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Children With Tolerance Of Baked Egg Demonstrate Higher Eliciting Doses In Challenges To Native Egg
Abstracts AB275
J ALLERGY CLIN IMMUNOL VOLUME 139, NUMBER 2
Predictors of Milk Tolerance Following Baked Milk Challenge
Joan H. Dunlop, MD1, Corinne Keet, MD, PhD1, Kim E. Mudd, RN, MSN, CCRP1, and Robert A. Wood, MD, FAAAAI2; 1Johns Hopkins University School of Medicine, Baltimore, MD, 2Johns Hopkins University School Medicine, Baltimore, MD. RATIONALE: Introduction of baked milk (BM) is a mainstay in the management of cow’s milk allergy. We sought to characterize predictors of BM tolerance and progression to baked cheese and direct milk among patients undergoing BM oral food challenges (OFC). METHODS: 126 patients challenged to BM from 2009-2011 were reviewed. OFC success was defined as consumption of ¼ cup BM. Logistic regression was performed utilizing milk-IgE level (log-transformed), age, gender, duration of follow-up, and OFC outcome to determine predictors of subsequent milk intake. RESULTS: 99 patients (4 months-18 years) old were included. Median duration of follow-up was 51 months (range 1.9-85 months). 65% passed the BM OFC. Among those failing, 91% were permitted to introduce specified quantities of BM. Of those passing, 75% progressed to unlimited BM or more, 61% advanced to baked cheese or more, and 38% advanced to direct milk, compared to 48%, 40%, and 26% of those failing the BM challenge (p50.004,0.046, and 0.234, respectively). Milk-IgE was significantly associated with OFC outcome (OR 0.19, p50.001) and progression to unlimited BM (OR 0.35, p50.046) or baked cheese (OR 0.38, p50.05) but not direct milk (OR 0.96, p50.16). Patients with milk-IgE >10kU/L were less likely to tolerate unlimited BM (10% vs 54%, p50.015), baked cheese (8% vs 45%, p50.04), or direct milk (4% vs 29% p50.06). Gender, duration of follow-up, and age were not significant predictors. CONCLUSIONS: OFC outcome and milk-IgE were the most important predictors of persistent tolerance to BM or more concentrated forms of milk.
863
Children With Tolerance Of Baked Egg Demonstrate Higher Eliciting Doses In Challenges To Native Egg
Peter S. Capucilli, MD, Jonathan M. Spergel, MD, PhD, FAAAAI, Terri F. Brown-Whitehorn, MD, FAAAAI, Antonella Cianferoni, MD, PhD, FAAAAI, Joel Fiedler, MD, FAAAAI, Laura M. Gober, MD, Nicholas A. Pawlowski, MD, Gita Ram, MD, Rushani W. Saltzman, MD, and Jennifer Heimall, MD; The Children’s Hospital of Philadelphia, Philadelphia, PA. RATIONALE: It is well recognized that some children with egg and milk allergy tolerate these foods in the heated or baked form. Our study defines differences in median eliciting dose for children undergoing native egg and milk oral food challenges (OFC) by previous tolerance and exposure to baked forms. METHODS: A retrospective chart review of 569 patients, ages 1-18y, who underwent OFC to native egg and milk from 1/2012 through 12/2015. The Mann-Whitney test was used to compare median eliciting doses for each group. Demographics, OFC results (dose, reaction), skin prick test and specific IgE were collected. RESULTS: For native egg, the median eliciting dose in children who previously reacted to baked egg (n535) was 0.50g (0.13g-9.88g), compared to 3.50g (0.13g-15.80g) in children who tolerated baked egg (n5235) (p50.0064) and 0.38g (0.13g-3.88g) in those with no exposure to baked egg (n572)(p<0.0001). For native milk, median eliciting dose in those who had reacted to baked milk (n540) was 2.32g (0.07g-8.50g), compared to 5.99g (0.15g-12.40g) in those with baked tolerance (n5105) (P50.318), and 4.49g (0.44g-17.70g) in those with no exposure to the baked form (n582) (P50.574). History of no exposure or reaction to baked egg was associated with epinephrine use for 59% and 63% of OFC reactions respectively, but only 42% in those who tolerated baked egg. CONCLUSIONS: Children who tolerate baked egg react at higher eliciting doses and require epinephrine less commonly when challenged
to native forms. There was no significant difference in eliciting dose to native milk based on baked milk exposure history.
864
Peanut, tree nuts and sesame seed allergies: Does a single nut allergy necessitate the dietary eviction of all nuts?
Jean. Christoph Caubet, MD1, Helen A. Brough, MD2, Angel Mazon3, Diab Haddad4, Antonio Nieto, MD5, Philippe A. Eigenmann1, and Gideon Lack, MD6; 1Geneva University Hospitals, Geneva, Switzerland, 2Guy’s and St. Thomas’ Hospital, Chislehurst, United Kingdom, 3Instituto de Investigacion Sanitaria La Fe, Valencia, Spain, 4St Peter’s Hospital, Chertsey, United Kingdom, 5Generalitat Valenciana, Valencia, Spain, 6St Thomas’ Hospital, St Thomas’ Hospital, London, United Kingdom. RATIONALE: Although there is a large cross-sensitivity by IgE testing among tree nuts and/or peanut, the clinical relevance remains unknown. In many allergy centres, allergy to either peanut or a tree-nut leads to recommendation for the avoidance of all nuts and often also sesame seed. METHODS: Based on up to 11 sequential nut challenges in each patient, we aimed to identify which nut allergic patients should apply selective or complete dietary avoidance of all nuts. We included children aged from 0 to 16 years with a convincing history of IgE-mediated systemic allergic _8 mm _1 nut within last 12 months and skin prick tests (SPT) > reaction to > _15kU/L (26kU/L for sesame) or a positive oral food challenge and/or IgE > to the nut. RESULTS: Ninety-two children were prospectively recruited in Geneva and London. Fifty-six percent of patients were allergic to more than one nut. We confirmed the strong association between pistachio and cashew nut allergy (84%), as well as between pecan, hazelnut and/or walnut allergy (59%). SPT had a high negative predictive value for the different types of nuts. Regarding hazelnut and peanut, specific IgE to Cor a 14 and Ara h 2, respectively, were the better discriminating factors with larger ROC areas under the curve (84% and 95%, respectively). CONCLUSIONS: Introduction of different nuts may decrease unnecessary dietary avoidance of peanut, tree-nuts and sesame seed. For most nuts, our data showed that SPT and/or specific IgE to recombinant allergens had a high diagnostic value to discriminate between allergic versus tolerant patients.
MONDAY
862
J ALLERGY CLIN IMMUNOL VOLUME 139, NUMBER 2
Predictors of Milk Tolerance Following Baked Milk Challenge
Joan H. Dunlop, MD1, Corinne Keet, MD, PhD1, Kim E. Mudd, RN, MSN, CCRP1, and Robert A. Wood, MD, FAAAAI2; 1Johns Hopkins University School of Medicine, Baltimore, MD, 2Johns Hopkins University School Medicine, Baltimore, MD. RATIONALE: Introduction of baked milk (BM) is a mainstay in the management of cow’s milk allergy. We sought to characterize predictors of BM tolerance and progression to baked cheese and direct milk among patients undergoing BM oral food challenges (OFC). METHODS: 126 patients challenged to BM from 2009-2011 were reviewed. OFC success was defined as consumption of ¼ cup BM. Logistic regression was performed utilizing milk-IgE level (log-transformed), age, gender, duration of follow-up, and OFC outcome to determine predictors of subsequent milk intake. RESULTS: 99 patients (4 months-18 years) old were included. Median duration of follow-up was 51 months (range 1.9-85 months). 65% passed the BM OFC. Among those failing, 91% were permitted to introduce specified quantities of BM. Of those passing, 75% progressed to unlimited BM or more, 61% advanced to baked cheese or more, and 38% advanced to direct milk, compared to 48%, 40%, and 26% of those failing the BM challenge (p50.004,0.046, and 0.234, respectively). Milk-IgE was significantly associated with OFC outcome (OR 0.19, p50.001) and progression to unlimited BM (OR 0.35, p50.046) or baked cheese (OR 0.38, p50.05) but not direct milk (OR 0.96, p50.16). Patients with milk-IgE >10kU/L were less likely to tolerate unlimited BM (10% vs 54%, p50.015), baked cheese (8% vs 45%, p50.04), or direct milk (4% vs 29% p50.06). Gender, duration of follow-up, and age were not significant predictors. CONCLUSIONS: OFC outcome and milk-IgE were the most important predictors of persistent tolerance to BM or more concentrated forms of milk.
863
Children With Tolerance Of Baked Egg Demonstrate Higher Eliciting Doses In Challenges To Native Egg
Peter S. Capucilli, MD, Jonathan M. Spergel, MD, PhD, FAAAAI, Terri F. Brown-Whitehorn, MD, FAAAAI, Antonella Cianferoni, MD, PhD, FAAAAI, Joel Fiedler, MD, FAAAAI, Laura M. Gober, MD, Nicholas A. Pawlowski, MD, Gita Ram, MD, Rushani W. Saltzman, MD, and Jennifer Heimall, MD; The Children’s Hospital of Philadelphia, Philadelphia, PA. RATIONALE: It is well recognized that some children with egg and milk allergy tolerate these foods in the heated or baked form. Our study defines differences in median eliciting dose for children undergoing native egg and milk oral food challenges (OFC) by previous tolerance and exposure to baked forms. METHODS: A retrospective chart review of 569 patients, ages 1-18y, who underwent OFC to native egg and milk from 1/2012 through 12/2015. The Mann-Whitney test was used to compare median eliciting doses for each group. Demographics, OFC results (dose, reaction), skin prick test and specific IgE were collected. RESULTS: For native egg, the median eliciting dose in children who previously reacted to baked egg (n535) was 0.50g (0.13g-9.88g), compared to 3.50g (0.13g-15.80g) in children who tolerated baked egg (n5235) (p50.0064) and 0.38g (0.13g-3.88g) in those with no exposure to baked egg (n572)(p<0.0001). For native milk, median eliciting dose in those who had reacted to baked milk (n540) was 2.32g (0.07g-8.50g), compared to 5.99g (0.15g-12.40g) in those with baked tolerance (n5105) (P50.318), and 4.49g (0.44g-17.70g) in those with no exposure to the baked form (n582) (P50.574). History of no exposure or reaction to baked egg was associated with epinephrine use for 59% and 63% of OFC reactions respectively, but only 42% in those who tolerated baked egg. CONCLUSIONS: Children who tolerate baked egg react at higher eliciting doses and require epinephrine less commonly when challenged
to native forms. There was no significant difference in eliciting dose to native milk based on baked milk exposure history.
864
Peanut, tree nuts and sesame seed allergies: Does a single nut allergy necessitate the dietary eviction of all nuts?
Jean. Christoph Caubet, MD1, Helen A. Brough, MD2, Angel Mazon3, Diab Haddad4, Antonio Nieto, MD5, Philippe A. Eigenmann1, and Gideon Lack, MD6; 1Geneva University Hospitals, Geneva, Switzerland, 2Guy’s and St. Thomas’ Hospital, Chislehurst, United Kingdom, 3Instituto de Investigacion Sanitaria La Fe, Valencia, Spain, 4St Peter’s Hospital, Chertsey, United Kingdom, 5Generalitat Valenciana, Valencia, Spain, 6St Thomas’ Hospital, St Thomas’ Hospital, London, United Kingdom. RATIONALE: Although there is a large cross-sensitivity by IgE testing among tree nuts and/or peanut, the clinical relevance remains unknown. In many allergy centres, allergy to either peanut or a tree-nut leads to recommendation for the avoidance of all nuts and often also sesame seed. METHODS: Based on up to 11 sequential nut challenges in each patient, we aimed to identify which nut allergic patients should apply selective or complete dietary avoidance of all nuts. We included children aged from 0 to 16 years with a convincing history of IgE-mediated systemic allergic _8 mm _1 nut within last 12 months and skin prick tests (SPT) > reaction to > _15kU/L (26kU/L for sesame) or a positive oral food challenge and/or IgE > to the nut. RESULTS: Ninety-two children were prospectively recruited in Geneva and London. Fifty-six percent of patients were allergic to more than one nut. We confirmed the strong association between pistachio and cashew nut allergy (84%), as well as between pecan, hazelnut and/or walnut allergy (59%). SPT had a high negative predictive value for the different types of nuts. Regarding hazelnut and peanut, specific IgE to Cor a 14 and Ara h 2, respectively, were the better discriminating factors with larger ROC areas under the curve (84% and 95%, respectively). CONCLUSIONS: Introduction of different nuts may decrease unnecessary dietary avoidance of peanut, tree-nuts and sesame seed. For most nuts, our data showed that SPT and/or specific IgE to recombinant allergens had a high diagnostic value to discriminate between allergic versus tolerant patients.
MONDAY
862