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NASAL EOSINOPHIL CORRELATION WITH AEROALLERGEN SENSITIZATION IN CHILDREN
Abstracts: Poster Sessions / Ann Allergy Asthma Immunol 121 (2018) S22−S62
Either a physician or an experienced nurse did all interviews and evaluations. Results: Data on 31 consecutive severe uncontrolled asthma (GINA and NAEPP guideline criteria) patients aged 9-76 were included; five were under the age of 12. Average age was 42. On average, ACT score was 17, ß2agonists were used 2.3 times a day, FEV1 was 68% predicted, FeNO was 52, and the number of ED visits plus hospitalizations was 4.3 in the year prior to the interview. None of the first 30 patients had ever been offered biologic therapy or bronchial thermoplasty for their asthma even through they are recommended as alternatives in Step 5 GINA guidelines. Conclusions: Recognizing these potential problems that drive the initiation of biologics for severe uncontrolled asthma therapy in this patient population, health care providers and Wisconsin Medicaid should take measures to achieve optimal therapy for all severe uncontrolled asthma patients, through shared decision-making. Rhinitis, Other Upper Airway Disorders
P450 NASAL EOSINOPHIL CORRELATION WITH AEROALLERGEN SENSITIZATION IN CHILDREN H. Kim*,1, H. Kim2, Y. Chun3, J. Yoon2, 1. Uijeongbu-si, Gyeonggi-do, Korea, Republic of; 2. Seoul, Korea, Republic of; 3. Incheon, Korea, Republic of Introduction: Identification of eosinophil leukocytes within the nasal mucosa and corresponding eosinophilia of the nasal secretions are common place findings in allergic rhinitis patients. We thought that sensitization to specific allergens would affect the results of the nasal eosinophil test. Therefore, we compared aeroallergen sensitization and nasal eosinophil counts in children with rhinitis. Methods: This study was conducted in 285 children under 18 years of age with acute or chronic rhinitis, who had had nasal eosinophil examinations and been tested for aeroallergens with the multiple allergen simultaneous test between March 2013 and February 2016 at the allergy clinic in a tertiary referral hospital. We retrospectively reviewed the patients’ medical and laboratory records and classified them according to the results of sensitization to each allergen to determine the association between nasal eosinophils and 18 aeroallergens. Results: A total of 245 children were enrolled in this study. The children’s mean age was 7.9 years and the male to female ratio was 1.75. Of the cases, 175 (71.4%) patients were sensitized to at least one of the 18 aeroallergens. In those sensitized, the mean percentage of nasal eosinophilia was 9.26%. There were significant differences in the percentage of nasal eosinophils between the groups sensitized and non-sensitized to aeroallergens (pAlternaria alternata among the 18 aeroallergens, showed the greatest mean percentage of nasal eosinophils (27.9%). Conclusions: Nasal eosinophilia was significantly associated with sensitization to aeroallergens. In particular, patients sensitized to Alternaria alternata are more likely to have nasal eosinophilia.
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subjects with and without reported asthma. IRB approval was obtained. Data for the 12 SQ-HDM dose approved in Europe/US are presented. Results: In all, 3473 subjects were randomized to 12 SQ-HDM (n=1663) or placebo (n=1810), 2036 (59%) of whom had reported asthma. Most asthma was moderate according to GINA criteria (66%, 12 SQ-HDM; 70%, placebo). The proportion of subjects reporting treatment-emergent adverse events (AEs) was similar between subjects with and without asthma (86% vs 85%, respectively) in the 12 SQ-HDM group and in the placebo group (70% vs 64%, respectively). The frequencies of treatmentrelated AEs, discontinuations due to AEs, severe AEs, and serious AEs were generally similar for subjects with and without asthma. One treatment-related systemic allergic reaction was reported; this event occurred in a subject without asthma. The frequency of asthma events in subjects with asthma was 11% with 12 SQ-HDM and 10% with placebo; in subjects without asthma the frequency was Conclusions: SQ HDM SLIT-tablet was well tolerated and did not appear to increase asthma events in patients with mild-to-moderate asthma. The safety profile was comparable for subjects with HDMinduced respiratory allergy irrespective of asthma status.
P452 SAFETY OF FIRST DOSE OF SQ HOUSE DUST MITE SUBLINGUAL IMMUNOTHERAPY TABLET IN CLINICAL TRIALS D. Bernstein*,1, J. Maloney2, I. Mosbech Smith3, H. Nolte2, 1. Cincinnati, OH; 2. Bedminster, NJ; 3. Hoersholm, Denmark Introduction: Supervision in the physician’s office for 30 minutes following the first dose of SQ house dust mite (HDM) sublingual immunotherapy (SLIT)-tablet is required to monitor for potential adverse reactions. Clinically important adverse events (AEs) occurring in connection to administration of the first dose were evaluated. Methods: Safety data from 14 DBPC trials (N=6784) of SQ HDM SLITtablet were analyzed for clinically important treatment-related AEs associated with the first dose. IRB approval was obtained. Data for the Europe/US approved dose of 12 SQ-HDM (N=2139) are presented. Results: The majority of treatment-related AEs with the first dose were mild or moderate local allergic reactions. In all, 2/2139 (0.09%) subjects experienced AEs requiring treatment with epinephrine within minutes of administration of the first dose. One subject developed laryngeal edema assessed as mild by the investigator, which was treated with epinephrine and resolved after 30 minutes; the subject completed the trial. The other subject discontinued treatment after experiencing a systemic allergic reaction (reported as moderate hypersensitivity), which was treated with epinephrine and resolved after 1 hour. Four additional subjects discontinued treatment on day 1 due to AEs, mainly mild/moderate local allergic reactions, all of which resolved within 2 hours. No late-phase allergic reactions occurred. No serious AEs related to first dose were observed. Conclusions: Clinically important AEs related to the first dose of SQ HDM SLIT-tablet occurred within minutes and were manageable with conventional allergy pharmacotherapy.
P451 SQ HOUSE DUST MITE SUBLINGUAL IMMUNOTHERAPY TABLET IS WELL TOLERATED IN SUBJECTS WITH ALLERGIC ASTHMA J. Maloney*,1, V. Hulstrøm2, I. Mosbech Smith2, H. Nolte1, 1. Bedminster, NJ; 2. Hoersholm, Denmark Introduction: Asthma is a risk factor for systemic allergic reactions to subcutaneous immunotherapy. The safety of SQ house dust mite (HDM) sublingual immunotherapy (SLIT)-tablet in subjects with or without asthma was evaluated. Methods: Safety data from 6 phase II/III double-blind, placebo-controlled trials of SQ HDM SLIT-tablet for the treatment of allergic rhinitis or mild-to-moderate asthma were pooled and compared between
P453 CHRONOLOGICAL CHANGE OF RHINITIS SYMPTOM PREVALENCE IN KOREAN CHILDREN WITH OR WITHOUT ALLERGIC SENSITIZATION S. Chang*, J. Kang, G. Lim, Jeju, Jeju, Korea, Republic of Introduction: It is difficult to accurately predict the natural course of allergic rhinitis. The aim of this study is to understand the change of prevalence of rhinitis symptom by age in school aged children with or without allergic sensitization. Methods: Children aged from 9 to 16 who participated in the health questionnaires and skin prick test were included for this study. The
Either a physician or an experienced nurse did all interviews and evaluations. Results: Data on 31 consecutive severe uncontrolled asthma (GINA and NAEPP guideline criteria) patients aged 9-76 were included; five were under the age of 12. Average age was 42. On average, ACT score was 17, ß2agonists were used 2.3 times a day, FEV1 was 68% predicted, FeNO was 52, and the number of ED visits plus hospitalizations was 4.3 in the year prior to the interview. None of the first 30 patients had ever been offered biologic therapy or bronchial thermoplasty for their asthma even through they are recommended as alternatives in Step 5 GINA guidelines. Conclusions: Recognizing these potential problems that drive the initiation of biologics for severe uncontrolled asthma therapy in this patient population, health care providers and Wisconsin Medicaid should take measures to achieve optimal therapy for all severe uncontrolled asthma patients, through shared decision-making. Rhinitis, Other Upper Airway Disorders
P450 NASAL EOSINOPHIL CORRELATION WITH AEROALLERGEN SENSITIZATION IN CHILDREN H. Kim*,1, H. Kim2, Y. Chun3, J. Yoon2, 1. Uijeongbu-si, Gyeonggi-do, Korea, Republic of; 2. Seoul, Korea, Republic of; 3. Incheon, Korea, Republic of Introduction: Identification of eosinophil leukocytes within the nasal mucosa and corresponding eosinophilia of the nasal secretions are common place findings in allergic rhinitis patients. We thought that sensitization to specific allergens would affect the results of the nasal eosinophil test. Therefore, we compared aeroallergen sensitization and nasal eosinophil counts in children with rhinitis. Methods: This study was conducted in 285 children under 18 years of age with acute or chronic rhinitis, who had had nasal eosinophil examinations and been tested for aeroallergens with the multiple allergen simultaneous test between March 2013 and February 2016 at the allergy clinic in a tertiary referral hospital. We retrospectively reviewed the patients’ medical and laboratory records and classified them according to the results of sensitization to each allergen to determine the association between nasal eosinophils and 18 aeroallergens. Results: A total of 245 children were enrolled in this study. The children’s mean age was 7.9 years and the male to female ratio was 1.75. Of the cases, 175 (71.4%) patients were sensitized to at least one of the 18 aeroallergens. In those sensitized, the mean percentage of nasal eosinophilia was 9.26%. There were significant differences in the percentage of nasal eosinophils between the groups sensitized and non-sensitized to aeroallergens (pAlternaria alternata among the 18 aeroallergens, showed the greatest mean percentage of nasal eosinophils (27.9%). Conclusions: Nasal eosinophilia was significantly associated with sensitization to aeroallergens. In particular, patients sensitized to Alternaria alternata are more likely to have nasal eosinophilia.
S59
subjects with and without reported asthma. IRB approval was obtained. Data for the 12 SQ-HDM dose approved in Europe/US are presented. Results: In all, 3473 subjects were randomized to 12 SQ-HDM (n=1663) or placebo (n=1810), 2036 (59%) of whom had reported asthma. Most asthma was moderate according to GINA criteria (66%, 12 SQ-HDM; 70%, placebo). The proportion of subjects reporting treatment-emergent adverse events (AEs) was similar between subjects with and without asthma (86% vs 85%, respectively) in the 12 SQ-HDM group and in the placebo group (70% vs 64%, respectively). The frequencies of treatmentrelated AEs, discontinuations due to AEs, severe AEs, and serious AEs were generally similar for subjects with and without asthma. One treatment-related systemic allergic reaction was reported; this event occurred in a subject without asthma. The frequency of asthma events in subjects with asthma was 11% with 12 SQ-HDM and 10% with placebo; in subjects without asthma the frequency was Conclusions: SQ HDM SLIT-tablet was well tolerated and did not appear to increase asthma events in patients with mild-to-moderate asthma. The safety profile was comparable for subjects with HDMinduced respiratory allergy irrespective of asthma status.
P452 SAFETY OF FIRST DOSE OF SQ HOUSE DUST MITE SUBLINGUAL IMMUNOTHERAPY TABLET IN CLINICAL TRIALS D. Bernstein*,1, J. Maloney2, I. Mosbech Smith3, H. Nolte2, 1. Cincinnati, OH; 2. Bedminster, NJ; 3. Hoersholm, Denmark Introduction: Supervision in the physician’s office for 30 minutes following the first dose of SQ house dust mite (HDM) sublingual immunotherapy (SLIT)-tablet is required to monitor for potential adverse reactions. Clinically important adverse events (AEs) occurring in connection to administration of the first dose were evaluated. Methods: Safety data from 14 DBPC trials (N=6784) of SQ HDM SLITtablet were analyzed for clinically important treatment-related AEs associated with the first dose. IRB approval was obtained. Data for the Europe/US approved dose of 12 SQ-HDM (N=2139) are presented. Results: The majority of treatment-related AEs with the first dose were mild or moderate local allergic reactions. In all, 2/2139 (0.09%) subjects experienced AEs requiring treatment with epinephrine within minutes of administration of the first dose. One subject developed laryngeal edema assessed as mild by the investigator, which was treated with epinephrine and resolved after 30 minutes; the subject completed the trial. The other subject discontinued treatment after experiencing a systemic allergic reaction (reported as moderate hypersensitivity), which was treated with epinephrine and resolved after 1 hour. Four additional subjects discontinued treatment on day 1 due to AEs, mainly mild/moderate local allergic reactions, all of which resolved within 2 hours. No late-phase allergic reactions occurred. No serious AEs related to first dose were observed. Conclusions: Clinically important AEs related to the first dose of SQ HDM SLIT-tablet occurred within minutes and were manageable with conventional allergy pharmacotherapy.
P451 SQ HOUSE DUST MITE SUBLINGUAL IMMUNOTHERAPY TABLET IS WELL TOLERATED IN SUBJECTS WITH ALLERGIC ASTHMA J. Maloney*,1, V. Hulstrøm2, I. Mosbech Smith2, H. Nolte1, 1. Bedminster, NJ; 2. Hoersholm, Denmark Introduction: Asthma is a risk factor for systemic allergic reactions to subcutaneous immunotherapy. The safety of SQ house dust mite (HDM) sublingual immunotherapy (SLIT)-tablet in subjects with or without asthma was evaluated. Methods: Safety data from 6 phase II/III double-blind, placebo-controlled trials of SQ HDM SLIT-tablet for the treatment of allergic rhinitis or mild-to-moderate asthma were pooled and compared between
P453 CHRONOLOGICAL CHANGE OF RHINITIS SYMPTOM PREVALENCE IN KOREAN CHILDREN WITH OR WITHOUT ALLERGIC SENSITIZATION S. Chang*, J. Kang, G. Lim, Jeju, Jeju, Korea, Republic of Introduction: It is difficult to accurately predict the natural course of allergic rhinitis. The aim of this study is to understand the change of prevalence of rhinitis symptom by age in school aged children with or without allergic sensitization. Methods: Children aged from 9 to 16 who participated in the health questionnaires and skin prick test were included for this study. The