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Prevalence and Risk Factors of Atopic Dermatitis in High School Students in Korea
S110 Abstracts
415
SUNDAY
Peanut Allergy is Associated with Increased Asthma Prevalence in Food Allergic Children J. M. Gaffin; Children’s Hospital, Boston, Boston, MA. RATIONALE: Children with food allergies often go on to develop asthma. Our objective was to determine if specific food allergies are associated with a higher prevalence of asthma. METHODS: Parental questionnaires were distributed to a cohort of 1233 children treated for food allergy in our allergy program. These questionnaires ascertained information regarding report of specific food allergies, environmental allergies, and parental report of asthma. Analysis was performed on children who had tried the specific food in question. RESULTS: In this cohort, the prevalence of asthma was 47.5% (N 5 774). Unadjusted odds ratios were significantly positive for each food allergy reported: dairy (OR 1.4; 95% CI:1.1-1.8; P 5 0.004), egg (OR 1.5; 95% CI:1.2-1.9; P 5 0.002), peanut (OR 1.6; 95% CI: 1.1-2.1; P 5 0.007), seafood (OR 1.9; 95% CI: 1.2-2.8; P 5 0.003), sesame seed (OR 2.1; 95% CI: 1.4-3.2; P 5 0.001), tree nut (OR 2.3; 95% CI: 1.6-3.3; P < 0.001). In multivariate analysis, after adjusting for age, sex, and allergy to egg, dairy, seafood, tree nuts, sesame seed, pollen and pets, children allergic to peanut had twice the odds of parental report of asthma (OR 5 2.1; 95% CI: 1.2-3.6; P 5 0.008). Furthermore, pollen allergy (OR 5 2.3, 95% CI: 1.3- 4.1, P 5 0.006), and pet allergy (OR 5 1.9, 95% CI: 1.1 - 3.4, P 5 0.022) were significantly associated with asthma. CONCLUSIONS: There is a high prevalence of asthma in the food allergic pediatric population. In children with reported food allergies, peanut allergy is significantly associated with parental report of asthma, independent of other factors.
416
Prevalence and Risk Factors of Atopic Dermatitis in High School Students in Korea S. Lee1, H. Kim2, J. Kim3, B. Kim3, Y. Song3, B. Kim3, J. Yu3, S. Yoo2, S. Hong3; 1Hallym Medical Center, Seoul, Republic of Korea, 2Inje University Sanggye Paik Hospital, Seoul, Republic of Korea, 3Asan Medical Center, Seoul, Republic of Korea. RATIONALE: Atopic dermatitis is a chronic inflammatory pruritic skin disease that affects a large number of children and adults in industrialized countries. But there have been few reports of atopic dermatitis prevalence in Korean adolescence. METHODS: A questionnaire survey was conducted among 1499 high school students, from 3 regions in Korea between April and May, 2006. They responded to a modified International Study of Asthma and Allergies in Childhood (ISAAC) written questionnaires (WQ). Seven hundred twenty four subjects of them underwent eosinophil ratio, total serum IgE levels, skin prick test and metacholine challenge test. RESULTS: The WQ showed that the lifetime and last twelve month prevalences of atopic dermatitis were 22.2% and 11.4%. The lifetime prevalence of atopic dermatitis diagnosis was 18.5% and last twelve month prevalence of atopic dermatitis treatment was 8.4%. Factors which increase of last twelve month prevalence of atopic dermatitis include body mass index (adjusted odds ratio [aOR] 5 1.064, 95% confidence interval [C.I.] 1.011-1.119); current asthma ([aOR] 5 2.864, 95% [C.I.] 1.128-7.270); current allergic rhinitis ([aOR] 5 2.219, 95% [C.I.] 1.2893.819); paternal atopic dermatitis. ([aOR] 5 5.527, 95% [C.I.] 2.86610.658) In a multiple logistic regression model, paternal atopic dermatitis was a significant risk factor for the twelve month prevalence of atopic dermatitis. CONCLUSIONS: Paternal atopic dermatitis was a significant risk factor for the twelve month prevalence of atopic dermatitis in adolescence. Genetic factors may contribute to the persistence of atopic dermatitis.
J ALLERGY CLIN IMMUNOL FEBRUARY 2009
417
Incidence of IgE-Mediated Cow's Milk Allergy in Pediatric Patients with a History of Cow's Milk Protein-Induced Proctocolitis E. L. Ching, R. C. Gutta, A. Mayuga, M. Xu, V. L. Paschall; Cleveland Clinic, Cleveland, OH. RATIONALE: In children with cow’s milk protein-induced proctocolitis (CMPIP), prick skin test (PST) and cow’s milk specific IgE (cm-IgE) are sometimes obtained before reintroduction of cow’s milk to evaluate for IgE-mediated hypersensitivity. We aim to determine if these children are at increased risk of developing IgE-mediated hypersensitivity to cow’s milk and describe the correlation between PST, cm-IgE, other food allergies, personal history, and family history of atopic disease with CMPIP. METHODS: Retrospective analysis of patients with CMPIP presenting with hematochezia from 2003-2008. RESULTS: 104 patients were identified with CMPIP to date, 51% male and 28% born prematurely with mean gestational age of 34.86 (63.04) weeks. Fifty-five patients had PST performed and 9% (95% CI: 3-20%) were positive to cow’s milk. Twenty-seven patients had cm-IgE obtained and 26% (95% CI: 11-46%) were positive. Of the 104 patients, 48% had soy protein-induced proctocolitis, 15% had atopic disease, and 8% had other food allergies. Fifty-four percent of patients had a family history of atopy and 22% had a family history of CMPIP. Of the 47 patients for which an absolute eosinophil count (AEC) was obtained, 33% had AEC >600 cells/L. Of the 59 patients who had milk reintroduced at home, 91% tolerated the challenge. CONCLUSIONS: The incidence of IgE-mediated cow’s milk allergy in patients with a history of CMPIP appears to be higher than the general population. Screening with prick skin test and/or cm-IgE is useful before reintroduction of cow’s milk. Prematurity, soy protein-induced proctocolitis, and family history of CMPIP correlated positively with the diagnosis of CMPIP.
418
Barley and Oat Allergy in Children with Wheat Allergy C. A. Keet, E. C. Matsui, G. Dhillon, P. J. Lenehan, R. A. Wood; Johns Hopkins University School of Medicine, Baltimore, MD. RATIONALE: To describe the sensitization and reaction patterns to barley and oat in children with wheat allergy. METHODS: The records of wheat-allergic patients seen in a tertiary referral clinic were reviewed. Data collected included: food allergy symptoms, food challenge results, wheat-specific IgE (wIgE), barley-specific IgE (bIgE) and oat-specific IgE (oIgE). RESULTS: Of 185 wheat allergic children, 56 (30%) tolerated barley, 24 (13%) reacted to it, and 105 (57%) had never been exposed or had unclear exposure histories. 110 (59%) tolerated oat, 18 (10%) reacted to it, and 57 (31%) had not been exposed or had unclear histories. BIgE was recorded for 136 subjects (368 observations, median: 18kU/L, IQR:5-56kU/L), oIgE for 124 (315 observations, median: 15kU/L, IQR:4-51kU/L), and wIgE for all (636 observations, median: 37kU/L, IQR:12-101kU/L). Although both peak bIgE and bIgE: wIgE ratio predicted clinical reactivity to barley (p < 0.01 for both), the peak bIgE: wIgE was a better predictor. For example, 1/8 with a bIgE: wIgE ratio <0.25 had clinical reactivity to barley, compared to 4/16 with a ratio 0.25-0.5, 7/17 between 0.5-1, and 11/14 1. For oat, neither the peak oIgE nor the peak oIgE: wIgE ratio was significantly associated with a history of reactivity (p 5 0.24 and 0.88). CONCLUSIONS: Among wheat allergic patients, at least 13% are reactive to barley and 10% to oat. For barley, the ratio of bIgE to wIgE is a useful predictor of clinical reactivity. Subjects with a ratio <0.25 are unlikely to be allergic to barley, and challenge should be considered when the ratio is 1.
415
SUNDAY
Peanut Allergy is Associated with Increased Asthma Prevalence in Food Allergic Children J. M. Gaffin; Children’s Hospital, Boston, Boston, MA. RATIONALE: Children with food allergies often go on to develop asthma. Our objective was to determine if specific food allergies are associated with a higher prevalence of asthma. METHODS: Parental questionnaires were distributed to a cohort of 1233 children treated for food allergy in our allergy program. These questionnaires ascertained information regarding report of specific food allergies, environmental allergies, and parental report of asthma. Analysis was performed on children who had tried the specific food in question. RESULTS: In this cohort, the prevalence of asthma was 47.5% (N 5 774). Unadjusted odds ratios were significantly positive for each food allergy reported: dairy (OR 1.4; 95% CI:1.1-1.8; P 5 0.004), egg (OR 1.5; 95% CI:1.2-1.9; P 5 0.002), peanut (OR 1.6; 95% CI: 1.1-2.1; P 5 0.007), seafood (OR 1.9; 95% CI: 1.2-2.8; P 5 0.003), sesame seed (OR 2.1; 95% CI: 1.4-3.2; P 5 0.001), tree nut (OR 2.3; 95% CI: 1.6-3.3; P < 0.001). In multivariate analysis, after adjusting for age, sex, and allergy to egg, dairy, seafood, tree nuts, sesame seed, pollen and pets, children allergic to peanut had twice the odds of parental report of asthma (OR 5 2.1; 95% CI: 1.2-3.6; P 5 0.008). Furthermore, pollen allergy (OR 5 2.3, 95% CI: 1.3- 4.1, P 5 0.006), and pet allergy (OR 5 1.9, 95% CI: 1.1 - 3.4, P 5 0.022) were significantly associated with asthma. CONCLUSIONS: There is a high prevalence of asthma in the food allergic pediatric population. In children with reported food allergies, peanut allergy is significantly associated with parental report of asthma, independent of other factors.
416
Prevalence and Risk Factors of Atopic Dermatitis in High School Students in Korea S. Lee1, H. Kim2, J. Kim3, B. Kim3, Y. Song3, B. Kim3, J. Yu3, S. Yoo2, S. Hong3; 1Hallym Medical Center, Seoul, Republic of Korea, 2Inje University Sanggye Paik Hospital, Seoul, Republic of Korea, 3Asan Medical Center, Seoul, Republic of Korea. RATIONALE: Atopic dermatitis is a chronic inflammatory pruritic skin disease that affects a large number of children and adults in industrialized countries. But there have been few reports of atopic dermatitis prevalence in Korean adolescence. METHODS: A questionnaire survey was conducted among 1499 high school students, from 3 regions in Korea between April and May, 2006. They responded to a modified International Study of Asthma and Allergies in Childhood (ISAAC) written questionnaires (WQ). Seven hundred twenty four subjects of them underwent eosinophil ratio, total serum IgE levels, skin prick test and metacholine challenge test. RESULTS: The WQ showed that the lifetime and last twelve month prevalences of atopic dermatitis were 22.2% and 11.4%. The lifetime prevalence of atopic dermatitis diagnosis was 18.5% and last twelve month prevalence of atopic dermatitis treatment was 8.4%. Factors which increase of last twelve month prevalence of atopic dermatitis include body mass index (adjusted odds ratio [aOR] 5 1.064, 95% confidence interval [C.I.] 1.011-1.119); current asthma ([aOR] 5 2.864, 95% [C.I.] 1.128-7.270); current allergic rhinitis ([aOR] 5 2.219, 95% [C.I.] 1.2893.819); paternal atopic dermatitis. ([aOR] 5 5.527, 95% [C.I.] 2.86610.658) In a multiple logistic regression model, paternal atopic dermatitis was a significant risk factor for the twelve month prevalence of atopic dermatitis. CONCLUSIONS: Paternal atopic dermatitis was a significant risk factor for the twelve month prevalence of atopic dermatitis in adolescence. Genetic factors may contribute to the persistence of atopic dermatitis.
J ALLERGY CLIN IMMUNOL FEBRUARY 2009
417
Incidence of IgE-Mediated Cow's Milk Allergy in Pediatric Patients with a History of Cow's Milk Protein-Induced Proctocolitis E. L. Ching, R. C. Gutta, A. Mayuga, M. Xu, V. L. Paschall; Cleveland Clinic, Cleveland, OH. RATIONALE: In children with cow’s milk protein-induced proctocolitis (CMPIP), prick skin test (PST) and cow’s milk specific IgE (cm-IgE) are sometimes obtained before reintroduction of cow’s milk to evaluate for IgE-mediated hypersensitivity. We aim to determine if these children are at increased risk of developing IgE-mediated hypersensitivity to cow’s milk and describe the correlation between PST, cm-IgE, other food allergies, personal history, and family history of atopic disease with CMPIP. METHODS: Retrospective analysis of patients with CMPIP presenting with hematochezia from 2003-2008. RESULTS: 104 patients were identified with CMPIP to date, 51% male and 28% born prematurely with mean gestational age of 34.86 (63.04) weeks. Fifty-five patients had PST performed and 9% (95% CI: 3-20%) were positive to cow’s milk. Twenty-seven patients had cm-IgE obtained and 26% (95% CI: 11-46%) were positive. Of the 104 patients, 48% had soy protein-induced proctocolitis, 15% had atopic disease, and 8% had other food allergies. Fifty-four percent of patients had a family history of atopy and 22% had a family history of CMPIP. Of the 47 patients for which an absolute eosinophil count (AEC) was obtained, 33% had AEC >600 cells/L. Of the 59 patients who had milk reintroduced at home, 91% tolerated the challenge. CONCLUSIONS: The incidence of IgE-mediated cow’s milk allergy in patients with a history of CMPIP appears to be higher than the general population. Screening with prick skin test and/or cm-IgE is useful before reintroduction of cow’s milk. Prematurity, soy protein-induced proctocolitis, and family history of CMPIP correlated positively with the diagnosis of CMPIP.
418
Barley and Oat Allergy in Children with Wheat Allergy C. A. Keet, E. C. Matsui, G. Dhillon, P. J. Lenehan, R. A. Wood; Johns Hopkins University School of Medicine, Baltimore, MD. RATIONALE: To describe the sensitization and reaction patterns to barley and oat in children with wheat allergy. METHODS: The records of wheat-allergic patients seen in a tertiary referral clinic were reviewed. Data collected included: food allergy symptoms, food challenge results, wheat-specific IgE (wIgE), barley-specific IgE (bIgE) and oat-specific IgE (oIgE). RESULTS: Of 185 wheat allergic children, 56 (30%) tolerated barley, 24 (13%) reacted to it, and 105 (57%) had never been exposed or had unclear exposure histories. 110 (59%) tolerated oat, 18 (10%) reacted to it, and 57 (31%) had not been exposed or had unclear histories. BIgE was recorded for 136 subjects (368 observations, median: 18kU/L, IQR:5-56kU/L), oIgE for 124 (315 observations, median: 15kU/L, IQR:4-51kU/L), and wIgE for all (636 observations, median: 37kU/L, IQR:12-101kU/L). Although both peak bIgE and bIgE: wIgE ratio predicted clinical reactivity to barley (p < 0.01 for both), the peak bIgE: wIgE was a better predictor. For example, 1/8 with a bIgE: wIgE ratio <0.25 had clinical reactivity to barley, compared to 4/16 with a ratio 0.25-0.5, 7/17 between 0.5-1, and 11/14 1. For oat, neither the peak oIgE nor the peak oIgE: wIgE ratio was significantly associated with a history of reactivity (p 5 0.24 and 0.88). CONCLUSIONS: Among wheat allergic patients, at least 13% are reactive to barley and 10% to oat. For barley, the ratio of bIgE to wIgE is a useful predictor of clinical reactivity. Subjects with a ratio <0.25 are unlikely to be allergic to barley, and challenge should be considered when the ratio is 1.