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Family History as an Indicator of Increased Risk for Food Allergy in Infants
S190 Abstracts
727
The Importance Of Early Diagnosis And Treatment Of Infantile Atopic Dermatitis Associated With Food Allergy T. Komata1, M. Ebisawa2; 1National Hospital Organization Sagamihara National Hospital, Kanagawa, Japan, 2National Hospital Organization Sagamihara National Hospital Clinical Research Center for Allergy and Rheumatology, Kanagawa, Japan. RATIONALE: Most of pediatric food allergy (FA) cases develop during infancy in Japan, and infantile FA cases’ onsets are associated with infantile atopic dermatitis(AD). The aim of this study is to evaluate the effect of early diagnosis and treatment for infantile AD associated with FA (AD/ FA). METHODS: 83 AD/FA patients who had visited our hospital from 2004 to 2006 were recruited to the study. The subjects were divided into two groups. The early (E) diagnosis group (n 5 44, mean first visit: 3.8 months) was patients who had visited our hospital within 6 months of the onset, and the late (L) group (n 5 39, 8.9 months) was patients who had visited later than 6 months of the onset. We analyzed clinical profiles and examination results with aging between two groups. RESULTS: We found statistically significant difference on total IgE, eggwhite (EW) specific IgE, and milk-specific IgE at initial visit between two groups (E group vs L group; mean total IgE (IU/ml): 125 vs 1034, EW-specific IgE (Ua/ml):8.0 vs 28.3, milk-specific IgE: 4.0 vs 14.9, respectively). We further found the difference at the age of 2 y (E vs L; total IgE: 307 vs 1503, EW-IgE: 11.4 vs 32.8, milk-IgE: 5.5 vs 23.8, respectively). We finally found the difference of tolerance acquisition rate of FA at the age of 2 years old between two groups (E vs L: egg; 45.2% vs 13.2%, milk; 57.7% vs 17.4%, respectively). CONCLUSIONS: Early diagnosis and treatment of AD/FA are very important for the sensitization against food allergens and the prognosis of FA.
728
MONDAY
Family History as an Indicator of Increased Risk for Food Allergy in Infants S. V. Chawla; Georgetown University Medical Center, Washington, DC. RATIONALE: With rising prevalence of food allergy among patients between 0-3 years, we sought to examine predictors of food allergy among infants in Northern Virginia. METHODS: Retrospective charts and computerized medical records of 138 patients from Northern Virginia between the ages of 0-3 were reviewed. All patients held the diagnosis of IgE-mediated food allergy. RESULTS: Of patients diagnosed with food allergy, 70.8% exhibited symptoms of eczema as first sign of allergies. Egg allergy was present in 58.3% of patients followed by peanut (45.8%), milk (23.6%), wheat (6.9%) and soy (6.0%). Atopy (allergic rhinitis, asthma, food allergy) in 1 or both parents was present in 81.9% of patients. Allergic rhinitis in 1 or both parents was present in 66.7% of patients. Asthma in 1 or both parents was present in 23.6% of patients. History of food allergy in 1 or both parents was present in 20.8% of patients. CONCLUSIONS: Our analysis revealed that family history of allergic rhinitis was the strongest predictor of food allergy in patients between 03 years of age in the Northern Virginia population. Eczema was most often the first presentation of food allergy. Amongst the most highly allergic foods, egg was found to be the most common food allergen followed by peanut, milk, wheat and soy. We therefore conclude that parental history of atopy is a strong risk factor for the development of food allergy in infants.
J ALLERGY CLIN IMMUNOL FEBRUARY 2009
729
Food Dependant Exercise Induced Anaphylaxis to Wheat May be Diagnosed Using Wheat Flour S. W. Oberhoff, J. M. El-Dahr, P. J. Klemawesch; Tulane University, New Orleans, LA. RATIONALE: Patients with suspected Food Dependant Exercise Induced Anaphylaxis (FDEIA) often are negative to foods when tested by CAPRAST or commercial food extracts, but may react to heat-labile food antigens. Gliadin, a heat-labile antigen in wheat, has been implicated as a common allergen in FDEIA but no practical test is currently available. METHODS: Skin testing was performed on three adolescents with a common history of anaphylaxis after eating products suspected to contain raw or partially cooked wheat flour and exercising shortly thereafter. Both standard commercial food extracts and a wheat flour slurry were used in addition to positive and negative controls. RESULTS: In all three cases the patients were negative when tested to commercial food extracts but were markedly positive when prick to prick was performed with raw wheat flour. Non-specific reactivity to wheat flour was not present when done on normal volunteers. CONCLUSIONS: Skin testing with standard commercial wheat extracts for patients with Food Dependant Exercise Induced Anaphylaxis may not be sufficient in determining whether wheat products are the responsible trigger. Prick-to-prick skin testing using wheat flour is an easy and practical way for clinicians to determine which patients should avoid wheat prior to exercise to prevent further episodes.
730
A Study for Allergenicity and Cross-reactivity of Rice Y. Jeon1, S. Oh2, H. Yang1, S. Lee2, B. Pyun1; 1Soonchunhyang University Hospital, Seoul, Republic of Korea, 2Ajou University Hospital, Suwon, Republic of Korea. RATIONALE: Rice is the staple food of Asian countries. Several case reports of rice allergy in Japan, rice allergy has become a hot issue and hypoallergenic rice is being produced. Recently, cases of rice allergy in Korean atopic dermatitis were increased. We aimed to find out the allergenicity and cross-reactivity of rice. METHODS: Twenty-four atopic dermatitis patients(15 male, 9 female, mean age 16.3 months) who were sensitized to rice antigen at Pediatric Allergy Respiratory Center in Soonchunhyang University Hospital, Seoul, Korea were enrolled. We investigated allergenicity of various types of rice (raw rice, cooked rice, rice treated with simulated gastric fluid{SGF}, and heat), cross-reactivity to other food using SDS-PAGE, IgE-immunoblot, and inhibition ELISA. RESULTS: Patients were sensitized to average 14 other food antigens and mean total IgE level was 6888.7 kU/L. More than 13 protein-bands were observed in raw rice whereas cooked rice showed nearly no proteinband. In rice treated with SGF, 9, 12, 18, 30 kDa protein-band was observed and in heat treated rice 9, 14 kDa remained. Protein-band of 14 kDa in 88.9%, 79 kDa in 50%, 18, 109 kDa in 44.4%, 9, 33, 46 kDa in 38.9% of patients was observed. In Inhibition ELISA(100 mg each antigen), the inhibition rate was 46% for barley, 30% for wheat, and 10% for buckwheat, potato, peanut. CONCLUSIONS: Rice did not show high cross-reactivity with other cereals. The protein-band 9, 14 kDa seems to be responsible for the symptoms of rice allergy. The search of the allergen through protein isolation and sequence analysis is in process.
727
The Importance Of Early Diagnosis And Treatment Of Infantile Atopic Dermatitis Associated With Food Allergy T. Komata1, M. Ebisawa2; 1National Hospital Organization Sagamihara National Hospital, Kanagawa, Japan, 2National Hospital Organization Sagamihara National Hospital Clinical Research Center for Allergy and Rheumatology, Kanagawa, Japan. RATIONALE: Most of pediatric food allergy (FA) cases develop during infancy in Japan, and infantile FA cases’ onsets are associated with infantile atopic dermatitis(AD). The aim of this study is to evaluate the effect of early diagnosis and treatment for infantile AD associated with FA (AD/ FA). METHODS: 83 AD/FA patients who had visited our hospital from 2004 to 2006 were recruited to the study. The subjects were divided into two groups. The early (E) diagnosis group (n 5 44, mean first visit: 3.8 months) was patients who had visited our hospital within 6 months of the onset, and the late (L) group (n 5 39, 8.9 months) was patients who had visited later than 6 months of the onset. We analyzed clinical profiles and examination results with aging between two groups. RESULTS: We found statistically significant difference on total IgE, eggwhite (EW) specific IgE, and milk-specific IgE at initial visit between two groups (E group vs L group; mean total IgE (IU/ml): 125 vs 1034, EW-specific IgE (Ua/ml):8.0 vs 28.3, milk-specific IgE: 4.0 vs 14.9, respectively). We further found the difference at the age of 2 y (E vs L; total IgE: 307 vs 1503, EW-IgE: 11.4 vs 32.8, milk-IgE: 5.5 vs 23.8, respectively). We finally found the difference of tolerance acquisition rate of FA at the age of 2 years old between two groups (E vs L: egg; 45.2% vs 13.2%, milk; 57.7% vs 17.4%, respectively). CONCLUSIONS: Early diagnosis and treatment of AD/FA are very important for the sensitization against food allergens and the prognosis of FA.
728
MONDAY
Family History as an Indicator of Increased Risk for Food Allergy in Infants S. V. Chawla; Georgetown University Medical Center, Washington, DC. RATIONALE: With rising prevalence of food allergy among patients between 0-3 years, we sought to examine predictors of food allergy among infants in Northern Virginia. METHODS: Retrospective charts and computerized medical records of 138 patients from Northern Virginia between the ages of 0-3 were reviewed. All patients held the diagnosis of IgE-mediated food allergy. RESULTS: Of patients diagnosed with food allergy, 70.8% exhibited symptoms of eczema as first sign of allergies. Egg allergy was present in 58.3% of patients followed by peanut (45.8%), milk (23.6%), wheat (6.9%) and soy (6.0%). Atopy (allergic rhinitis, asthma, food allergy) in 1 or both parents was present in 81.9% of patients. Allergic rhinitis in 1 or both parents was present in 66.7% of patients. Asthma in 1 or both parents was present in 23.6% of patients. History of food allergy in 1 or both parents was present in 20.8% of patients. CONCLUSIONS: Our analysis revealed that family history of allergic rhinitis was the strongest predictor of food allergy in patients between 03 years of age in the Northern Virginia population. Eczema was most often the first presentation of food allergy. Amongst the most highly allergic foods, egg was found to be the most common food allergen followed by peanut, milk, wheat and soy. We therefore conclude that parental history of atopy is a strong risk factor for the development of food allergy in infants.
J ALLERGY CLIN IMMUNOL FEBRUARY 2009
729
Food Dependant Exercise Induced Anaphylaxis to Wheat May be Diagnosed Using Wheat Flour S. W. Oberhoff, J. M. El-Dahr, P. J. Klemawesch; Tulane University, New Orleans, LA. RATIONALE: Patients with suspected Food Dependant Exercise Induced Anaphylaxis (FDEIA) often are negative to foods when tested by CAPRAST or commercial food extracts, but may react to heat-labile food antigens. Gliadin, a heat-labile antigen in wheat, has been implicated as a common allergen in FDEIA but no practical test is currently available. METHODS: Skin testing was performed on three adolescents with a common history of anaphylaxis after eating products suspected to contain raw or partially cooked wheat flour and exercising shortly thereafter. Both standard commercial food extracts and a wheat flour slurry were used in addition to positive and negative controls. RESULTS: In all three cases the patients were negative when tested to commercial food extracts but were markedly positive when prick to prick was performed with raw wheat flour. Non-specific reactivity to wheat flour was not present when done on normal volunteers. CONCLUSIONS: Skin testing with standard commercial wheat extracts for patients with Food Dependant Exercise Induced Anaphylaxis may not be sufficient in determining whether wheat products are the responsible trigger. Prick-to-prick skin testing using wheat flour is an easy and practical way for clinicians to determine which patients should avoid wheat prior to exercise to prevent further episodes.
730
A Study for Allergenicity and Cross-reactivity of Rice Y. Jeon1, S. Oh2, H. Yang1, S. Lee2, B. Pyun1; 1Soonchunhyang University Hospital, Seoul, Republic of Korea, 2Ajou University Hospital, Suwon, Republic of Korea. RATIONALE: Rice is the staple food of Asian countries. Several case reports of rice allergy in Japan, rice allergy has become a hot issue and hypoallergenic rice is being produced. Recently, cases of rice allergy in Korean atopic dermatitis were increased. We aimed to find out the allergenicity and cross-reactivity of rice. METHODS: Twenty-four atopic dermatitis patients(15 male, 9 female, mean age 16.3 months) who were sensitized to rice antigen at Pediatric Allergy Respiratory Center in Soonchunhyang University Hospital, Seoul, Korea were enrolled. We investigated allergenicity of various types of rice (raw rice, cooked rice, rice treated with simulated gastric fluid{SGF}, and heat), cross-reactivity to other food using SDS-PAGE, IgE-immunoblot, and inhibition ELISA. RESULTS: Patients were sensitized to average 14 other food antigens and mean total IgE level was 6888.7 kU/L. More than 13 protein-bands were observed in raw rice whereas cooked rice showed nearly no proteinband. In rice treated with SGF, 9, 12, 18, 30 kDa protein-band was observed and in heat treated rice 9, 14 kDa remained. Protein-band of 14 kDa in 88.9%, 79 kDa in 50%, 18, 109 kDa in 44.4%, 9, 33, 46 kDa in 38.9% of patients was observed. In Inhibition ELISA(100 mg each antigen), the inhibition rate was 46% for barley, 30% for wheat, and 10% for buckwheat, potato, peanut. CONCLUSIONS: Rice did not show high cross-reactivity with other cereals. The protein-band 9, 14 kDa seems to be responsible for the symptoms of rice allergy. The search of the allergen through protein isolation and sequence analysis is in process.