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Acute Urticaria In Pediatric Emergency Room: Clinical Impact And Therapeutic Response To Non Sedating Antihistamines
Abstracts S107
J ALLERGY CLIN IMMUNOL VOLUME 123, NUMBER 2
The Natural History of Chronic Urticaria: A Cross-sectional Retrospective Study at a Tertiary Care Center, Bangkok, Thailand S. Chantbuddhiwet, K. Ruxrungtham, W. Korkij, N. Noppakun; King Chulalongkorn Hospital, BKK, Thailand. RATIONALE: Limit studies about natural course of chronic urticaria METHODS: Cross-sectional retrospective study of patients with chronic urticaria from Jan 1st,2003 to Dec 31st,2006. Initial screening was based on the recorded hospital database system and all patients were interviewed on the telephone. RESULTS: 291 patients with chronic urticaria were female 75.9%. Mean age of disease onset 32.83 years and mean duration times of disease 2.65 years. Personal and family history of atopy was 11.0% and 17.2%. Unknown aggravating factors 65.3%. Foods were the most aggravating factors (11.0%). Stool exam was positive for parasites and/or ovums 9/ 127 patients, include Giardia cyst (3), S. stercoralis (2), A. lumbricoides (1), Hook worm eggs (1) and O. viverini eggs (2). 82.8% treated with H1-antihistamines alone and 8.9% with H1 and H2 antihistamines. 41% had complete remission, median duration of remission of 2.0 years. Multivariate analysis, showed 4 factors associated with complete remission which include female gender, present of underlying atopic disease, family history of atopy and angioedema (p < 0.05). CONCLUSIONS: Majority of patients could not identify the etiology and aggravating factors. Female with atopic disease or family history of atopy and patients with angioedema may be associated with complete remission. Further prospective study design is warranted to see if we can improve the outcome of chronic urticaria .
404
Acute Urticaria In Pediatric Emergency Room: Clinical Impact And Therapeutic Response To Non Sedating Antihistamines G. Hernandez, A. Franco Sycz, J. Mendez, J. F. Ma´spero; Hospital Alema´n, Buenos Aires, Argentina. RATIONALE: acute urticaria is very common in children. Few studies have been published, data regarding the efficacy of non sedating antihistamines in this age group are missing. We describe the clinical features, personal and family impact of the disease and response to guideline defined treatment with non sedating antihistamines. METHODS: We assessed in a standardized way all cases of acute urticaria attending the pediatric emergency department. Data regarding the actual episode, severity, demography, allergic background, possible etiologic factors, school and parental work absenteeism and response to treatment were obtained during hospital stay and follow up phone calls. Patients were treated either with desloratadine or cetirizine (approved doses) according hospital guidelines. RESULTS: 122 patients entered the study, ages 6 months to 15 years, median 4 years, 68 males .Severity score median was 6 points (maximum 9) 53,8% of the children missed at least a school day and 20% of the parents missed one working day .The response to non sedative antihistamines by day 3 resulted in complete symptom relief in 83,6% of the patients,16.4% needed a second antihistamine or a course of systemic steroids (14.4%) due to insufficient improvement. Adverse events occurred in 16% of the children, were mild and transient and somnolence was the more common. CONCLUSIONS: Acute urticaria impacts the kids and families, has hidden costs due to productivity losses, most of the cases can be controlled with non sedating antihistamines.
405
Presence of IgG Anti-IgE Autoantibodies in Chronic Urticaria and Atopic Dermatitis M. L. Altrich, J. Bohn, J. F. Halsey; IBT Laboratories, Lenexa, KS. RATIONALE: Autoantibodies specific for IgE have been detected in multiple disease states. In chronic urticaria (CU) a subset of patients have an autoimmune etiology with auto-antibodies against IgE, FceRI or FceRII. IgE autoantibodies have also been described in atopic dermatitis (AD). It has been suggested that these autoantibodies may inhibit the inflammatory cascade. The autoantibodies may bind to the surface of mast cells and basophils initiating a signal transduction cascade that results in the secretion of histamine and other mediators and the amplification of ongoing allergic reactions. The goal was to develop and standardize a quantitative assay for these autoantibodies. METHODS: IgG antibodies specific for IgE are quantified a non-competitive ELISA. The assay calibration curve was based on standards prepared from a humanized monoclonal anti-IgE. The test was evaluated with sera from autoimmune CU (n 5 97), idiopathic CU (n 5 142), AD (n 5 75) patients and healthy controls (n 5 61). RESULTS: A population of healthy controls was used to determine the cutoff for the assay. The 95% cutoff was 60ng/mL. The assay demonstrated high reproducibility (intra- (7.4%) and inter-assay (10%)) and good linearity (inter-dilutional coefficient of variation of 14%). This study confirmed the presence of autoantibodies in healthy individuals (mean 5 16.1). Patients with autoimmune CU and AD had higher rates of samples with elevated anti-IgE, 20.6% and 29.3% compared to healthy controls (3.3%) and idiopathic CU patients (4.9%). CONCLUSIONS: A quantitative assay can be useful for the detailed evaluation of autoantibodies against IgE in diseases such as autoimmune chronic urticaria, atopic dermatitis, allergic rhinitis, and idiopathic rhinitis.
406
Skin Reactions to Surgical Tape: Lack of Utility as a Screening Question for Latex Allergy S. P. DaVeiga, X. Liu, L. C. Pien, S. Golubski, M. Xu; Cleveland Clinic Foundation, Cleveland, OH. RATIONALE: Rare reports of latex allergy (LA) presenting as contact urticaria to surgical tape have led to the use of a preoperative screening question for rash with adhesive exposure. Patients who report local cutaneous symptoms with adhesive exposure are referred for LA evaluation; it is unknown whether this clinical history is a risk factor for LA. METHODS: Retrospective review of LA evaluations in an academic institution, 01/07-05/08. Variables examined for each evaluation: reason for evaluation, latex exposure and symptoms, occupation, other atopic disease and final diagnosis of LA based on one or more positive diagnostic confirmatory tests. RESULTS: There were 134 evaluations for LA. Of these, 58 (43%) were requested preoperatively. Subjects were predominantly female (87%), mean age 46 (18-84) years. Local cutaneous symptoms with exposure via latex gloves, condoms, dental/medical examination or surgery represented the most frequently reported clinical history prompting LA evaluation (59%). Of 58 preoperative referrals, local rash with adhesive alone prompted 10(17.2%(95%CI: 8.6-29.4%)) evaluations compared with 5(6.6%(95%CI: 2.2-14.7%)) of the 76 non-operative evaluations. History of local rash with adhesive accounted for zero diagnoses of LA compared with other reported symptoms and exposures to latex (p 5 0.001). Of the 58 preoperative subjects, LA was diagnosed in 12 (20.7%(95%CI: 11.233.4%)) compared with 35 (46.0%(95%CI: 34.5-57.9%)) subjects of the 76 non-operative evaluations. CONCLUSIONS: LA diagnosis among preoperative referrals was lower than for non-operative LA evaluations. Report of local cutaneous symptoms with adhesive in the absence of other significant history was not useful as a screening question for referral for LA and not indicative of LA in our subjects.
SUNDAY
403
J ALLERGY CLIN IMMUNOL VOLUME 123, NUMBER 2
The Natural History of Chronic Urticaria: A Cross-sectional Retrospective Study at a Tertiary Care Center, Bangkok, Thailand S. Chantbuddhiwet, K. Ruxrungtham, W. Korkij, N. Noppakun; King Chulalongkorn Hospital, BKK, Thailand. RATIONALE: Limit studies about natural course of chronic urticaria METHODS: Cross-sectional retrospective study of patients with chronic urticaria from Jan 1st,2003 to Dec 31st,2006. Initial screening was based on the recorded hospital database system and all patients were interviewed on the telephone. RESULTS: 291 patients with chronic urticaria were female 75.9%. Mean age of disease onset 32.83 years and mean duration times of disease 2.65 years. Personal and family history of atopy was 11.0% and 17.2%. Unknown aggravating factors 65.3%. Foods were the most aggravating factors (11.0%). Stool exam was positive for parasites and/or ovums 9/ 127 patients, include Giardia cyst (3), S. stercoralis (2), A. lumbricoides (1), Hook worm eggs (1) and O. viverini eggs (2). 82.8% treated with H1-antihistamines alone and 8.9% with H1 and H2 antihistamines. 41% had complete remission, median duration of remission of 2.0 years. Multivariate analysis, showed 4 factors associated with complete remission which include female gender, present of underlying atopic disease, family history of atopy and angioedema (p < 0.05). CONCLUSIONS: Majority of patients could not identify the etiology and aggravating factors. Female with atopic disease or family history of atopy and patients with angioedema may be associated with complete remission. Further prospective study design is warranted to see if we can improve the outcome of chronic urticaria .
404
Acute Urticaria In Pediatric Emergency Room: Clinical Impact And Therapeutic Response To Non Sedating Antihistamines G. Hernandez, A. Franco Sycz, J. Mendez, J. F. Ma´spero; Hospital Alema´n, Buenos Aires, Argentina. RATIONALE: acute urticaria is very common in children. Few studies have been published, data regarding the efficacy of non sedating antihistamines in this age group are missing. We describe the clinical features, personal and family impact of the disease and response to guideline defined treatment with non sedating antihistamines. METHODS: We assessed in a standardized way all cases of acute urticaria attending the pediatric emergency department. Data regarding the actual episode, severity, demography, allergic background, possible etiologic factors, school and parental work absenteeism and response to treatment were obtained during hospital stay and follow up phone calls. Patients were treated either with desloratadine or cetirizine (approved doses) according hospital guidelines. RESULTS: 122 patients entered the study, ages 6 months to 15 years, median 4 years, 68 males .Severity score median was 6 points (maximum 9) 53,8% of the children missed at least a school day and 20% of the parents missed one working day .The response to non sedative antihistamines by day 3 resulted in complete symptom relief in 83,6% of the patients,16.4% needed a second antihistamine or a course of systemic steroids (14.4%) due to insufficient improvement. Adverse events occurred in 16% of the children, were mild and transient and somnolence was the more common. CONCLUSIONS: Acute urticaria impacts the kids and families, has hidden costs due to productivity losses, most of the cases can be controlled with non sedating antihistamines.
405
Presence of IgG Anti-IgE Autoantibodies in Chronic Urticaria and Atopic Dermatitis M. L. Altrich, J. Bohn, J. F. Halsey; IBT Laboratories, Lenexa, KS. RATIONALE: Autoantibodies specific for IgE have been detected in multiple disease states. In chronic urticaria (CU) a subset of patients have an autoimmune etiology with auto-antibodies against IgE, FceRI or FceRII. IgE autoantibodies have also been described in atopic dermatitis (AD). It has been suggested that these autoantibodies may inhibit the inflammatory cascade. The autoantibodies may bind to the surface of mast cells and basophils initiating a signal transduction cascade that results in the secretion of histamine and other mediators and the amplification of ongoing allergic reactions. The goal was to develop and standardize a quantitative assay for these autoantibodies. METHODS: IgG antibodies specific for IgE are quantified a non-competitive ELISA. The assay calibration curve was based on standards prepared from a humanized monoclonal anti-IgE. The test was evaluated with sera from autoimmune CU (n 5 97), idiopathic CU (n 5 142), AD (n 5 75) patients and healthy controls (n 5 61). RESULTS: A population of healthy controls was used to determine the cutoff for the assay. The 95% cutoff was 60ng/mL. The assay demonstrated high reproducibility (intra- (7.4%) and inter-assay (10%)) and good linearity (inter-dilutional coefficient of variation of 14%). This study confirmed the presence of autoantibodies in healthy individuals (mean 5 16.1). Patients with autoimmune CU and AD had higher rates of samples with elevated anti-IgE, 20.6% and 29.3% compared to healthy controls (3.3%) and idiopathic CU patients (4.9%). CONCLUSIONS: A quantitative assay can be useful for the detailed evaluation of autoantibodies against IgE in diseases such as autoimmune chronic urticaria, atopic dermatitis, allergic rhinitis, and idiopathic rhinitis.
406
Skin Reactions to Surgical Tape: Lack of Utility as a Screening Question for Latex Allergy S. P. DaVeiga, X. Liu, L. C. Pien, S. Golubski, M. Xu; Cleveland Clinic Foundation, Cleveland, OH. RATIONALE: Rare reports of latex allergy (LA) presenting as contact urticaria to surgical tape have led to the use of a preoperative screening question for rash with adhesive exposure. Patients who report local cutaneous symptoms with adhesive exposure are referred for LA evaluation; it is unknown whether this clinical history is a risk factor for LA. METHODS: Retrospective review of LA evaluations in an academic institution, 01/07-05/08. Variables examined for each evaluation: reason for evaluation, latex exposure and symptoms, occupation, other atopic disease and final diagnosis of LA based on one or more positive diagnostic confirmatory tests. RESULTS: There were 134 evaluations for LA. Of these, 58 (43%) were requested preoperatively. Subjects were predominantly female (87%), mean age 46 (18-84) years. Local cutaneous symptoms with exposure via latex gloves, condoms, dental/medical examination or surgery represented the most frequently reported clinical history prompting LA evaluation (59%). Of 58 preoperative referrals, local rash with adhesive alone prompted 10(17.2%(95%CI: 8.6-29.4%)) evaluations compared with 5(6.6%(95%CI: 2.2-14.7%)) of the 76 non-operative evaluations. History of local rash with adhesive accounted for zero diagnoses of LA compared with other reported symptoms and exposures to latex (p 5 0.001). Of the 58 preoperative subjects, LA was diagnosed in 12 (20.7%(95%CI: 11.233.4%)) compared with 35 (46.0%(95%CI: 34.5-57.9%)) subjects of the 76 non-operative evaluations. CONCLUSIONS: LA diagnosis among preoperative referrals was lower than for non-operative LA evaluations. Report of local cutaneous symptoms with adhesive in the absence of other significant history was not useful as a screening question for referral for LA and not indicative of LA in our subjects.
SUNDAY
403