those patients that have a high eliciting dose right off the bat. I think those are the patients maybe this gives some reassurance that there is some ability to get to that point and maybe trying to push them a little bit to see if they can freely eat after omalizumab is discontinued.

I'm not sure if it changes anything day one for me, but it does give me some food for thought.

Stanley M. Fineman, MD, MBA: It's interesting, you know, these patients, as we all know, had very low thresholds for trigger. And so they're kind of the highest of the high-risk patients. But what scares me is the fact that, they didn't have a great outcome. And there is so much oral immunotherapy for food allergy going on right now with the variety of different protocols and it is almost like the wild west sometimes when you think about it.

So it just worries me. I know some patients are going to do well and, and these very, very high-risk ones, could definitely have trouble. And I think, glad to see this third phase come out, or stage three come out, the data and I think we're going to learn and hopefully it's going to help us, care for these complicated and difficult patients in the future.

Gerald Lee, MD: Yeah, I think overall, the take-home is that we do need more studies like this. Stan, your point is very well taken that because there's so much variability in the treatment as well as the variability in patients, making heads or tails of best practices or patient selection, especially if you're trying to do shared decision-making, gets convoluted with that data.

So ultimately we can continue to at least encourage patients to participate in research trials, not as gatekeeping OIT, but to really understand and answer some of these important questions. I think like that is really what's going to move this field forward and making sure we reduce adverse events as much as possible and get patients what they want, whatever that is.

And I would say avoidance and protection from reactions is absolutely a fine goal. I'm not going to say patients even need to go for reintroduction of the food. It's really, I'm just going to work with that caregiver on what they want. And then we're going to make a plan together on how they're going to achieve their goals.

And I'm so happy we can do that. That's the most exciting part, that we finally can do these sorts of things rather than here's epinephrine, here's your refill. I'll see you next year. Thank goodness, that's like the dark ages, right?

Stanley M. Fineman, MD, MBA: Yeah, but you also make sure, don't tell your patients or warn them about Chat GPT. For those of you who listened to the last podcast episode 58, we talked about an article where ChatGPT, answered common questions and didn't do so well. So, uh, I refer you to that episode if you haven't heard it already.

Gerald Lee, MD: Yeah. Thanks for that callback, Stan. Okay, well let's wrap this up. And Sham, this is like a really interesting article. I mean, it's really proposing standard rhinitis therapy as a protection against COVID. So tell us about this.

Shayam Joshi, MD: Yeah, this is a article that came out of JAMA Internal Medicine, which again, call out to Allergy Watch. Because this is not a journal that we are generally reading as allergists, but it is a really important article. So it's Azelastine Nasal Spray for prevention of SARS-CoV-2 Infections, a phase two randomized clinical trial.

This is a trial out of Germany and the authors decided to do this trial based off of kind of several studies that have happened over the last 3, 4, 5 years. And so there have been in vitro studies for cell cultures, but also reconstituted human nasal tissue that have shown that Azelastine does have some antiviral activity against a range of respiratory viruses, not just COVID, also RSV, influenza A. And knowing that there was again, some proposed mechanisms of how can this actually even happen?

So we know Azelastine may have several mechanisms that reduces viral load, viral reproduction. And that could be through angiotensin converting enzyme 2, ACE2 inhibition of SARS-CoV-2 protease mpro, modulation of alpha one receptor and suppression of ICAM one upregulation. And so through those various mechanisms, that's generally thought of as, could be the reason why it has some antiviral properties.

And so, there have also been some randomized trials demonstrating that Azelastine nasal spray reduces the viral load in patients with lab confirmed SARS COV2 infection, suggesting that there could be some therapeutic efficacy when used in patients who already have COVID, right? So we decrease the viral load and these were a couple trials in 2023 and 2024, and they showed that reduction in COVID-19 viral load, it was statistically significant.

But when you look at it, it's unclear if it was clinically relevant in terms of reduction in viral load, but statistically significant. So there is seems to be something there. So then the authors are like, okay, we know that it can decrease viral load in somebody who already is infected, especially the milder infections.

Could it potentially be used as a prophylaxis therapy to reduce getting COVID in the first place, which would be phenomenal. So that's where this trial was really born from. And so they recruited 450 patients. So a decent sized trial for a kind of a phase two here. 227 of them received Azelastine.

The rest were on placebo. And these are patient's aged 18 to 65. It is important to note that 93% of these patient's were white. So, it was a very white, heavy population. It is from Germany, 1% of African descent and 5% of Asian descent. So maybe not the same population we have here in the US but it's again, just to understand that while we're going through this.

All these patients at the beginning of the trial were negative for COVID, right? We're looking at prophylaxis, not a treatment. And that they were not allowed to use any other antihistamines throughout this process. That includes oral, ocular, or other nasal sprays. And these were again, mainly healthy. Almost 99% of them were previously vaccinated.

And this was a single center study. They did get baseline serology testing for all of these patients just to see if their level of antibodies specifically to the nucleocapsid and spike antibodies, were they different in the placebo and the therapeutic group? And did that affect their rate of getting infections in the future.

And there wasn't anything there. So this intervention took place between March, 2023 and July, 2024. And that's important to know because of just kind of COVID, waxing and waning throughout the year. And so this did cover pretty much a year and a half cycle. So we're catching winter season, summer season, we're catching everything.

And the therapeutic intervention was Azelastine 0.1%, one puff in each nostril three times a day. So, again, a little bit different than how we use Azelastine, but still in the range. The other group got placebo. And so they tested each of these patients twice a week with a nasal pharyngeal swab.

That is impressive that they got these patients to endure that because that is not a fun process. But these are through trained professionals. This wasn't self swabs. These were actually through trained professionals and a total of 56 days. Their primary outcome was incidence of PCR confirmed COVID-19 infection. They had a bunch of secondary outcomes as well.

I'm only going to mention a couple, but they had quite a few. They were also looking for time to COVID infection, incidence of other viral upper respiratory infections. They used a multiplex PCR to look for other forms as well. All right, results. So, about 50 patients in each group were not included in the per protocol analysis.

We're not going to talk about that group specifically, but they had a lot of poor adherence, withdrawals and some deviation from protocols. Okay? So of the two groups, 2.2% of the patients that were on Azelastine got COVID during that 56 day period. Compared to 6.7% in the placebo group.

So we're looking at a threefold increase here. These are still relatively small numbers, right? Even in the placebo group, we're talking about 15 cases of COVID in that 56 day period versus five cases in the Azelastine group. But it is statistically significant and I would say that's clinically meaningful for sure.

When you look at the per protocol analysis, so these are the patients that actually completed the trial, were on the protocol the whole time. It was 2.8% in the Azelastine group and 7.5% in the placebo group. So even actually a little bit bigger difference in those patients that were actually taking Azelastine appropriately.

And then in addition to that, you looked at the overall number of PCR confirmed infections. So this includes beyond just COVID. And you see in the Azelastine group, you have 9.3% versus the placebo group of 22%. So again, a twofold increase in the placebo group. And specifically the one virus that stood out of all of those was rhinovirus that they had, the placebo group had an increased risk of getting rhinovirus.

And so I thought it was a really interesting study calling out a medication that we prescribe very often that there could be some antiviral properties there that not only help with COVID, and I don't think we would've come to this study if COVID didn't happen, right? There wouldn't have been this interest.

But now we're also seeing potentially that it could reduce rhinovirus infections as well. I'm not saying that we should go and prescribe this to everybody who's at-risk. All of our immune deficient patients get Azelastine. I'm not saying that at all, but, I do think it is worthwhile with some follow-up studies, some larger phase three trials to really look at could this be a useful tool for our patient's that have nasal symptoms that could benefit from Azelastine for their nasal symptoms, but also get this potentially great secondary benefit.

Stanley M. Fineman, MD, MBA: Well, I could tell you a study with an N of one. Because I used Azelastine and have for a while, and my wife has had COVID and my kids have had COVID and I, I better knock on wood, but I've not had it yet. But I don't know if that's because of the azelastine or not.

But I, I was wondering, you know, we also have olopatadine as a topical antihistamine. Is the mechanism, the antiviral mechanism unique to Azelastine, or is that also present with the Olopatadine, or you think it might be with Olopatadine?

Shayam Joshi, MD: Yeah, that's a great question. I was thinking about that when I was preparing for this podcast and there isn't as much data out there, but looking at their mechanisms being pretty similar, I would say that they would have at least share some of the potential mechanisms in terms of effectiveness and prevention.

But again, I think we would still have to have some studies to really prove that that has the same effect as Azelastine does.

Gerald Lee, MD: And do we know about even intranasal steroids? I'm just curious.

Shayam Joshi, MD: I don't think we have as much data there, especially for COVID specifically that has been shown to be as efficacious as Azelastine is.

Stanley M. Fineman, MD, MBA: Yeah, the steroids don't have the antiviral, wouldn't have that same effect that you mentioned Shayam, is that right?

Shayam Joshi, MD: They theoretically shouldn't, but could they have other mechanisms potentially? But I'm not aware of any good studies, especially, again, this is a pretty solid 450 patients placebo controlled trial that you just don't see these very often. I thought it was, it is really important to bring up to this group.

Gerald Lee, MD: Yeah. My only follow-up question is did they actually report how many of these patients had chronic rhinitis, allergic rhinitis, or that sort of thing?

Shayam Joshi, MD: Yeah, they were pretty even across the board in terms of atopic disease. And so they looked at classic symptoms. COVID I don't think they mentioned specifically allergic rhinitis, or chronic rhinitis or CRS in the two groups though.

Gerald Lee, MD: Okay. The motivation of the question is this, and again, this is not evidence-based, I'm just telling you my observation. I have been referred so many children and the chief concern of the caregiver is the infections are longer than they should be, and my child's sick all the time. I think my child has an immune deficiency.

And I'm going to tell you, there are many, many, many, many, many, many patients, where their immune system is beautiful, but they have horrible, horrible airway inflammation and you treat that inflammation, they do awesome. Right? It's allergies. So I'm not saying that explains the mechanism, but it just shows that airway inflammation is really important.

It is absolutely a susceptibility factor in my opinion. And anti-inflammatory therapy, if not helpful, I think a susceptibility factor. Again, I really have no ground to stand on, but we do know that patients with rhinitis and asthma certainly have significance triggers due to infection and maybe incorrectly, I'm linking the two, but absolutely.

There's a lot of patients who do respond to these anti-inflammatory therapies in terms of infection severity.

Shayam Joshi, MD: No, I completely agree. I think that's absolutely true, and I think when we manage those, whether it's intranasal steroids or Azelastine or just better asthma management, they do better. They absolutely do better. So yeah, it could be part of it though. It could be part of just understanding the mechanism of why that happens a little bit better is hidden in this, process here.

Gerald Lee, MD: Well, there are a lot of smart people who are listening to this podcast or maybe watching. If you have the answer, absolutely contact us. Our email is allergytalk one word@acaai.org. And again, if you like what you're hearing, please rate us on your favorite podcast app or rate us on YouTube.

Again, if you want to hear more episodes of Allergy Talk, we just have a whole just host of episodes available for you. The website is education.acaai.org/allergytalk, as well as the publication will review even more articles. And that's college.acaai.org/publications/allergywatch. Now, one last thing, and I think we've already talked about it, but I wanted to pause and number one, absolutely thank Dr. Stan Fineman for number one greenlighting this podcast, for his leadership as Editor-in-Chief of Allergy Watch.

You're going to have to remind me, Dr. Fineman, how long you have been running the ship at Allergy Watch, but if you could just sort of tell me about you know, reflecting back on your tenure as Editor-in-Chief, I'd love to take a few moments if you could just tell us some of your reflections.

Stanley M. Fineman, MD, MBA: Well, Allergy Watch was started by Bud Bardana, who in fact is at Dr. Joshi's program. And he, it was his brainchild. And Tony Montanaro, who I know Dr. Joshi works with, Shayam works with closely up in Oregon was the Editor-in-Chief for a number of years. I was just an editor, you know, associate editor for over 20 years.

Under, in fact, under Dr. Bardana, and I remember he would really be very critical about some of our reviews and make sure that we had what he called pithy comments. And so I think that the average allergist, when they look at Allergy Watch, they're looking at our comments as editors to really try to figure out, what exactly, you know, to glean what's the take-home message for the article.

And I think so that, you know, as an allergist, when you read through Allergy Watch, you can really take that home with you and, and understand this is the meat of the study. So I want to give credit to them. And, I think that from the feedback I get, the fact that Allergy Watch, we review the ABAI CAP, MOC articles twice a year, that comes out twice a year.

And uh, that's been a very popular issue. I remember when I was uh, doing the MOC, I would always read the Allergy Watch first before I read the whole article. Just because it is kind of like reading the book cover or the back of the book. Like, when you start a new book you want get a little bit of a heads up on what it's about.

So, it gives you a heads up and it gets you in the mood to, study more effectively when you're preparing for the MOC. But I think that ultimately I just wanted to note that Shayam I'm glad that he's taking over as Editor-in-Chief. And the fact that it's sort of going a full circle back to Oregon and I'm sure his mentors are happy for him.

And I think we're going to be in excellent, excellent hands. So, you know, Shayam, thanks for taking it over.

Gerald Lee, MD: Yeah, Shayam, congrats to you for getting the Editor-in-Chief position. I think I'm really excited about what your plans are for Allergy Watch. I don't know if you wanted to give us a preview of things that you've been thinking or changes you might see in the future.

Shayam Joshi, MD: Yeah, I think we're building off such great tradition all the way from Bud Bardano to Tony Monero to Dr. Fineman here. And really it's such a good product already. I don't want to rock the boat too much because I do think it's where allergists are finding a lot of their key information and finding it in journals that maybe we don't read that regularly, like Journal Science in the last podcast we had, or JAMA Internal Medicine.

And so we want to make sure that we are still covering all of the relevant articles, all of the relevant journals that allergists need to know. And continuing to really provide high quality pithy comments. My goal is to continue to expand the breadth of knowledge from our assistant editors, creating some new, getting some new blood, some new interests making sure that we have a good variety of experts in drug allergy as well as food allergy, as well as immune deficiency, et cetera, et cetera.

And so I hope to continue this excellence of Allergy Watch that has lived for years now and really make sure that we continue to provide that valuable resource to all of the college members.

Gerald Lee, MD: Here, Here. I absolutely again, value the experience. I learn a lot. Again, congrats you Stan. Thank you for your years of service for the College and Allergy Watch, and this podcast and everything. And a mentor for me in Atlanta. Again, thank you for all you've done. So again, I think that's the end of the episode.

I hope you have a wonderful day. Thanks for listening and watching.

Host: If you enjoy what you're listening to or watching, please rate us on YouTube, please rate us on your favorite podcast app. And maybe you have thoughts. Please give us your emails, your comments. The email to contact us is allergytalk-- one word-- @acaai.org. And just remember we have all these other episodes available for you to get CME on.

The website is education.acaai.org/allergytalk. And of course, the published issues of Allergy Watch are archived on college.acaai.org/publications/allergywatch

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