- Email: [email protected]
“Real World” Influenza Vaccination Practice Patterns in Egg-Allergic Patients
Abstracts AB243
J ALLERGY CLIN IMMUNOL VOLUME 127, NUMBER 2
''Real World'' Influenza Vaccination Practice Patterns in EggAllergic Patients S. Mithani1, S. Schuval1,2; 1North Shore- Long Island Jewish Health System, Great Neck, NY, 2Hofstra North Shore-Long Island Jewish School of Medicine, Hempstead, NY. RATIONALE: All available seasonal and H1N1 influenza vaccines contain egg protein. Therefore, vaccine administration poses a risk of allergic reaction in patients with egg allergy. For 2009, the AAAAI recommended influenza vaccine skin testing followed by test dosing, for egg-allergic patients prior to vaccine administration. We sought to determine ‘‘real world’’ patterns of influenza vaccine administration in egg-allergic patients. METHODS: This was a retrospective review of medical records of patients with physician-diagnosed egg-allergy, ages 1 to 65 years, followed by the North Shore-Long Island Jewish Health System Division of Allergy between 2006 and 2010. RESULTS: A total of 119 egg allergic patients were identified. Of these, 51 (43%) did not receive an influenza vaccine. Forty-two patients (35%) received an influenza vaccine in our office according to 2009 AAAAI recommendations and no adverse reactions occurred. However, 26 patients (22%) had received an influenza vaccine at other physicians’ offices without vaccine testing or test dosing. Of the data available from these patients, 5/20 (25%) reported adverse reactions, 11/20 (55%) were given an influenza vaccine information statement, and 10/20 (50%) knew that severe egg allergy was a contraindication for influenza vaccine administration. CONCLUSIONS: Adverse reactions may occur in egg-allergic patients receiving influenza vaccine. Therefore, vaccine skin testing and/or test dosing should be considered for egg-allergic individuals. Each fall and winter, primary care providers should familiarize themselves with vaccine administration guidelines and contraindications, as recommendations may change from year to year. Also, improved educational measures are needed for egg-allergic patients regarding immunization with egg-protein containing vaccines.
940
Further Evidence For Tick Bites As A Cause Of The IgE Responses To Alpha-gal That Underlie A Major Increased In Delayed Anaphylaxis To Meat H. R. James1, S. P. Commins1, L. A. Kelly1, S. L. Pochan1, L. J. Workman1, R. J. Mullins2, T. A. E. Platts-Mills1; 1University of Virginia, Charlottesville, VA, 2John James Medical Centre, Canberra, AUSTRALIA. RATIONALE: Delayed onset of urticaria or anaphylaxis after eating meat in patients who have IgE to alpha-gal is now a common presenting cause of food allergy in Virginia. The evidence that ticks are related to this IgE response comes from histories of bites, absence of this ab in areas where tick bites are rare, and from following IgE responses after tick bites. METHODS: Detailed histories and assays for IgE were compared in a population of anaphylaxis, asthma, and clinic controls. RESULTS: Among those with full histories (n5100), a report of prolonged or severe reactions to tick bites correlated with titer of IgE to alpha-gal (Chi-square 5 17.6, p<0.001). The IgE responses following tick bites have distinctive features: a) they can increase to high level (i.e., greater than 50 IU/ml within a month), b) IgE to cat and dog epithelium and beef increase in parallel with IgE to alpha-gal, while IgE to other allergens remain negative or unchanged, and c) absorption experiments confirm that these IgE responses to alpha-gal explain up to 50% of total serum IgE. In keeping with this, titers of total IgE and IgE to alpha-gal correlate closely (r50.7, p<0.001). CONCLUSION: Some of the patients have had episodes of delayed anaphylaxis for over 15 years; however, the bulk of these cases are of recent onset. At present, the best explanation for increasing incidence of this syndrome is a major increase in tick bites related to the massive increase in the population of their primary host, the white-tailed deer.
941
Elevation of Serum IL-17 Levels was Demonstrated after Oral Food Challenge in Infants with Food Protein-Induced Enterocolitis Syndrome T. Shoda1,2, K. Hashimoto3, H. Morita4, I. Nomura1, A. Isozaki2, Y. Ohya1, T. Ichiyama3, H. Saito4, K. Matsumoto4, Y. Kawano2; 1Division of Allergy, Department of Medical Subspecialties, National Center for Child Health and Development, Tokyo, JAPAN, 2Department of Pediatrics, Medical Center for Allergy and Immune diseases, Yokohama City Minato Red Cross Hospital, Yokohama, JAPAN, 3Department of Pediatrics, Yamaguchi University Graduate School of Medicine, Yamaguchi, JAPAN, 4Department of Allergy and Immunology, National Research Institute for Child Health & Development, Tokyo, JAPAN. RATIONALE: Food protein-induced enterocolitis syndrome (FPIES) is characterized by cell-mediated immune responses with elevated neutrophil counts, however, no data have been available regarding the role of IL-17 in the pathogenesis of FPIES. We present here two infants fulfilling FPIES criteria who demonstrated elevated serum IL-17 levels after oral food challenge (OFC). METHODS: Two boys with trisomy 21 developed vomiting and diarrhea at least 2 hours after ingestion of milk at the age of 2 and 4 months, respectively. Open OFC tests were undertaken at 8 month-old and 2 year old after informed consent was obtained. Blood samples were serially collected before and up to 24 hours after OFC. PBMC from each patient were incubated with LPS-depleted cow’s milk proteins and the culture supernatants were harvested at 6 and 24 hours after culture. The concentrations of various cytokines were measured by ELISA and CBA. RESULTS: The patients developed recurrent vomiting, fever and lethargy within 2 hours and watery diarrhea 6 hours after OFC. Peripheral blood neutrophil counts were also elevated. Significantly elevated serum IL17A levels (74 and 324 pg/mL) and IL-6 levels were observed in each patient at one and two hours after OFC. However, IL-17Awas undetectable in the culture supernatants of PBMC after antigen stimulation. CONCLUSIONS: Our study suggests that in a certain subtype of patients with FPIES, IL-17 is secreted in a very early stage and is likely to be involved in the recruitment of neutorphils, whereas the source(s) of IL-17 remains to be clarified.
942
Identification of Probiotic Strains Capable of Gluten Peptide Degradation K. J. Clark1, C. Hernandez Gaitan1, S. L. Taylor2, J. Walter1; 1University of Nebraska, Lincoln, NE, 2Food Allergy Research and Resource Program, University of Nebraska, Lincoln, NE. RATIONALE: Celiac disease is an increasingly diagnosed enteropathy induced by gluten, a common food protein found in wheat, barley and rye. Currently, there are no treatments available to individuals with celiac disease, and they must commit to a permanent gluten-free diet. Our interest is to identify probiotic strains capable of degrading gluten peptides as a future treatment in the management of celiac disease. METHODS: Two dietary treatments were fed to weaned pigs: a basal corn-soybean meal diet and an experimental diet, basal 1 20% wheat gluten (Vital Wheat Gluten, ADM Milling Co.). At the conclusion of the trial, the pigs were sacrificed and ileal contents were obtained. To identify strains capable of degrading the proline and glutamine rich polypeptides found in gluten, culture dependent and independent techniques were used. The cultured isolates were screened, using chromogenic substrates, for production of proteolytic enzymes (prolyl endopeptidase, aminopeptidase type N, and proline iminopeptidase) that have been shown to degrade immunotoxic gluten peptides. RESULTS: 140 isolates were cultured from the small intestine of pigs fed the gluten supplemented diet. The isolates were typed using RAPD-PCR; over 50 distinct types were identified. The RAPD types were classified using 16s rDNA sequencing. The phenotypic characterization of the isolates revealed several Lactobacillus strains as the dominant producers of specialized enzymes capable of gluten peptide hydrolysis. CONCLUSIONS: This approach has identified bacterial strains capable of degrading gluten epitopes. With further experiments, these isolates could provide a therapy for patients suffering from celiac disease.
TUESDAY
939
J ALLERGY CLIN IMMUNOL VOLUME 127, NUMBER 2
''Real World'' Influenza Vaccination Practice Patterns in EggAllergic Patients S. Mithani1, S. Schuval1,2; 1North Shore- Long Island Jewish Health System, Great Neck, NY, 2Hofstra North Shore-Long Island Jewish School of Medicine, Hempstead, NY. RATIONALE: All available seasonal and H1N1 influenza vaccines contain egg protein. Therefore, vaccine administration poses a risk of allergic reaction in patients with egg allergy. For 2009, the AAAAI recommended influenza vaccine skin testing followed by test dosing, for egg-allergic patients prior to vaccine administration. We sought to determine ‘‘real world’’ patterns of influenza vaccine administration in egg-allergic patients. METHODS: This was a retrospective review of medical records of patients with physician-diagnosed egg-allergy, ages 1 to 65 years, followed by the North Shore-Long Island Jewish Health System Division of Allergy between 2006 and 2010. RESULTS: A total of 119 egg allergic patients were identified. Of these, 51 (43%) did not receive an influenza vaccine. Forty-two patients (35%) received an influenza vaccine in our office according to 2009 AAAAI recommendations and no adverse reactions occurred. However, 26 patients (22%) had received an influenza vaccine at other physicians’ offices without vaccine testing or test dosing. Of the data available from these patients, 5/20 (25%) reported adverse reactions, 11/20 (55%) were given an influenza vaccine information statement, and 10/20 (50%) knew that severe egg allergy was a contraindication for influenza vaccine administration. CONCLUSIONS: Adverse reactions may occur in egg-allergic patients receiving influenza vaccine. Therefore, vaccine skin testing and/or test dosing should be considered for egg-allergic individuals. Each fall and winter, primary care providers should familiarize themselves with vaccine administration guidelines and contraindications, as recommendations may change from year to year. Also, improved educational measures are needed for egg-allergic patients regarding immunization with egg-protein containing vaccines.
940
Further Evidence For Tick Bites As A Cause Of The IgE Responses To Alpha-gal That Underlie A Major Increased In Delayed Anaphylaxis To Meat H. R. James1, S. P. Commins1, L. A. Kelly1, S. L. Pochan1, L. J. Workman1, R. J. Mullins2, T. A. E. Platts-Mills1; 1University of Virginia, Charlottesville, VA, 2John James Medical Centre, Canberra, AUSTRALIA. RATIONALE: Delayed onset of urticaria or anaphylaxis after eating meat in patients who have IgE to alpha-gal is now a common presenting cause of food allergy in Virginia. The evidence that ticks are related to this IgE response comes from histories of bites, absence of this ab in areas where tick bites are rare, and from following IgE responses after tick bites. METHODS: Detailed histories and assays for IgE were compared in a population of anaphylaxis, asthma, and clinic controls. RESULTS: Among those with full histories (n5100), a report of prolonged or severe reactions to tick bites correlated with titer of IgE to alpha-gal (Chi-square 5 17.6, p<0.001). The IgE responses following tick bites have distinctive features: a) they can increase to high level (i.e., greater than 50 IU/ml within a month), b) IgE to cat and dog epithelium and beef increase in parallel with IgE to alpha-gal, while IgE to other allergens remain negative or unchanged, and c) absorption experiments confirm that these IgE responses to alpha-gal explain up to 50% of total serum IgE. In keeping with this, titers of total IgE and IgE to alpha-gal correlate closely (r50.7, p<0.001). CONCLUSION: Some of the patients have had episodes of delayed anaphylaxis for over 15 years; however, the bulk of these cases are of recent onset. At present, the best explanation for increasing incidence of this syndrome is a major increase in tick bites related to the massive increase in the population of their primary host, the white-tailed deer.
941
Elevation of Serum IL-17 Levels was Demonstrated after Oral Food Challenge in Infants with Food Protein-Induced Enterocolitis Syndrome T. Shoda1,2, K. Hashimoto3, H. Morita4, I. Nomura1, A. Isozaki2, Y. Ohya1, T. Ichiyama3, H. Saito4, K. Matsumoto4, Y. Kawano2; 1Division of Allergy, Department of Medical Subspecialties, National Center for Child Health and Development, Tokyo, JAPAN, 2Department of Pediatrics, Medical Center for Allergy and Immune diseases, Yokohama City Minato Red Cross Hospital, Yokohama, JAPAN, 3Department of Pediatrics, Yamaguchi University Graduate School of Medicine, Yamaguchi, JAPAN, 4Department of Allergy and Immunology, National Research Institute for Child Health & Development, Tokyo, JAPAN. RATIONALE: Food protein-induced enterocolitis syndrome (FPIES) is characterized by cell-mediated immune responses with elevated neutrophil counts, however, no data have been available regarding the role of IL-17 in the pathogenesis of FPIES. We present here two infants fulfilling FPIES criteria who demonstrated elevated serum IL-17 levels after oral food challenge (OFC). METHODS: Two boys with trisomy 21 developed vomiting and diarrhea at least 2 hours after ingestion of milk at the age of 2 and 4 months, respectively. Open OFC tests were undertaken at 8 month-old and 2 year old after informed consent was obtained. Blood samples were serially collected before and up to 24 hours after OFC. PBMC from each patient were incubated with LPS-depleted cow’s milk proteins and the culture supernatants were harvested at 6 and 24 hours after culture. The concentrations of various cytokines were measured by ELISA and CBA. RESULTS: The patients developed recurrent vomiting, fever and lethargy within 2 hours and watery diarrhea 6 hours after OFC. Peripheral blood neutrophil counts were also elevated. Significantly elevated serum IL17A levels (74 and 324 pg/mL) and IL-6 levels were observed in each patient at one and two hours after OFC. However, IL-17Awas undetectable in the culture supernatants of PBMC after antigen stimulation. CONCLUSIONS: Our study suggests that in a certain subtype of patients with FPIES, IL-17 is secreted in a very early stage and is likely to be involved in the recruitment of neutorphils, whereas the source(s) of IL-17 remains to be clarified.
942
Identification of Probiotic Strains Capable of Gluten Peptide Degradation K. J. Clark1, C. Hernandez Gaitan1, S. L. Taylor2, J. Walter1; 1University of Nebraska, Lincoln, NE, 2Food Allergy Research and Resource Program, University of Nebraska, Lincoln, NE. RATIONALE: Celiac disease is an increasingly diagnosed enteropathy induced by gluten, a common food protein found in wheat, barley and rye. Currently, there are no treatments available to individuals with celiac disease, and they must commit to a permanent gluten-free diet. Our interest is to identify probiotic strains capable of degrading gluten peptides as a future treatment in the management of celiac disease. METHODS: Two dietary treatments were fed to weaned pigs: a basal corn-soybean meal diet and an experimental diet, basal 1 20% wheat gluten (Vital Wheat Gluten, ADM Milling Co.). At the conclusion of the trial, the pigs were sacrificed and ileal contents were obtained. To identify strains capable of degrading the proline and glutamine rich polypeptides found in gluten, culture dependent and independent techniques were used. The cultured isolates were screened, using chromogenic substrates, for production of proteolytic enzymes (prolyl endopeptidase, aminopeptidase type N, and proline iminopeptidase) that have been shown to degrade immunotoxic gluten peptides. RESULTS: 140 isolates were cultured from the small intestine of pigs fed the gluten supplemented diet. The isolates were typed using RAPD-PCR; over 50 distinct types were identified. The RAPD types were classified using 16s rDNA sequencing. The phenotypic characterization of the isolates revealed several Lactobacillus strains as the dominant producers of specialized enzymes capable of gluten peptide hydrolysis. CONCLUSIONS: This approach has identified bacterial strains capable of degrading gluten epitopes. With further experiments, these isolates could provide a therapy for patients suffering from celiac disease.
TUESDAY
939