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Are Angiotensin Converting Enzyme Inhibitors the Main Elicitors of Tongue Angioedema?
Abstracts AB255
J ALLERGY CLIN IMMUNOL VOLUME 137, NUMBER 2
Are Angiotensin Converting Enzyme Inhibitors the Main Elicitors of Tongue Angioedema?
Dasha Roa Medellin, MD, Ana Rodriguez Fernandez, MD, Sarah Micozzi, MD, Mercedes Saenz de Santa Maria, MD, Marta Seoane, MD, Marıa L. Baeza, MD, PhD; Hospital General Universitario Gregorio Mara~ n on. Department of Allergy, Madrid, Spain. RATIONALE: ACE-I has been considered main elicitor in angioedema of the tongue (AET) but its real implication is undetermined. METHODS: A retrospective-descriptive study including patients diagnosed with AET at the Emergency Department (ED) Jan-2013 to Dec-2014 at the third level Hospital was conducted. RESULTS: 300.300 Patients were attended at the ED. 513 were identified with angioedema. (Incidence 0.17%) 70 had AET. (13%) Mean age: 60 DS +/-20,07. Median 64, with no gender differences. 32 (51,52%) had recurrent episodes. In 44 patients (62,85 %) the AET was isolated, 17 (24,28%) was accompanied by facial angioedema (eye lid, lips or cheeks), 10 (14,28%) had pharyngolaryngeal involvement. 16 patients (22,85%) had breathing or swallowing difficulties and one required intubation. ACE-I were responsible for the AET in 24 patients (34,28%), other drugs were suspected in 12 (17,14%), foods 7 (10,%), unknown in 26 (37,14%) and others 1(1,42%). AETwas isolated in 54,2% of the ACE-I-induced AE, compared to the 63,2% on the rest of the patients. 47 cases were later studied at the Allergy Department. They were classified as histaminergic 21 (45,65%), no histaminergic 24 (52,17%). There were 2 cases of inflammatory edema. On the first group foods were involved in 3 (15%) and 18 (85%) were considered idiopathic. In the second group the most common cause identified was ACE-I 21(87,5%), followed by hereditary AE 2(8,33%) and idiopathic AE 1 (4.16%). CONCLUSIONS: ACE-I was the cause of a third of the AET, being responsible for 87,5% of the non-histaminergic episodes. Most of the histaminergic AET were idiopathic.
832
Skin Prick Testing Alone Is Not a Good Predictor of Allergy Symptom Severity in Grass Allergic Patients
Sameer Patel, MD, Victoria Nelson, MSc, Tara Sadoway, MSc, Peter Couroux, MD, Anne Marie Salapatek, PhD; Inflamax Research, Mississauga, ON, Canada. RATIONALE: Skin prick tests (SPT) are a useful initial diagnostic tool for assessing allergic response. The Environmental Exposure chamber (EEC) is used to expose subjects to controlled, natural levels of allergen in order to evaluate their allergic response. We wanted to determine if the SPT could predict patient’s symptom severity in the EEC. METHODS: A study involving 152 patients was analyzed to determine correlations between SPT and maximum TSS. Subjects underwent a screening visit where a panel of SPT were performed including three different grass allergen extracts (5-grass mix, Meadow fescue grass, and Rye grass and were exposed to grass pollen in the EEC at a concentration of 3500 6 500 grains/m3 for 6 hours, over 3 consecutive days. Total symptom scores (TSS) were obtained at scheduled intervals. RESULTS: Correlation analysis revealed a weak correlation between the 5-grass mix SPT and the symptom severity (r250.31). A correlation of r250.34 was identified when comparing the Meadow Fescue grass SPT to the maximum TSS. This also shows a weak correlation between the SPT and TSS. Finally, the rye grass showed the weakest correlation of r250.29 between the SPT and maximum TSS. CONCLUSIONS: This analysis demonstrates that the SPT is correlated with symptom response. The value is less than 0.5, indicating SPT alone cannot be used as a predictor of allergic response when exposed to allergen. Overall, enrolling subjects in allergic rhinitis clinical trials based on SPT alone may not be suitable and additional clinical response assessment such as EEC exposure should be done for eligibility.
833
Quality of Life in Patients Immunotherapy for Food Allergy
during
Oral
Na’ama Epstein Rigbi1, Yitzhak Katz, MD, FAAAAI1,2, Michael R. Goldberg, MD, PhD1, Michael B. Levy, MD, FAAAAI1, Liat Nachshon, MD1, Arnon Elizur, MD1,2; 1Assaf Harofeh Medical Center, Zerifin, Israel, 2Department of Pediatrics, Sackler School of Medicine, Tel Aviv, Israel. RATIONALE: Quality of life (QOL) of patients with food allergy improves following oral immunotherapy (OIT) but may be adversely affected by the treatment process itself. METHODS: Parents of children aged 4-12 years undergoing OIT for milk, peanut and egg allergies were recruited. Patient demographics and clinical histories before OIT, and their treatment course, including dose escalation rate, reactions and treatments required were recorded. The Food Allergy Quality of Life Questionnaire-Parental Form (FAQLQ-PF) was completed at the beginning and following 5 months of treatment. Patients with improved (reduction of >0.5 points), unchanged (reduction/increase of <0.5 points) and diminished (increase of >0.5 points) FAQLQ-PF scores were compared using Chi test and One-way Anova. RESULTS: Of the 108 patients recruited, 18 were excluded, either because of incomplete questionnaires (n517), or treatment failure (n51). Of the remaining 90 patients (milk; n548, peanut; n537, egg; n55), 46 were in the dose escalation phase and the remainders were in maintenance (full dose; n537, and partial dose; n57). Patients with improved (n532), unchanged (n539) and diminished (n519) total score on the FAQLQ-PF did not differ in pre-OIT clinical histories, tolerated dose at treatment initiation, course of treatment (reactions, epinephrine use, rate of dose escalation) or stage of treatment. Patients with improved FAQLQ-PF total score had a significantly diminished score at baseline (4.36) compared to those with unchanged score (3.56, p50.016) and decreased score (2.75, p<0.001). CONCLUSIONS: Patients with diminished QOL before OIT benefit significantly during treatment. Those whose QOL is minimally affected at baseline might benefit from better preparedness for OIT.
834
Impact of Parent-Reported Food Allergies on Children's Growth and Quality of Life of the Caregivers
Tanya Kajornrattana1, Pasuree Sangsupawanich, MD, PhD2, Araya Yuenyongviwat, MD3; 1Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand, 2Prince of Songkla University, Hat-yai, Thailand, 3Prince of Songkla University, Songkhla, Thailand. RATIONALE: Some caregivers who believe their children have food allergies avoid feeding certain foods to their children without proper allergy tests. Such actions, made without a proper diagnosis, can negatively impact children’s health and impose unnecessary burden on the caregivers. In this study, we hypothesized that parent-reported allergies without proper diagnosis can result in higher stress levels for the caregivers, and might deter the children’s growth. METHODS: An observational cross-sectional study was performed in 200 children aged less than five years, who have parent-reported food allergies. The caregivers’ Quality of Life (QoL) was evaluated by two questionnaires - the Food Allergy Quality of Life-Parental Burden (FAQL-PB) and the Scale of Psychosocial Factors in Food Allergy (SPS-FA). The growth of the children was evaluated by their weight-for-age and length/height-for-age percentiles. RESULTS: Among the caregivers, 50% expressed worry that their children might be allergic to some foods, and 30% were concerned about leaving their children in others’ care. According to the QoL scores, caregivers whose children underwent Oral Food Challenges (OFC) were significantly less stressed, while caregivers whose children had multiple food allergies and had experienced at least one anaphylactic reaction were significantly more stressed. Regarding the children’s growth, the distributions of both weightfor-age and length/height-for-age percentiles were normal in the 50th percentile range, showing no significant differences from the general population. CONCLUSIONS: Parent-reported food allergies could put caregivers under high stress, but the OFC test could reduce stress among anxious, over-parenting caregivers. Parent-reported food allergies did not result in the diets that deterred children’s growth.
MONDAY
831
J ALLERGY CLIN IMMUNOL VOLUME 137, NUMBER 2
Are Angiotensin Converting Enzyme Inhibitors the Main Elicitors of Tongue Angioedema?
Dasha Roa Medellin, MD, Ana Rodriguez Fernandez, MD, Sarah Micozzi, MD, Mercedes Saenz de Santa Maria, MD, Marta Seoane, MD, Marıa L. Baeza, MD, PhD; Hospital General Universitario Gregorio Mara~ n on. Department of Allergy, Madrid, Spain. RATIONALE: ACE-I has been considered main elicitor in angioedema of the tongue (AET) but its real implication is undetermined. METHODS: A retrospective-descriptive study including patients diagnosed with AET at the Emergency Department (ED) Jan-2013 to Dec-2014 at the third level Hospital was conducted. RESULTS: 300.300 Patients were attended at the ED. 513 were identified with angioedema. (Incidence 0.17%) 70 had AET. (13%) Mean age: 60 DS +/-20,07. Median 64, with no gender differences. 32 (51,52%) had recurrent episodes. In 44 patients (62,85 %) the AET was isolated, 17 (24,28%) was accompanied by facial angioedema (eye lid, lips or cheeks), 10 (14,28%) had pharyngolaryngeal involvement. 16 patients (22,85%) had breathing or swallowing difficulties and one required intubation. ACE-I were responsible for the AET in 24 patients (34,28%), other drugs were suspected in 12 (17,14%), foods 7 (10,%), unknown in 26 (37,14%) and others 1(1,42%). AETwas isolated in 54,2% of the ACE-I-induced AE, compared to the 63,2% on the rest of the patients. 47 cases were later studied at the Allergy Department. They were classified as histaminergic 21 (45,65%), no histaminergic 24 (52,17%). There were 2 cases of inflammatory edema. On the first group foods were involved in 3 (15%) and 18 (85%) were considered idiopathic. In the second group the most common cause identified was ACE-I 21(87,5%), followed by hereditary AE 2(8,33%) and idiopathic AE 1 (4.16%). CONCLUSIONS: ACE-I was the cause of a third of the AET, being responsible for 87,5% of the non-histaminergic episodes. Most of the histaminergic AET were idiopathic.
832
Skin Prick Testing Alone Is Not a Good Predictor of Allergy Symptom Severity in Grass Allergic Patients
Sameer Patel, MD, Victoria Nelson, MSc, Tara Sadoway, MSc, Peter Couroux, MD, Anne Marie Salapatek, PhD; Inflamax Research, Mississauga, ON, Canada. RATIONALE: Skin prick tests (SPT) are a useful initial diagnostic tool for assessing allergic response. The Environmental Exposure chamber (EEC) is used to expose subjects to controlled, natural levels of allergen in order to evaluate their allergic response. We wanted to determine if the SPT could predict patient’s symptom severity in the EEC. METHODS: A study involving 152 patients was analyzed to determine correlations between SPT and maximum TSS. Subjects underwent a screening visit where a panel of SPT were performed including three different grass allergen extracts (5-grass mix, Meadow fescue grass, and Rye grass and were exposed to grass pollen in the EEC at a concentration of 3500 6 500 grains/m3 for 6 hours, over 3 consecutive days. Total symptom scores (TSS) were obtained at scheduled intervals. RESULTS: Correlation analysis revealed a weak correlation between the 5-grass mix SPT and the symptom severity (r250.31). A correlation of r250.34 was identified when comparing the Meadow Fescue grass SPT to the maximum TSS. This also shows a weak correlation between the SPT and TSS. Finally, the rye grass showed the weakest correlation of r250.29 between the SPT and maximum TSS. CONCLUSIONS: This analysis demonstrates that the SPT is correlated with symptom response. The value is less than 0.5, indicating SPT alone cannot be used as a predictor of allergic response when exposed to allergen. Overall, enrolling subjects in allergic rhinitis clinical trials based on SPT alone may not be suitable and additional clinical response assessment such as EEC exposure should be done for eligibility.
833
Quality of Life in Patients Immunotherapy for Food Allergy
during
Oral
Na’ama Epstein Rigbi1, Yitzhak Katz, MD, FAAAAI1,2, Michael R. Goldberg, MD, PhD1, Michael B. Levy, MD, FAAAAI1, Liat Nachshon, MD1, Arnon Elizur, MD1,2; 1Assaf Harofeh Medical Center, Zerifin, Israel, 2Department of Pediatrics, Sackler School of Medicine, Tel Aviv, Israel. RATIONALE: Quality of life (QOL) of patients with food allergy improves following oral immunotherapy (OIT) but may be adversely affected by the treatment process itself. METHODS: Parents of children aged 4-12 years undergoing OIT for milk, peanut and egg allergies were recruited. Patient demographics and clinical histories before OIT, and their treatment course, including dose escalation rate, reactions and treatments required were recorded. The Food Allergy Quality of Life Questionnaire-Parental Form (FAQLQ-PF) was completed at the beginning and following 5 months of treatment. Patients with improved (reduction of >0.5 points), unchanged (reduction/increase of <0.5 points) and diminished (increase of >0.5 points) FAQLQ-PF scores were compared using Chi test and One-way Anova. RESULTS: Of the 108 patients recruited, 18 were excluded, either because of incomplete questionnaires (n517), or treatment failure (n51). Of the remaining 90 patients (milk; n548, peanut; n537, egg; n55), 46 were in the dose escalation phase and the remainders were in maintenance (full dose; n537, and partial dose; n57). Patients with improved (n532), unchanged (n539) and diminished (n519) total score on the FAQLQ-PF did not differ in pre-OIT clinical histories, tolerated dose at treatment initiation, course of treatment (reactions, epinephrine use, rate of dose escalation) or stage of treatment. Patients with improved FAQLQ-PF total score had a significantly diminished score at baseline (4.36) compared to those with unchanged score (3.56, p50.016) and decreased score (2.75, p<0.001). CONCLUSIONS: Patients with diminished QOL before OIT benefit significantly during treatment. Those whose QOL is minimally affected at baseline might benefit from better preparedness for OIT.
834
Impact of Parent-Reported Food Allergies on Children's Growth and Quality of Life of the Caregivers
Tanya Kajornrattana1, Pasuree Sangsupawanich, MD, PhD2, Araya Yuenyongviwat, MD3; 1Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand, 2Prince of Songkla University, Hat-yai, Thailand, 3Prince of Songkla University, Songkhla, Thailand. RATIONALE: Some caregivers who believe their children have food allergies avoid feeding certain foods to their children without proper allergy tests. Such actions, made without a proper diagnosis, can negatively impact children’s health and impose unnecessary burden on the caregivers. In this study, we hypothesized that parent-reported allergies without proper diagnosis can result in higher stress levels for the caregivers, and might deter the children’s growth. METHODS: An observational cross-sectional study was performed in 200 children aged less than five years, who have parent-reported food allergies. The caregivers’ Quality of Life (QoL) was evaluated by two questionnaires - the Food Allergy Quality of Life-Parental Burden (FAQL-PB) and the Scale of Psychosocial Factors in Food Allergy (SPS-FA). The growth of the children was evaluated by their weight-for-age and length/height-for-age percentiles. RESULTS: Among the caregivers, 50% expressed worry that their children might be allergic to some foods, and 30% were concerned about leaving their children in others’ care. According to the QoL scores, caregivers whose children underwent Oral Food Challenges (OFC) were significantly less stressed, while caregivers whose children had multiple food allergies and had experienced at least one anaphylactic reaction were significantly more stressed. Regarding the children’s growth, the distributions of both weightfor-age and length/height-for-age percentiles were normal in the 50th percentile range, showing no significant differences from the general population. CONCLUSIONS: Parent-reported food allergies could put caregivers under high stress, but the OFC test could reduce stress among anxious, over-parenting caregivers. Parent-reported food allergies did not result in the diets that deterred children’s growth.
MONDAY
831