- Email: [email protected]
A SURVEY OF FOOD ALLERGY AWARENESS IN CHILDCARE PROVIDERS. - FP8
ABSTRACTS: POSTED AT FOOD ALLERGY SYMPOSIUM any adverse symptoms. CONCLUSIONS: Slim-Fast contains potent food allergens that may induce anaphylactic reactivity in sensitized individuals. Patients sensitzed to latex allergens may experience dramatic allergy symptoms when drinking this food product. The good intentions of some are not always rewarded.
FP5 DELAYED FOOD-DEPENDENT, EXERCISE-INDUCED ANAPHYLAXIS. B.I. Oyefara,' S. Bahna,' I. Monroe. LA; 2. Shreveport. LA. Specific food-dependent, exercise-induced anaphylaxis has been well documented in the literature. However, its pathophysiology has not been clearly elucidated and its clinical presentation continues to evolve in heterogeneous ways. It is often misdiagnosed particularly in cases with delayed development of symptoms as illustrated in this case. A 16 year old male had several episodes of anaphylaxis since he was I I years of age. His symptoms usually occurred following strenuous exercise if it was preceded within I hour by intake of a wheat-containing food (pizza, cheese stake sandwich, biscuits). His symptoms consisted of generalized urticaria, angioedema, abdominal pain, headache, shortness of breath, and sometimes loss of consciousness. Ingestion of wheat without exercise or exercise after intake of any other food did not trigger anaphylaxis. He was usually treated at the emergency room and released without Epi-Pen prescription. The latter was prescribed at the age of 14 years when he was evaluated by a dermatologist. His RAST was negative to milk, peanut, chicken, and tomato and was not tested for wheat. Subsequent anaphylaxis episodes were self-treated with Epi-Pen. In March 2003, I hour after eating a cheese stake sandwich, he played basket ball for I hour without immediate problems and he thought all was well. About 2 hours later, while he was at home alone, he developed generalized urticaria and shortness of breath. He immediately dialed 911 but he fell unconscious before he could talk or get to his Epi-Pen. The paramedic arrived a few minutes later. He was resuscitated and transported to the hospital. His serum tryptase level was 18 ng/ml(normal< 11.4 ng/ml). Complete blood count, serum electrolytes, liver enzymes, CH50, C2, C4, thyroid function test, thyroid autoantibodies, ESR, ANA titer, RPR, and hepatitis profile were all normal. His latex RAST was negative. Skin prick test with 32 foods was only positive to wheat (grade 4; 22 mm wheal/43 mm erythema). Wheat/exercise challenge was not done. The delayed presentation of near-fatal anaphylaxis in this case illustrates the need for early diagnosis, avoidance of exercise for a few hours after a meal that may contain the offending food, and easy accessibility of Epi-Pen as the onset of symptoms can be delayed. TABLE: Mean % Change in BMD After 2 Years of Treatment
various food-extracts viz. cereals, pulses, fruits, vegetables, nuts, egg, fish, chicken and milk. Specific and totallgE levels were estimated by ELISA. The food proteins were characterized by SDS-PAGE and Western Blot. RESULTS: Out of901 patients, 505 (56.04%) had history of food allergy. SPT was performed on 120 patients and 24 (20.0%) were positive. Extracts from pulses showed reactivity in maximum no. of patients viz. blackgram in II followed by limabean, frenchbean (7 each), lentil (4), redgram and chickpea (2 each). Sp IgE to foods was higher in patients (O.D. 0.7-1.2) than normal controls (O.D. 0.18-0.24). Pulses showed around 9-16 allergenic bands on immunoblot with mol.wt. 12-97 kDa. Blackgram showed allergenic bands ofapprox. 97, 85, 52, 42, 40,38,35,32,28 and 16 kDa. and the major bands are 97, 52,42, 35, 32, 28, 16 and 12 kDa. The major bands in lentil are in the molecular weight 67,39,29,27,23, 18 and 16 kDa; in chickpea 97,82,74,58,55,55,33,30,28,24,20 and 13 kDa; in limabean 43,28,27 and 21 kDa and in frenchbean 95, 77, 54, 39, 33, 31, 28, 25,19 and 17kDa. Bands with MW. 97, 39, 28, 27, 25 and 18.kDa are common in two or more pulses and may be cross-reacting proteins among the legumes. CONCLUSION: A sizeable number of cases show sensitization to foods among rhinitis and asthmatics. Extracts of pulses should be included in food allergy diagnosis kits.
FP7 CROSS-REACTIVITY OF SHRIMP, ABALONE AND DERPI. B. Sun.!" y. we.' N. Zhong,' I. HongKong. China; 2. CuangZhou. China. Background:Shellfish are a common cause of adverse food reactions in hypersensitive individuals, shrimp and abalone are the most frequently reported causes of allergic reaction. Objective:To investigate cross-reactivity of shrimp, abalone and Derp I. Methods: Shrimp and abalone extracts were prepare from raw seafood. Sera from 17 individuals by IgE ELISA analyses comfirmed the combined sensitization to shrimp,abalone and Derp I. Specific-lgE ELISA and Immunoblot assays were accomplished for shrimp and abalone extracts inhibited by Derp I and Derp 1 ELISA and Immunoblot assays inhibited by shrimp and abalone extracts. Results: ELISA inhibition showed that most IgE antibodies against shrimp and abalone were cross-reactive with Derp I and the same time, Derp I ELISA was inhibition by shrimp and abalone extract.The inhibition percent(%)of shrimp extract(GM:53.28%) and abalone extract(GM:33.46%)by Derpl were significantly higher than Derpl ELISA by shrimp extract(GM:26.65%) and abalone extract (GM:21.26%).(P~0.000 and P~0.009).,and there was a signifinant correlation of ELISA inhibition percent between shrimp extract, abalone extract and Derpl inhibited by each other; SDS-PAGE and immunoblot of raw shrimp and abalone demonstrated prominent protein allergens at 38KD,lgE-lmmunoblot demonstrated inhibition of shrimp and abalone by Derp I and Derp I by shrimp and abalone. Conclusion: This indicates that Derp I was the sensitizing agent.Shrimp,abalone and Derp I demonstrate significant cross-reactivity. These findings com firm that the primary cross-reactive allergen of shrimp and abalone is 38KD allergen.
FP6 PULSES AS A CAUSATIVE FACTOR IN SENSITIZATION OF PATIENTS WITH ASTHMA AND RHINITIS. D. Kurnari;" R. Kumar, S. Sridhara, N. Arora, S.N. Gaur, B.P. Singh, Delhi. India. INTRODUCTION: Foods are important causative agents of atopic diseases. Incidence offood allergy to common foods is not known in India. Pulses are important constituent of Indian diet The study was aimed to determine the prevalence of immunoglobulin E-mediated food allergy in respiratory allergy. METHODS: Clinical history of patients reporting at V.P.C.I, Delhi during year 2002 was recorded including symptoms of asthma, rhinitis, and other allergic conditions using a standard questionnaire. Based on history, patients were skin-prick tested (SPT) with
FP8 A SURVEY OF FOOD ALLERGY AWARENESS IN CHILDCARE PROVIDERS.
J. Oldham,' C. Healy, M. Levy, Milwaukee. WI. BACKGROUND: Food allergies are common, affecting 6% of preschool- and school-aged children. Strict avoidance of the offending foods helps to prevent many reactions. Two-thirds of food allergic children may experience an acciden-
ACAAI International Food Allergy Symposium
S54
ANNALS OF ALLERGY, ASTHMA & IMMUNOLOGY
ABSTRACTS: POSTED AT FOOD ALLERGY SYMPOSIUM
tal exposure, and reactions may occur in half. Many of these unintentional exposures occur in the preschool setting. Therefore, education of childcare providers is crucial to ensure prompt recognition and effective treatment of these reactions. METHODS: 91 childcare providers participated in the study. A questionnaire was administered. Policies regarding food allergic children, reactions, treatment that is given and proper use of an Epi-pen" were questioned. A seminar was then given to the providers on the recognition, management, and avoidance of food allergic reactions, including the proper technique for Epi-pen" use. RESULTS: 75/91(82%) of the childcare providers worked at a day care or preschool with the remainder being in a home setting. 53/84(63%) reported caring for at least one child with a food allergy. Of the children with food allergies, 46/81(57%) of the families did not provide any medication to have available. Half of the providers were familiar with an Epi-pen" and 29/42(69%) of them felt they would know how to use it in case of an emergency. Of the providers who were familiar with the Epi-pen", only 17/45(38%) correctly identified pulling off the gray cap as the first step in using it. 47/80(59%) of providers reported being given a written action plan for their food allergic children. Within the past two years 24/87(28%) reported the occurrence of one or more food allergic reactions. The most common policies for children with food allergies were having the meals prepared by the parents, no sharing offood between children, and special meals or substitutions provided for individual children. CONCLUSION: Many childcare providers are not given medications to treat allergic reactions and many are not familiar with the proper use of an Epi-pcn'". Many providers are not given action plans for children with food allergies. It is important that we continue to educate childcare providers about food allergies, action plans, avoidance, and treatment of food allergic reactions.
FP9 CAN MOLD ALLERGY BE TRIGGERED VIA THE ORAL ROUTE? S. Luccioli,* J. Malka-Rais, T.M. Nsouli, L. Chiazze, J.A. Bellanti, Wash-
ington, DC It is generally accepted that mold allergy involves sensitization by inhalation of mold spores through the respiratory tract. However, there is recent evidence to suggest that sensitization through the GI tract may be an alternate pathogenetic route. Despite these observations, only a limited number of studies have been performed to evaluate whether oral ingestion of molds may provoke hypersensitivity reactions in mold allergic patients. Twenty-two adult patients with histories of various allergic disorders, including asthma, were initially selected based on skin test positivity to mold(s) or other inhalants following which all subjects underwent a single blind, placebo-controlled oral challenge to increasing doses of a mixed preparation ofmolds commonly found in foods, [kindly provided by Allergen Laboratories, Liberty, MOj, (Alternaria, Cladosporium, Aspergillus, Mucor, Fusarium, Epicoccum, Pulullaria and Penicillium species). Of these patients, 16 were found to be skin test positive by skin-prick-test (SPT) and/or intradermal test (ID) to the mold mix preparation, and 6 allergic patients were negative to both. All subjects were challenged orally with increasing doses of mold ranging from 100 ng to 10 mg, which are quantitative dose estimates of molds that commonly contaminate foods. Symptoms were assessed at 15 minute intervals during the challenge period and by telephone follow-up at 24 hours using a modified scoring system (MSS), for which 5 points were assigned for each symptom, within the following organ systems, (i.e., skin, nose, chest, abdomen and cardiovascular), elicited by the challenge. Based upon the skin testing methodology, it was possible to differentiate the mold sensitive subjects into three groups as shown in the table below together with the results of skin testing, the provocation challenge (MSS score) and the average dose provoking concentrations (ADPC). In contrast to the positive relationship of skin sensitivity to MSS score an inverse relationship was seen between ADPC and dermal reactivity to molds within the 3 groups. The results of these preliminary studies suggest that ingestion of molds, at doses commonly found in foods, may provoke hypersensitivity reactions in mold allergic patients and may thus be a contributing factor to allergic symptoms in mold sensitive patients.
AOPC of mold antigen (ug)
Provocation
Group
n
SPT
10
I
10
+
+
1
10 t2.47
2
6
+
10
8.3 ±2.1O
3
6
-
-
10.100
3.3 tl.67
Skin testingt 10 mold I
MSS
FPIO IGE AND IGG ANTIBODY RESPONSES TO WALNUT AND CASHEW ALLERGENS IN ORALLY IMMUNIZED MICE. P. Gaudry,' * S.B. Lehrer,' K. Roux.' S. Teuber,' J. New Orleans, LA; 2. Tallahassee, FL; 3. Davis, CA. Rationale: Past attempts to define potential allergenicity of protein molecules tested 4 mouse strains (C3H/HeJ, CBA/J, C57BL/6J, and Balb/C) using 3 immunization procedures to develop IgE antibody responses to known human food allergens. Immunizations of mice with peanut or shrimp + cholera toxin (CT) orally yielded maximallgE antibody responses similar to those of food-allergic subjects. The current study further evaluated the oral immunization procedure in 7-8 week old female C3 H/HeJ mice, testing 2 major nut allergens, walnut and cashew. Methods: Mice (20 per group) were immunized i.g. with 10 mg, I mg, or 0.1 mg nut extract plus 10 ug CT 4 times over a 6 week period. One week following the last antigen injection, mice were sacrificed by exsanguination, sera per group pooled and assayed for IgE and IgG antibody responses. Results: Elevated IgE and IgG antibody responses in mice were demonstrated by allergen-specific ELISA to both walnut and cashew extracts. Nut-specific IgG antibody responses were generally 20 to 200-fold greater than IgE for walnut and 70 to 2000-fold greater than IgE for cashew. For mice immunized with walnut, IgE antibody levels ranged from 60 to 1800 ng/rnl, while IgG antibody levels ranged from 9.1 ug/ml to 376 ug/ml. For cashew-immunized mice, IgE ranged from 135 to 620 ng/ml, while IgG ranged from 9.4 ug/ml to 1373 ug/ml. Generally, there appears to be a correlation in magnitude oflgG with IgE antibody responses for both walnut and cashew-immunized mice. Interestingly, maximal IgE antibody reactivity to cashew was observed in mice immunized at the highest dose (10 mg cashew), whereas maximal IgE antibody responses to walnut occurred at intermediate and low doses (l mg, 0.1 mg walnut). Current studies are further evaluating murine IgE antibody reactivity to major allergens in walnut and cashew as compared to the responses of nutallergic subjects. Conclusions: These studies suggest that one can stimulate significant IgE antibody responses in mice to walnut and cashew, two important nut allergens. These results support our previous conclusions that mice provide a useful animal model for investigating allergenic proteins in food.
FPll IDENTIFICATION OF SOY PROTEINS ASSOCIATED WITH SERA OF PATIENTS WITH ATOPIC DERMATITIS BY SEROLOGICAL ANALYSIS OF CDNA EXPRESSION LIBRARY (SEREX). Kim, H., Kim, J., Park, T., Jeoung, D., Lee, S., Suwon, South Korea. Soy protein is common causes of allergic reactions in Korean children. We performed serological analysis of eDNA expression library (SEREX) to identify soy proteins associated with sera of patients with atopic dermatitis. The screening of soybean eDNA expression library with pooled sera of patients with atopic dermatitis yielded 9 independent clones. These clones are granule-bound starch synthase Ib, enolase, cytosolic malate dehydrogenase, cyclophilin, 3-ketoacylCoA thiolase and four unidentified genes. We are currently working the functional characterization of these allergens.
FP12 THE USE OF FOOD PATCH TESTING IN EOSINOPHILIC GASTROENTERITIS. WM. Ryan,* Falmouth, MA. Eosinophilic gastroenteritis etiology is uncertain in most cases. Hypersensitivity skin testing has not been very helpful in elucidating the cause in most cases. Current medical management of this disease is either modestly effective or has significant side effects. Therefore if the cause can be identified the disease maybe better managed. Patch testing can be utilized as one of the diagnostic methods. Study type: observational Data:This is a 42 y.o. male who has a history of asthma, allergic rhinitis. The patient had developed gastroesophogeal reflux (GER) which became progressive. As the GER worsened, so did the patient's asthma to the point of steroid dependency. Endoscopy was performed and the gastric biopsy was positive for eosinophils. Peripheral blood showed no eosinophil. Total IgE was nonnal. Hypersensitivity prick skin testing was negative for foods. Patient underwent surgery having a Nissan fundaplication and gastric jejunostomy. Initially patient did well titrated off oral steroid to low dose inhaled steroids. Two years post operation, the GER recurred confrimed by barium swallow. His asthma was once again steroid dependent. Gastic biopsy showed eosinophils.Patient was placed on medical management with little success. Patient had patch testing which was positive to wheat and peanut. Prick skin testing was negative. Anti gliadin antibodies were negative. Wheat and peanut were eliminated from the diet. Within two months symptoms resolved. Repeat gastric biopsy showed normal gastric
ACAAI International Food Allergy Symposium
VOLUME 93, NOVEMBER, 2004
S55
FP5 DELAYED FOOD-DEPENDENT, EXERCISE-INDUCED ANAPHYLAXIS. B.I. Oyefara,' S. Bahna,' I. Monroe. LA; 2. Shreveport. LA. Specific food-dependent, exercise-induced anaphylaxis has been well documented in the literature. However, its pathophysiology has not been clearly elucidated and its clinical presentation continues to evolve in heterogeneous ways. It is often misdiagnosed particularly in cases with delayed development of symptoms as illustrated in this case. A 16 year old male had several episodes of anaphylaxis since he was I I years of age. His symptoms usually occurred following strenuous exercise if it was preceded within I hour by intake of a wheat-containing food (pizza, cheese stake sandwich, biscuits). His symptoms consisted of generalized urticaria, angioedema, abdominal pain, headache, shortness of breath, and sometimes loss of consciousness. Ingestion of wheat without exercise or exercise after intake of any other food did not trigger anaphylaxis. He was usually treated at the emergency room and released without Epi-Pen prescription. The latter was prescribed at the age of 14 years when he was evaluated by a dermatologist. His RAST was negative to milk, peanut, chicken, and tomato and was not tested for wheat. Subsequent anaphylaxis episodes were self-treated with Epi-Pen. In March 2003, I hour after eating a cheese stake sandwich, he played basket ball for I hour without immediate problems and he thought all was well. About 2 hours later, while he was at home alone, he developed generalized urticaria and shortness of breath. He immediately dialed 911 but he fell unconscious before he could talk or get to his Epi-Pen. The paramedic arrived a few minutes later. He was resuscitated and transported to the hospital. His serum tryptase level was 18 ng/ml(normal< 11.4 ng/ml). Complete blood count, serum electrolytes, liver enzymes, CH50, C2, C4, thyroid function test, thyroid autoantibodies, ESR, ANA titer, RPR, and hepatitis profile were all normal. His latex RAST was negative. Skin prick test with 32 foods was only positive to wheat (grade 4; 22 mm wheal/43 mm erythema). Wheat/exercise challenge was not done. The delayed presentation of near-fatal anaphylaxis in this case illustrates the need for early diagnosis, avoidance of exercise for a few hours after a meal that may contain the offending food, and easy accessibility of Epi-Pen as the onset of symptoms can be delayed. TABLE: Mean % Change in BMD After 2 Years of Treatment
various food-extracts viz. cereals, pulses, fruits, vegetables, nuts, egg, fish, chicken and milk. Specific and totallgE levels were estimated by ELISA. The food proteins were characterized by SDS-PAGE and Western Blot. RESULTS: Out of901 patients, 505 (56.04%) had history of food allergy. SPT was performed on 120 patients and 24 (20.0%) were positive. Extracts from pulses showed reactivity in maximum no. of patients viz. blackgram in II followed by limabean, frenchbean (7 each), lentil (4), redgram and chickpea (2 each). Sp IgE to foods was higher in patients (O.D. 0.7-1.2) than normal controls (O.D. 0.18-0.24). Pulses showed around 9-16 allergenic bands on immunoblot with mol.wt. 12-97 kDa. Blackgram showed allergenic bands ofapprox. 97, 85, 52, 42, 40,38,35,32,28 and 16 kDa. and the major bands are 97, 52,42, 35, 32, 28, 16 and 12 kDa. The major bands in lentil are in the molecular weight 67,39,29,27,23, 18 and 16 kDa; in chickpea 97,82,74,58,55,55,33,30,28,24,20 and 13 kDa; in limabean 43,28,27 and 21 kDa and in frenchbean 95, 77, 54, 39, 33, 31, 28, 25,19 and 17kDa. Bands with MW. 97, 39, 28, 27, 25 and 18.kDa are common in two or more pulses and may be cross-reacting proteins among the legumes. CONCLUSION: A sizeable number of cases show sensitization to foods among rhinitis and asthmatics. Extracts of pulses should be included in food allergy diagnosis kits.
FP7 CROSS-REACTIVITY OF SHRIMP, ABALONE AND DERPI. B. Sun.!" y. we.' N. Zhong,' I. HongKong. China; 2. CuangZhou. China. Background:Shellfish are a common cause of adverse food reactions in hypersensitive individuals, shrimp and abalone are the most frequently reported causes of allergic reaction. Objective:To investigate cross-reactivity of shrimp, abalone and Derp I. Methods: Shrimp and abalone extracts were prepare from raw seafood. Sera from 17 individuals by IgE ELISA analyses comfirmed the combined sensitization to shrimp,abalone and Derp I. Specific-lgE ELISA and Immunoblot assays were accomplished for shrimp and abalone extracts inhibited by Derp I and Derp 1 ELISA and Immunoblot assays inhibited by shrimp and abalone extracts. Results: ELISA inhibition showed that most IgE antibodies against shrimp and abalone were cross-reactive with Derp I and the same time, Derp I ELISA was inhibition by shrimp and abalone extract.The inhibition percent(%)of shrimp extract(GM:53.28%) and abalone extract(GM:33.46%)by Derpl were significantly higher than Derpl ELISA by shrimp extract(GM:26.65%) and abalone extract (GM:21.26%).(P~0.000 and P~0.009).,and there was a signifinant correlation of ELISA inhibition percent between shrimp extract, abalone extract and Derpl inhibited by each other; SDS-PAGE and immunoblot of raw shrimp and abalone demonstrated prominent protein allergens at 38KD,lgE-lmmunoblot demonstrated inhibition of shrimp and abalone by Derp I and Derp I by shrimp and abalone. Conclusion: This indicates that Derp I was the sensitizing agent.Shrimp,abalone and Derp I demonstrate significant cross-reactivity. These findings com firm that the primary cross-reactive allergen of shrimp and abalone is 38KD allergen.
FP6 PULSES AS A CAUSATIVE FACTOR IN SENSITIZATION OF PATIENTS WITH ASTHMA AND RHINITIS. D. Kurnari;" R. Kumar, S. Sridhara, N. Arora, S.N. Gaur, B.P. Singh, Delhi. India. INTRODUCTION: Foods are important causative agents of atopic diseases. Incidence offood allergy to common foods is not known in India. Pulses are important constituent of Indian diet The study was aimed to determine the prevalence of immunoglobulin E-mediated food allergy in respiratory allergy. METHODS: Clinical history of patients reporting at V.P.C.I, Delhi during year 2002 was recorded including symptoms of asthma, rhinitis, and other allergic conditions using a standard questionnaire. Based on history, patients were skin-prick tested (SPT) with
FP8 A SURVEY OF FOOD ALLERGY AWARENESS IN CHILDCARE PROVIDERS.
J. Oldham,' C. Healy, M. Levy, Milwaukee. WI. BACKGROUND: Food allergies are common, affecting 6% of preschool- and school-aged children. Strict avoidance of the offending foods helps to prevent many reactions. Two-thirds of food allergic children may experience an acciden-
ACAAI International Food Allergy Symposium
S54
ANNALS OF ALLERGY, ASTHMA & IMMUNOLOGY
ABSTRACTS: POSTED AT FOOD ALLERGY SYMPOSIUM
tal exposure, and reactions may occur in half. Many of these unintentional exposures occur in the preschool setting. Therefore, education of childcare providers is crucial to ensure prompt recognition and effective treatment of these reactions. METHODS: 91 childcare providers participated in the study. A questionnaire was administered. Policies regarding food allergic children, reactions, treatment that is given and proper use of an Epi-pen" were questioned. A seminar was then given to the providers on the recognition, management, and avoidance of food allergic reactions, including the proper technique for Epi-pen" use. RESULTS: 75/91(82%) of the childcare providers worked at a day care or preschool with the remainder being in a home setting. 53/84(63%) reported caring for at least one child with a food allergy. Of the children with food allergies, 46/81(57%) of the families did not provide any medication to have available. Half of the providers were familiar with an Epi-pen" and 29/42(69%) of them felt they would know how to use it in case of an emergency. Of the providers who were familiar with the Epi-pen", only 17/45(38%) correctly identified pulling off the gray cap as the first step in using it. 47/80(59%) of providers reported being given a written action plan for their food allergic children. Within the past two years 24/87(28%) reported the occurrence of one or more food allergic reactions. The most common policies for children with food allergies were having the meals prepared by the parents, no sharing offood between children, and special meals or substitutions provided for individual children. CONCLUSION: Many childcare providers are not given medications to treat allergic reactions and many are not familiar with the proper use of an Epi-pcn'". Many providers are not given action plans for children with food allergies. It is important that we continue to educate childcare providers about food allergies, action plans, avoidance, and treatment of food allergic reactions.
FP9 CAN MOLD ALLERGY BE TRIGGERED VIA THE ORAL ROUTE? S. Luccioli,* J. Malka-Rais, T.M. Nsouli, L. Chiazze, J.A. Bellanti, Wash-
ington, DC It is generally accepted that mold allergy involves sensitization by inhalation of mold spores through the respiratory tract. However, there is recent evidence to suggest that sensitization through the GI tract may be an alternate pathogenetic route. Despite these observations, only a limited number of studies have been performed to evaluate whether oral ingestion of molds may provoke hypersensitivity reactions in mold allergic patients. Twenty-two adult patients with histories of various allergic disorders, including asthma, were initially selected based on skin test positivity to mold(s) or other inhalants following which all subjects underwent a single blind, placebo-controlled oral challenge to increasing doses of a mixed preparation ofmolds commonly found in foods, [kindly provided by Allergen Laboratories, Liberty, MOj, (Alternaria, Cladosporium, Aspergillus, Mucor, Fusarium, Epicoccum, Pulullaria and Penicillium species). Of these patients, 16 were found to be skin test positive by skin-prick-test (SPT) and/or intradermal test (ID) to the mold mix preparation, and 6 allergic patients were negative to both. All subjects were challenged orally with increasing doses of mold ranging from 100 ng to 10 mg, which are quantitative dose estimates of molds that commonly contaminate foods. Symptoms were assessed at 15 minute intervals during the challenge period and by telephone follow-up at 24 hours using a modified scoring system (MSS), for which 5 points were assigned for each symptom, within the following organ systems, (i.e., skin, nose, chest, abdomen and cardiovascular), elicited by the challenge. Based upon the skin testing methodology, it was possible to differentiate the mold sensitive subjects into three groups as shown in the table below together with the results of skin testing, the provocation challenge (MSS score) and the average dose provoking concentrations (ADPC). In contrast to the positive relationship of skin sensitivity to MSS score an inverse relationship was seen between ADPC and dermal reactivity to molds within the 3 groups. The results of these preliminary studies suggest that ingestion of molds, at doses commonly found in foods, may provoke hypersensitivity reactions in mold allergic patients and may thus be a contributing factor to allergic symptoms in mold sensitive patients.
AOPC of mold antigen (ug)
Provocation
Group
n
SPT
10
I
10
+
+
1
10 t2.47
2
6
+
10
8.3 ±2.1O
3
6
-
-
10.100
3.3 tl.67
Skin testingt 10 mold I
MSS
FPIO IGE AND IGG ANTIBODY RESPONSES TO WALNUT AND CASHEW ALLERGENS IN ORALLY IMMUNIZED MICE. P. Gaudry,' * S.B. Lehrer,' K. Roux.' S. Teuber,' J. New Orleans, LA; 2. Tallahassee, FL; 3. Davis, CA. Rationale: Past attempts to define potential allergenicity of protein molecules tested 4 mouse strains (C3H/HeJ, CBA/J, C57BL/6J, and Balb/C) using 3 immunization procedures to develop IgE antibody responses to known human food allergens. Immunizations of mice with peanut or shrimp + cholera toxin (CT) orally yielded maximallgE antibody responses similar to those of food-allergic subjects. The current study further evaluated the oral immunization procedure in 7-8 week old female C3 H/HeJ mice, testing 2 major nut allergens, walnut and cashew. Methods: Mice (20 per group) were immunized i.g. with 10 mg, I mg, or 0.1 mg nut extract plus 10 ug CT 4 times over a 6 week period. One week following the last antigen injection, mice were sacrificed by exsanguination, sera per group pooled and assayed for IgE and IgG antibody responses. Results: Elevated IgE and IgG antibody responses in mice were demonstrated by allergen-specific ELISA to both walnut and cashew extracts. Nut-specific IgG antibody responses were generally 20 to 200-fold greater than IgE for walnut and 70 to 2000-fold greater than IgE for cashew. For mice immunized with walnut, IgE antibody levels ranged from 60 to 1800 ng/rnl, while IgG antibody levels ranged from 9.1 ug/ml to 376 ug/ml. For cashew-immunized mice, IgE ranged from 135 to 620 ng/ml, while IgG ranged from 9.4 ug/ml to 1373 ug/ml. Generally, there appears to be a correlation in magnitude oflgG with IgE antibody responses for both walnut and cashew-immunized mice. Interestingly, maximal IgE antibody reactivity to cashew was observed in mice immunized at the highest dose (10 mg cashew), whereas maximal IgE antibody responses to walnut occurred at intermediate and low doses (l mg, 0.1 mg walnut). Current studies are further evaluating murine IgE antibody reactivity to major allergens in walnut and cashew as compared to the responses of nutallergic subjects. Conclusions: These studies suggest that one can stimulate significant IgE antibody responses in mice to walnut and cashew, two important nut allergens. These results support our previous conclusions that mice provide a useful animal model for investigating allergenic proteins in food.
FPll IDENTIFICATION OF SOY PROTEINS ASSOCIATED WITH SERA OF PATIENTS WITH ATOPIC DERMATITIS BY SEROLOGICAL ANALYSIS OF CDNA EXPRESSION LIBRARY (SEREX). Kim, H., Kim, J., Park, T., Jeoung, D., Lee, S., Suwon, South Korea. Soy protein is common causes of allergic reactions in Korean children. We performed serological analysis of eDNA expression library (SEREX) to identify soy proteins associated with sera of patients with atopic dermatitis. The screening of soybean eDNA expression library with pooled sera of patients with atopic dermatitis yielded 9 independent clones. These clones are granule-bound starch synthase Ib, enolase, cytosolic malate dehydrogenase, cyclophilin, 3-ketoacylCoA thiolase and four unidentified genes. We are currently working the functional characterization of these allergens.
FP12 THE USE OF FOOD PATCH TESTING IN EOSINOPHILIC GASTROENTERITIS. WM. Ryan,* Falmouth, MA. Eosinophilic gastroenteritis etiology is uncertain in most cases. Hypersensitivity skin testing has not been very helpful in elucidating the cause in most cases. Current medical management of this disease is either modestly effective or has significant side effects. Therefore if the cause can be identified the disease maybe better managed. Patch testing can be utilized as one of the diagnostic methods. Study type: observational Data:This is a 42 y.o. male who has a history of asthma, allergic rhinitis. The patient had developed gastroesophogeal reflux (GER) which became progressive. As the GER worsened, so did the patient's asthma to the point of steroid dependency. Endoscopy was performed and the gastric biopsy was positive for eosinophils. Peripheral blood showed no eosinophil. Total IgE was nonnal. Hypersensitivity prick skin testing was negative for foods. Patient underwent surgery having a Nissan fundaplication and gastric jejunostomy. Initially patient did well titrated off oral steroid to low dose inhaled steroids. Two years post operation, the GER recurred confrimed by barium swallow. His asthma was once again steroid dependent. Gastic biopsy showed eosinophils.Patient was placed on medical management with little success. Patient had patch testing which was positive to wheat and peanut. Prick skin testing was negative. Anti gliadin antibodies were negative. Wheat and peanut were eliminated from the diet. Within two months symptoms resolved. Repeat gastric biopsy showed normal gastric
ACAAI International Food Allergy Symposium
VOLUME 93, NOVEMBER, 2004
S55