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O030 Correlating rast, component levels, skin testing, and epinephrine requirements in patients with anaphylaxis to peanut
Abstracts: Oral Concurrent Sessions / Ann Allergy Asthma Immunol 117 (2016) S1eS21
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cutoffs of 25(OH)D levels (20ng/ml vs. 30ng/ml). Only one study used 30ng/ml for a cut off and found children with 25(OH)D less than 30ng/ ml were more likely to report food allergy than children with 25(OH)D levels of 30ng/ml or more (OR¼2.04,95%CI:1.02,4.04,p¼0.04). Four studies compared children with 25(OH)D levels less than 20ng/ml to children with 25(OH)D levels of 20ng/ml or more and found no significant differences (OR¼1.18,95%CI:0.62,2.27,p¼0.62,I2¼62.7%). Conclusion: There was no association between Vitamin-D deficiency or insufficiency in children with established food allergy. Longitudinal studies are warranted to further assess for the potential role of vitamin-D deficiency in the development of food allergy.
Pooled Odds Ratios from included studies
Table 1. Expected number of anaphylaxis episodes, described by potential contributing factors (unadjusted). Examined in 75 peanut anaphylaxis patients. Expected number of anaphylaxis episodes, described by potential contributing factors (unadjusted). Examined in 75 peanut anaphylaxis patients. Average follow-up (child age) of 7.8 years.
O030 CORRELATING RAST, COMPONENT LEVELS, SKIN TESTING, AND EPINEPHRINE REQUIREMENTS IN PATIENTS WITH ANAPHYLAXIS TO PEANUT I. Randhawa*, C. Caperton, Long Beach, CA. Introduction: Peanut allergen exposure resulting in epinephrinerequiring anaphylaxis is a major health concern. Peanut IgE and components are increasingly ordered, yet research-guided directives regarding clinical correlation and utilization of peanut component diagnostic testing is lacking. In patients with WAO Grade II or higher peanut anaphylaxis, we investigated the correlation between serum-specific peanut IgE (sIgE), component levels, skin prick testing (SPT) and number of anaphylactic episodes and epinephrine use. Methods: The Gallegos Food Allergy Center performed peanut IgE, comprehensive component-resolved diagnostics (Ara h1, Ara h2, Ara h3, Ara h8, Ara h9), and SPT in 74 patients with known peanut anaphylaxis (SPT >3mm and clinical history of anaphylaxis requiring epinephrine). Number of anaphylactic episodes and requirement for epinephrine were recorded for average follow-up (child age) of 7.8 years. The correlation of individual diagnostics was assessed with continuous and dichotomous scales. Results: Patients with Ara h9 >0.2 kUA/L had 67% more anaphylactic episodes (IRR¼1.67,p¼0.002). Higher values of Ara h8 correlated with increased number of anaphylactic episodes (IRR¼1.012, p¼0.004). Neither SPT nor sIgE values corresponded to increased anaphylaxis; sIgE >0.35 was associated with reduced number of epinephrine uses (IRR¼0.40,p¼0.009). Conclusions: In our subset of patients with history of anaphylaxis to peanut, we demonstrated positive correlations between Ara h8 and Ara h9 levels and increasing number of anaphylactic episodes. Interestingly, findings did not support a strong influence of SPT results on number of anaphylactic episodes or epinephrine usage. This information aids in ascertaining the clinical utility of component diagnostics in assessing risk for anaphylaxis in peanut-allergic patients.
O031 EVALUATING ANXIETY IN CHILDREN WITH EOSINOPHILIC ESOPHAGITIS J. Jose*1, A. Horwitz1, P. Jhaveri2, 1. Hershey, PA; 2. Hummelstown, PA. Introduction: Anxiety disorders have a lifetime prevalence of 31.9% with a median age of onset of 6 years. One recent study found that children with food allergies did not have increased anxiety but mothers reported more symptoms of panic disorder in their children. Assessing anxiety in children with eosinophilic esophagitis (EoE) has not been studied. We hypothesize that this population may be at greater risk for anxiety and depression than those without EoE, and assessment for these disorders should be part of the overall evaluation in EoE. Methods: After Institutional Review Board (IRB) approval, all parents of children with EoE who presented to our outpatient clinic were requested to complete the Screen for Child Anxiety Related Emotional Disorders (SCARED) questionnaire. SCARED is a 41-item standardized screen for anxiety validated for use in children aged 8 to 16 years. Data were entered into REDCap. Results: To date, eight questionnaires have been completed with majority (88%) (n¼7) male and a mean age of 12.3 years. Three patients (38%) met the criteria for anxiety and of that group, two met at least one subscale cutoff score indicating the presence of specific anxiety related disorders. One out of eight parents reported some bullying secondary to EoE. Conclusion: Children with EoE are potentially at increased risk for anxiety. Screening and referral to mental health services may be warranted in some individuals. Future direction will involve comparing anxiety disorders of EoE patients to those with a diagnosis of food allergies, anxiety disorder, and a healthy control group.
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cutoffs of 25(OH)D levels (20ng/ml vs. 30ng/ml). Only one study used 30ng/ml for a cut off and found children with 25(OH)D less than 30ng/ ml were more likely to report food allergy than children with 25(OH)D levels of 30ng/ml or more (OR¼2.04,95%CI:1.02,4.04,p¼0.04). Four studies compared children with 25(OH)D levels less than 20ng/ml to children with 25(OH)D levels of 20ng/ml or more and found no significant differences (OR¼1.18,95%CI:0.62,2.27,p¼0.62,I2¼62.7%). Conclusion: There was no association between Vitamin-D deficiency or insufficiency in children with established food allergy. Longitudinal studies are warranted to further assess for the potential role of vitamin-D deficiency in the development of food allergy.
Pooled Odds Ratios from included studies
Table 1. Expected number of anaphylaxis episodes, described by potential contributing factors (unadjusted). Examined in 75 peanut anaphylaxis patients. Expected number of anaphylaxis episodes, described by potential contributing factors (unadjusted). Examined in 75 peanut anaphylaxis patients. Average follow-up (child age) of 7.8 years.
O030 CORRELATING RAST, COMPONENT LEVELS, SKIN TESTING, AND EPINEPHRINE REQUIREMENTS IN PATIENTS WITH ANAPHYLAXIS TO PEANUT I. Randhawa*, C. Caperton, Long Beach, CA. Introduction: Peanut allergen exposure resulting in epinephrinerequiring anaphylaxis is a major health concern. Peanut IgE and components are increasingly ordered, yet research-guided directives regarding clinical correlation and utilization of peanut component diagnostic testing is lacking. In patients with WAO Grade II or higher peanut anaphylaxis, we investigated the correlation between serum-specific peanut IgE (sIgE), component levels, skin prick testing (SPT) and number of anaphylactic episodes and epinephrine use. Methods: The Gallegos Food Allergy Center performed peanut IgE, comprehensive component-resolved diagnostics (Ara h1, Ara h2, Ara h3, Ara h8, Ara h9), and SPT in 74 patients with known peanut anaphylaxis (SPT >3mm and clinical history of anaphylaxis requiring epinephrine). Number of anaphylactic episodes and requirement for epinephrine were recorded for average follow-up (child age) of 7.8 years. The correlation of individual diagnostics was assessed with continuous and dichotomous scales. Results: Patients with Ara h9 >0.2 kUA/L had 67% more anaphylactic episodes (IRR¼1.67,p¼0.002). Higher values of Ara h8 correlated with increased number of anaphylactic episodes (IRR¼1.012, p¼0.004). Neither SPT nor sIgE values corresponded to increased anaphylaxis; sIgE >0.35 was associated with reduced number of epinephrine uses (IRR¼0.40,p¼0.009). Conclusions: In our subset of patients with history of anaphylaxis to peanut, we demonstrated positive correlations between Ara h8 and Ara h9 levels and increasing number of anaphylactic episodes. Interestingly, findings did not support a strong influence of SPT results on number of anaphylactic episodes or epinephrine usage. This information aids in ascertaining the clinical utility of component diagnostics in assessing risk for anaphylaxis in peanut-allergic patients.
O031 EVALUATING ANXIETY IN CHILDREN WITH EOSINOPHILIC ESOPHAGITIS J. Jose*1, A. Horwitz1, P. Jhaveri2, 1. Hershey, PA; 2. Hummelstown, PA. Introduction: Anxiety disorders have a lifetime prevalence of 31.9% with a median age of onset of 6 years. One recent study found that children with food allergies did not have increased anxiety but mothers reported more symptoms of panic disorder in their children. Assessing anxiety in children with eosinophilic esophagitis (EoE) has not been studied. We hypothesize that this population may be at greater risk for anxiety and depression than those without EoE, and assessment for these disorders should be part of the overall evaluation in EoE. Methods: After Institutional Review Board (IRB) approval, all parents of children with EoE who presented to our outpatient clinic were requested to complete the Screen for Child Anxiety Related Emotional Disorders (SCARED) questionnaire. SCARED is a 41-item standardized screen for anxiety validated for use in children aged 8 to 16 years. Data were entered into REDCap. Results: To date, eight questionnaires have been completed with majority (88%) (n¼7) male and a mean age of 12.3 years. Three patients (38%) met the criteria for anxiety and of that group, two met at least one subscale cutoff score indicating the presence of specific anxiety related disorders. One out of eight parents reported some bullying secondary to EoE. Conclusion: Children with EoE are potentially at increased risk for anxiety. Screening and referral to mental health services may be warranted in some individuals. Future direction will involve comparing anxiety disorders of EoE patients to those with a diagnosis of food allergies, anxiety disorder, and a healthy control group.