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Oral Desensitization Therpy In Children With Egg Allergy
S74 Abstracts
SATURDAY
288
The Utility of Combining Skin Prick and Specific IgE Antibody Testing as a Predictor of Clinical Reactivity to Milk, Egg, and Peanut D. R. Naimi, N. M. Paranich, J. M. Spergel, J. L. Beausoleil; The Children’s Hospital of Philadelphia, Philadelphia, PA. RATIONALE: Cut-off values for food-specific IgE have been developed as a means to guide when to perform an oral food challenge (OFC). We propose that by combining the results of specific IgE levels and skin prick test (SPT) wheal size, we can establish higher cut-off values for milk, egg and peanut. METHODS: Retrospective review of OFC outcomes in children compared to specific IgE levels and SPT measurements to milk, egg, and peanut. RESULTS: 61 children underwent OFC to milk, 76 to egg, and 52 to peanut. 46% of milk challenges were passed compared with 38% for egg, and 35% for peanut. Milk specific IgE levels of <6 kU/L and SPT wheal size <6mm were associated with an 87% chance of passing (NPV: 87%, PPV: 66%, Sensitivity: 89%, Specificity: 61%). Egg specific IgE levels of <7 kU/L and SPT wheal size <5mm were associated with a 79% chance of passing (NPV: 79%, PPV: 48%, Sensitivity: 79%, Specificity: 47%). Peanut specific IgE levels of <3 kU/L and SPT wheal size <5mm were associated with an 89% chance of passing (NPV: 89%, PPV: 48%, Sensitivity: 89%, Specificity: 50%). CONCLUSIONS: By combining the results of food-specific IgE levels and SPT wheal size, we have established values for milk, egg and peanut with excellent negative predictive value but with higher cut-off values than has previously been reported. With these new criteria, many children who are not truly allergic will be more likely to undergo OFC, thereby preventing the unnecessary avoidance of foods.
289
Consumer Awareness and Response Following the Food Allergen Labeling and Consumer Protection Act (FALCPA) H. Lemon-Mule1, T. J. Furlong2, S. H. Sicherer1; 1Mt Sinai School Of Medicine, New York, NY, 2Food Allergy & Anaphylaxis Network, Fairfax, VA. RATIONALE: The 2006 FALCPA legislation requires major allergen disclosure but does not advise precautionary allergen statements; consumer response to new labeling has not been assessed. METHODS: A survey was completed by 645 participants attending 2006 FAAN meetings in New York, Baltimore and Chicago. RESULTS: A majority (64%) noted major food allergens added to ingredient lists with the following frequency: milk (61%), peanut (55%), tree nut (38%), egg (31%), wheat (21%), soy (21%) and others (6%). New precautionary labels (e.g. ’’may contain’’) were noted by 83% with the following frequency: peanut (84%), tree nut (67%), milk (59%), egg (45%), wheat (35%), soy (35%) and others (14%). Participants reported baked products (60%) as the most common foods with new allergen disclosures. Consumers reported (28%) contacting manufacturers to inquire about added allergens. Only 46% of the manufacturers reported that the allergen was a newly added ingredient. In addition, 20% contacted manufacturers about new precautionary labels and only 14% of manufacturers reported product formula changes. Consumer avoidance varied by use of specific precautionary terms (e.g. ’’may contain traces,’’ ’’manufactured in a facility,’’ etc). Compared with data collected in 2003, participants in 2006 were more likely (25% versus 15%, p<0.001) to purchase food products with precautionary allergen statements. CONCLUSIONS: Consumers have noted numerous ingredient label changes that often did not represent new ingredients (apparent omissions from previous labels). Consumers are increasingly ignoring precautionary allergen statements.
J ALLERGY CLIN IMMUNOL JANUARY 2007
290
Preliminary Support for a Group Intervention for Children with Food Allergy and Their Parents J. S. LeBovidge, K. G. Timmons, C. Rich, A. Rosenstock, K. Fowler, L. C. Schneider; Children’s Hospital Boston, Boston, MA. RATIONALE: Group interventions may improve child and parent coping with food allergy. We evaluated the impact of a half-day psychoeducational/support workshop for children with food allergy and their parents on parent perceived competence in coping with food allergy and burden associated with food allergy. METHODS: 33 children ages 5 to 7 years with food allergy and their parents attended a half-day workshop, with separate parent and child groups run concurrently. Parents completed measures of perceived competence in coping with food allergy at 3 timepoints: before participating in the workshop (pre), immediately following the workshop (post), and 4-8 weeks after the workshop (follow-up). Parents completed a measure of burden associated with food allergy at the pre and follow-up timepoints. Parents and children completed evaluations of the workshop. RESULTS: There were significant changes in parent ratings of competence in coping with food allergy over time, with increases from the pre to the post timepoint (p<0.05), and from the pre to the follow-up timepoint (p<.001). Parent ratings of burden associated with food allergy decreased from the pre to the follow-up timepoint (p<0.01). Workshop evaluations indicated that parents found program material helpful and particularly benefited from discussion with other parents. Children reported that they enjoyed the workshop, particularly engaging in medical play and meeting other children with food allergy. CONCLUSIONS: These results provide preliminary support for the effectiveness and feasibility of a group intervention for children with food allergy and their families. Directions for future research may include randomized controlled studies of multi-session interventions. Funding: Jaffe Family Foundation
291
Oral Desensitization Therpy In Children With Egg Allergy M. Akashi, M. Narita, A. Saito, T. Suda, I. Nomura, A. Akasawa, Y. Ohya; National Center for Child Health and Development, Tokyo, JAPAN. RATIONALE: At present, basic treatment for food allergy is elimination diet. However, this is very difficult for Japanese children with egg allergy, because egg is contained in many foods. Recently, some authors reported efficacy of oral desensitization therapy. The aim of this study is to investigate efficacy and safety of oral desensitization therapy in children with egg allergy. METHODS: Thirteen children (aged 4-8 years) who were diagnosed as egg allergy by double-blind placebo-controlled food challenge test were admitted to the study. Oral desensitization was performed with increasing dose starting from 0.4mg of egg. Moreover, specific immunoglobulin E and immunoglobulin G4 were assessed at baseline and after 6 months. RESULTS: Eleven of 13 children (85%) could eat 14g of egg during 6 month period. Two of 13 children tolerated 2g and 7g of egg after 6 months, respectively. During treatment, most patients experienced some mild adverse reactions, such as oral allergy symptom or abdominal pain. There was no anaphylactic episode throughout 6 month period. Specific immunoglobulin G4 after 6 months significantly increased compared to those at baseline (p<0.05). CONCLUSIONS: We succeeded in desensitizing 11 of 13 children with egg allergy safely. We reduced the risk of critical allergic reaction with accidental ingestion of egg in all patients. Funding: Taiho Pharmaceutical Co.
SATURDAY
288
The Utility of Combining Skin Prick and Specific IgE Antibody Testing as a Predictor of Clinical Reactivity to Milk, Egg, and Peanut D. R. Naimi, N. M. Paranich, J. M. Spergel, J. L. Beausoleil; The Children’s Hospital of Philadelphia, Philadelphia, PA. RATIONALE: Cut-off values for food-specific IgE have been developed as a means to guide when to perform an oral food challenge (OFC). We propose that by combining the results of specific IgE levels and skin prick test (SPT) wheal size, we can establish higher cut-off values for milk, egg and peanut. METHODS: Retrospective review of OFC outcomes in children compared to specific IgE levels and SPT measurements to milk, egg, and peanut. RESULTS: 61 children underwent OFC to milk, 76 to egg, and 52 to peanut. 46% of milk challenges were passed compared with 38% for egg, and 35% for peanut. Milk specific IgE levels of <6 kU/L and SPT wheal size <6mm were associated with an 87% chance of passing (NPV: 87%, PPV: 66%, Sensitivity: 89%, Specificity: 61%). Egg specific IgE levels of <7 kU/L and SPT wheal size <5mm were associated with a 79% chance of passing (NPV: 79%, PPV: 48%, Sensitivity: 79%, Specificity: 47%). Peanut specific IgE levels of <3 kU/L and SPT wheal size <5mm were associated with an 89% chance of passing (NPV: 89%, PPV: 48%, Sensitivity: 89%, Specificity: 50%). CONCLUSIONS: By combining the results of food-specific IgE levels and SPT wheal size, we have established values for milk, egg and peanut with excellent negative predictive value but with higher cut-off values than has previously been reported. With these new criteria, many children who are not truly allergic will be more likely to undergo OFC, thereby preventing the unnecessary avoidance of foods.
289
Consumer Awareness and Response Following the Food Allergen Labeling and Consumer Protection Act (FALCPA) H. Lemon-Mule1, T. J. Furlong2, S. H. Sicherer1; 1Mt Sinai School Of Medicine, New York, NY, 2Food Allergy & Anaphylaxis Network, Fairfax, VA. RATIONALE: The 2006 FALCPA legislation requires major allergen disclosure but does not advise precautionary allergen statements; consumer response to new labeling has not been assessed. METHODS: A survey was completed by 645 participants attending 2006 FAAN meetings in New York, Baltimore and Chicago. RESULTS: A majority (64%) noted major food allergens added to ingredient lists with the following frequency: milk (61%), peanut (55%), tree nut (38%), egg (31%), wheat (21%), soy (21%) and others (6%). New precautionary labels (e.g. ’’may contain’’) were noted by 83% with the following frequency: peanut (84%), tree nut (67%), milk (59%), egg (45%), wheat (35%), soy (35%) and others (14%). Participants reported baked products (60%) as the most common foods with new allergen disclosures. Consumers reported (28%) contacting manufacturers to inquire about added allergens. Only 46% of the manufacturers reported that the allergen was a newly added ingredient. In addition, 20% contacted manufacturers about new precautionary labels and only 14% of manufacturers reported product formula changes. Consumer avoidance varied by use of specific precautionary terms (e.g. ’’may contain traces,’’ ’’manufactured in a facility,’’ etc). Compared with data collected in 2003, participants in 2006 were more likely (25% versus 15%, p<0.001) to purchase food products with precautionary allergen statements. CONCLUSIONS: Consumers have noted numerous ingredient label changes that often did not represent new ingredients (apparent omissions from previous labels). Consumers are increasingly ignoring precautionary allergen statements.
J ALLERGY CLIN IMMUNOL JANUARY 2007
290
Preliminary Support for a Group Intervention for Children with Food Allergy and Their Parents J. S. LeBovidge, K. G. Timmons, C. Rich, A. Rosenstock, K. Fowler, L. C. Schneider; Children’s Hospital Boston, Boston, MA. RATIONALE: Group interventions may improve child and parent coping with food allergy. We evaluated the impact of a half-day psychoeducational/support workshop for children with food allergy and their parents on parent perceived competence in coping with food allergy and burden associated with food allergy. METHODS: 33 children ages 5 to 7 years with food allergy and their parents attended a half-day workshop, with separate parent and child groups run concurrently. Parents completed measures of perceived competence in coping with food allergy at 3 timepoints: before participating in the workshop (pre), immediately following the workshop (post), and 4-8 weeks after the workshop (follow-up). Parents completed a measure of burden associated with food allergy at the pre and follow-up timepoints. Parents and children completed evaluations of the workshop. RESULTS: There were significant changes in parent ratings of competence in coping with food allergy over time, with increases from the pre to the post timepoint (p<0.05), and from the pre to the follow-up timepoint (p<.001). Parent ratings of burden associated with food allergy decreased from the pre to the follow-up timepoint (p<0.01). Workshop evaluations indicated that parents found program material helpful and particularly benefited from discussion with other parents. Children reported that they enjoyed the workshop, particularly engaging in medical play and meeting other children with food allergy. CONCLUSIONS: These results provide preliminary support for the effectiveness and feasibility of a group intervention for children with food allergy and their families. Directions for future research may include randomized controlled studies of multi-session interventions. Funding: Jaffe Family Foundation
291
Oral Desensitization Therpy In Children With Egg Allergy M. Akashi, M. Narita, A. Saito, T. Suda, I. Nomura, A. Akasawa, Y. Ohya; National Center for Child Health and Development, Tokyo, JAPAN. RATIONALE: At present, basic treatment for food allergy is elimination diet. However, this is very difficult for Japanese children with egg allergy, because egg is contained in many foods. Recently, some authors reported efficacy of oral desensitization therapy. The aim of this study is to investigate efficacy and safety of oral desensitization therapy in children with egg allergy. METHODS: Thirteen children (aged 4-8 years) who were diagnosed as egg allergy by double-blind placebo-controlled food challenge test were admitted to the study. Oral desensitization was performed with increasing dose starting from 0.4mg of egg. Moreover, specific immunoglobulin E and immunoglobulin G4 were assessed at baseline and after 6 months. RESULTS: Eleven of 13 children (85%) could eat 14g of egg during 6 month period. Two of 13 children tolerated 2g and 7g of egg after 6 months, respectively. During treatment, most patients experienced some mild adverse reactions, such as oral allergy symptom or abdominal pain. There was no anaphylactic episode throughout 6 month period. Specific immunoglobulin G4 after 6 months significantly increased compared to those at baseline (p<0.05). CONCLUSIONS: We succeeded in desensitizing 11 of 13 children with egg allergy safely. We reduced the risk of critical allergic reaction with accidental ingestion of egg in all patients. Funding: Taiho Pharmaceutical Co.