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Clinical Characteristics Of Seafood Allergy In Canadian Children
Abstracts AB203
J ALLERGY CLIN IMMUNOL VOLUME 133, NUMBER 2
Prevalence Of Food Allergy In Patients With Irritable Bowel Syndrome Erin L. Reigh, MD, MS1, Dr. Javed Sheikh, MD, FAAAAI2, Anna Kovalszki, MD1; 1Beth Israel Deaconess Medical Center, Boston, MA, 2Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA. RATIONALE: Patients with irritable bowel syndrome (IBS) are often referred to allergists for food allergy (FA) testing even when they lack immediate-type hypersensitivity symptoms (ITHS). The clinical utility of FA testing in this population is uncertain. We hypothesized that patients with IBS who lack ITHS have a FA rate comparable to the general population. METHODS: We performed a cross-sectional, epidemiological study by medical record review of 247 adult patients with IBS who had FA testing at Beth Israel Deaconess Medical Center. We recorded food-related symptomatic triggers, presence of ITHS, and FA testing results. Chi-square test was used for analysis. RESULTS: Patients with IBS had higher rates of positive FA testing compared to the NHANES asymptomatic general population [n593 (38%); 95% CI, 32-44% vs. 6.4%; p<0.001], and higher rates of FA compared to the general population [n545 (18%); 95% CI, 13-23% vs. 4%; p<0.001]. Of the 45 patients with FA, 41 (91%) had ITHS while only 4 (9%) had gastrointestinal symptoms attributable to FA. Milk (28%) and wheat (23%) were the most common self-reported gastrointestinal symptom triggers, but sensitization to these foods was rare (1.2% and 0.4%, respectively). CONCLUSIONS: Patients with IBS who lacked ITHS had a rate of FA that was similar to the general population, while patients with ITHS had a significantly higher rate of FA. ITHS in patients with IBS may be a useful screening tool for assessing the utility of FA testing in this population.
703
Clinical Characteristics Of Seafood Allergy In Canadian Children Dr. Victoria Cook1, Dr. Edmond S. Chan, MD, FAAAAI2, Dr. Ann Elaine Clarke, MD, MSc3, Mr. Greg Shand4, Dr. Moshe Ben-Shoshan, MD, MSc5; 1Department of Pediatrics, University of British Columbia, BC Children’s Hospital, Vancouver, BC, Canada, 2Department of Pediatrics, Faculty of Medicine, University of British Columbia, 3Division of Allergy and Clinical Immunology, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada; Division of Clinical Epidemiology, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada, 4Department of Medicine, Division of Clinical Epidemiology, McGill University Health Center, Montreal, QC, Canada, 5Division of Paediatric Allergy and Clinical Immunology, Department of Paediatrics, McGill University Health Center, Montreal, QC, Canada. RATIONALE: There is minimal data describing presentation of seafood allergy. We have characterized first reactions in seafood-allergic children. METHODS: Children with seafood allergy were recruited from allergy clinics at the Montreal Children’s Hospital from March 2011 to May 2013. Questionnaires assessed demographics, cause, location, diagnosis, severity, and management of first reaction. RESULTS: Twenty-one fish and 18 shellfish-allergic patients responded (36.2% and 51.4% response rate). Age, sex, trigger and reaction severity were comparable between respondents and non-respondents. Median age at initial reaction was 2.0 and 4.8 years respectively. Almost 60% were males. Fish and shellfish reactions typically followed ingestion [90.5%(95%CI, 68.2%,98.3%) and 94.4%(70.1%,99.7%) respectively], and occurred more commonly to cooked fish [81.0%(57.4%,93.7%)] and shellfish [81.0%(57.4%,93.7%)]. Tilapia (28.6%) and shrimp (83.3%) were the most common causative foods. Most reactions occurred at home (61.9% and 83.3%). Average age at introduction was 1.5 years for fish and 3.2 years for shellfish. Mean time to diagnosis following initial reaction was 8 months (fish) and 10 months (shellfish). Most (85%) reactions were classified as moderate to severe, yet only 21%(9.6%,39.4%) of these patients sought medical attention. At the time of questionnaire administration, all children had seen a physician, but 33.3% (15.5%,56.9%) of patients with fish allergy and 52.9% (28.5%,76.1%) of those with shellfish allergy were not prescribed an auto-injector. CONCLUSIONS: Seafood allergy presents at an early age and the most common causative foods are tilapia and shrimp. Following initial reaction,
there appears to be a delay in physician diagnosis and low rates of autoinjector prescription.
704
Changes In Total IgE Levels To Predic Food Challenge Test Outcomes Dr. Kenta Horimukai1, Dr. Masami Narita, MD, PhD2, Dr. Ichiro Nomura, MD, PhD3, Dr. Kenji Matsumoto, MD, PhD4, Dr. Yukihiro Ohya, MD, PhD5; 1Jikei University Katsushika Medical Center, Tokyo, Japan, 2National Center for Child Health and Development, Tokyo, Japan, 3 National Center for Child Health and Development, Setagayaku, Japan, 4 Department of Allergy and Immunology, National Research Institute for Child Health and Development, Tokyo, Japan, 5Division of Allergy, National Center for Child Health and Development, Tokyo, Japan. RATIONALE: Probability curves using food-specific IgE antibodies have transformed them into a more accessible tool; nevertheless, decision factors may be different for various facilities conducting Oral food challenge(OFC). This study aimed to determine whether the combination of total serum IgE and specific IgE values affected the prediction of OFC results. METHODS: Between April 2010 and February 2013, we recruited 315 patients (males, 208; females, 107; median age, 43 months; range 5 months–14 years) with suspected egg allergy who completed the open OFC test by consuming heated egg whites (total, 3.5 g), and 245 patients (males, 168; females, 77; median age, 53 months; range, 7 months–13 years) with suspected milk allergy who completed the open OFC test by consuming raw milk (total, 3.1 mL).Serum total and specific IgE antibodies levels (ovomucoid and milk) were determined by ImmunoCAP within 180 days before OFC.Binary logistic regression analyses evaluated the associations between the allergen-specific serum IgE and positive OFC results. RESULTS: Each probability curve (Ovomucoid-specific IgE, Milkspecific IgE) was compared with three total IgE concentration groups [low (<250 UA/mL), intermediate (250–750 UA/mL), and high groups _750 UA/mL)] using either ovomucoid-specific IgE or milk-specific IgE. (> Consequently, lower the total IgE levels higher the positive ratio for OFC. CONCLUSIONS: Total serum IgE levels affected the prediction of OFC results.
705
Situational and Environmental Factors Associated With a Child's Willingness To Use An Epinephrine Auto-Injector Amanda Tantleff1, Dr. Anna H. Nowak-Wegrzyn, MD, FAAAAI2; 1Byram Hills High School, 2Icahn School of Medicine at Mount Sinai, New York, NY. RATIONALE: Epinephrine is the first-line treatment for anaphylaxis. We sought to determine factors that create anxiety in children with food allergies that might lead to under-utilization of epinephrine auto-injectors and to determine if children are capable of properly administering an EpiPen and Auvi-Q. METHODS: A survey with a Likert scale was utilized to measure anxiety in various social settings, and subsequently the children were graded based on a rubric to correlate their ability to utilize an auto-injector with manufacturer-approved directions. RESULTS: A total of 109 food-allergic children, ages 7 through 17 years, who had been prescribed an epinephrine auto-injector were surveyed at the Jaffe Food Allergy Institute at Mount Sinai Hospital. There were significant differences [P<0.0001] in reported anxiety regarding whether an adult was present or absent at a familiar restaurant, unfamiliar restaurant, home, friend’s home, vacation in a foreign country, and vacation in another country where you speak the same language. The difference in comfort between being in school and in the cafeteria was significant (P <0.0001); the difference in comfort between being in a cafeteria and a nut-free cafeteria was also significant, P<0.0001. The average EpiPen score was 5 out of 8 and average Auvi-Q score was 5 out of 6 (P50.8). The majority (86.5%) preferred the Auvi-Q over EpiPen. CONCLUSIONS: Children and teenagers with food allergies are more comfortable in the presence of adults. The proficiency in auto-injector use was not different; however, the majority preferred Auvi-Q.
MONDAY
702
J ALLERGY CLIN IMMUNOL VOLUME 133, NUMBER 2
Prevalence Of Food Allergy In Patients With Irritable Bowel Syndrome Erin L. Reigh, MD, MS1, Dr. Javed Sheikh, MD, FAAAAI2, Anna Kovalszki, MD1; 1Beth Israel Deaconess Medical Center, Boston, MA, 2Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA. RATIONALE: Patients with irritable bowel syndrome (IBS) are often referred to allergists for food allergy (FA) testing even when they lack immediate-type hypersensitivity symptoms (ITHS). The clinical utility of FA testing in this population is uncertain. We hypothesized that patients with IBS who lack ITHS have a FA rate comparable to the general population. METHODS: We performed a cross-sectional, epidemiological study by medical record review of 247 adult patients with IBS who had FA testing at Beth Israel Deaconess Medical Center. We recorded food-related symptomatic triggers, presence of ITHS, and FA testing results. Chi-square test was used for analysis. RESULTS: Patients with IBS had higher rates of positive FA testing compared to the NHANES asymptomatic general population [n593 (38%); 95% CI, 32-44% vs. 6.4%; p<0.001], and higher rates of FA compared to the general population [n545 (18%); 95% CI, 13-23% vs. 4%; p<0.001]. Of the 45 patients with FA, 41 (91%) had ITHS while only 4 (9%) had gastrointestinal symptoms attributable to FA. Milk (28%) and wheat (23%) were the most common self-reported gastrointestinal symptom triggers, but sensitization to these foods was rare (1.2% and 0.4%, respectively). CONCLUSIONS: Patients with IBS who lacked ITHS had a rate of FA that was similar to the general population, while patients with ITHS had a significantly higher rate of FA. ITHS in patients with IBS may be a useful screening tool for assessing the utility of FA testing in this population.
703
Clinical Characteristics Of Seafood Allergy In Canadian Children Dr. Victoria Cook1, Dr. Edmond S. Chan, MD, FAAAAI2, Dr. Ann Elaine Clarke, MD, MSc3, Mr. Greg Shand4, Dr. Moshe Ben-Shoshan, MD, MSc5; 1Department of Pediatrics, University of British Columbia, BC Children’s Hospital, Vancouver, BC, Canada, 2Department of Pediatrics, Faculty of Medicine, University of British Columbia, 3Division of Allergy and Clinical Immunology, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada; Division of Clinical Epidemiology, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada, 4Department of Medicine, Division of Clinical Epidemiology, McGill University Health Center, Montreal, QC, Canada, 5Division of Paediatric Allergy and Clinical Immunology, Department of Paediatrics, McGill University Health Center, Montreal, QC, Canada. RATIONALE: There is minimal data describing presentation of seafood allergy. We have characterized first reactions in seafood-allergic children. METHODS: Children with seafood allergy were recruited from allergy clinics at the Montreal Children’s Hospital from March 2011 to May 2013. Questionnaires assessed demographics, cause, location, diagnosis, severity, and management of first reaction. RESULTS: Twenty-one fish and 18 shellfish-allergic patients responded (36.2% and 51.4% response rate). Age, sex, trigger and reaction severity were comparable between respondents and non-respondents. Median age at initial reaction was 2.0 and 4.8 years respectively. Almost 60% were males. Fish and shellfish reactions typically followed ingestion [90.5%(95%CI, 68.2%,98.3%) and 94.4%(70.1%,99.7%) respectively], and occurred more commonly to cooked fish [81.0%(57.4%,93.7%)] and shellfish [81.0%(57.4%,93.7%)]. Tilapia (28.6%) and shrimp (83.3%) were the most common causative foods. Most reactions occurred at home (61.9% and 83.3%). Average age at introduction was 1.5 years for fish and 3.2 years for shellfish. Mean time to diagnosis following initial reaction was 8 months (fish) and 10 months (shellfish). Most (85%) reactions were classified as moderate to severe, yet only 21%(9.6%,39.4%) of these patients sought medical attention. At the time of questionnaire administration, all children had seen a physician, but 33.3% (15.5%,56.9%) of patients with fish allergy and 52.9% (28.5%,76.1%) of those with shellfish allergy were not prescribed an auto-injector. CONCLUSIONS: Seafood allergy presents at an early age and the most common causative foods are tilapia and shrimp. Following initial reaction,
there appears to be a delay in physician diagnosis and low rates of autoinjector prescription.
704
Changes In Total IgE Levels To Predic Food Challenge Test Outcomes Dr. Kenta Horimukai1, Dr. Masami Narita, MD, PhD2, Dr. Ichiro Nomura, MD, PhD3, Dr. Kenji Matsumoto, MD, PhD4, Dr. Yukihiro Ohya, MD, PhD5; 1Jikei University Katsushika Medical Center, Tokyo, Japan, 2National Center for Child Health and Development, Tokyo, Japan, 3 National Center for Child Health and Development, Setagayaku, Japan, 4 Department of Allergy and Immunology, National Research Institute for Child Health and Development, Tokyo, Japan, 5Division of Allergy, National Center for Child Health and Development, Tokyo, Japan. RATIONALE: Probability curves using food-specific IgE antibodies have transformed them into a more accessible tool; nevertheless, decision factors may be different for various facilities conducting Oral food challenge(OFC). This study aimed to determine whether the combination of total serum IgE and specific IgE values affected the prediction of OFC results. METHODS: Between April 2010 and February 2013, we recruited 315 patients (males, 208; females, 107; median age, 43 months; range 5 months–14 years) with suspected egg allergy who completed the open OFC test by consuming heated egg whites (total, 3.5 g), and 245 patients (males, 168; females, 77; median age, 53 months; range, 7 months–13 years) with suspected milk allergy who completed the open OFC test by consuming raw milk (total, 3.1 mL).Serum total and specific IgE antibodies levels (ovomucoid and milk) were determined by ImmunoCAP within 180 days before OFC.Binary logistic regression analyses evaluated the associations between the allergen-specific serum IgE and positive OFC results. RESULTS: Each probability curve (Ovomucoid-specific IgE, Milkspecific IgE) was compared with three total IgE concentration groups [low (<250 UA/mL), intermediate (250–750 UA/mL), and high groups _750 UA/mL)] using either ovomucoid-specific IgE or milk-specific IgE. (> Consequently, lower the total IgE levels higher the positive ratio for OFC. CONCLUSIONS: Total serum IgE levels affected the prediction of OFC results.
705
Situational and Environmental Factors Associated With a Child's Willingness To Use An Epinephrine Auto-Injector Amanda Tantleff1, Dr. Anna H. Nowak-Wegrzyn, MD, FAAAAI2; 1Byram Hills High School, 2Icahn School of Medicine at Mount Sinai, New York, NY. RATIONALE: Epinephrine is the first-line treatment for anaphylaxis. We sought to determine factors that create anxiety in children with food allergies that might lead to under-utilization of epinephrine auto-injectors and to determine if children are capable of properly administering an EpiPen and Auvi-Q. METHODS: A survey with a Likert scale was utilized to measure anxiety in various social settings, and subsequently the children were graded based on a rubric to correlate their ability to utilize an auto-injector with manufacturer-approved directions. RESULTS: A total of 109 food-allergic children, ages 7 through 17 years, who had been prescribed an epinephrine auto-injector were surveyed at the Jaffe Food Allergy Institute at Mount Sinai Hospital. There were significant differences [P<0.0001] in reported anxiety regarding whether an adult was present or absent at a familiar restaurant, unfamiliar restaurant, home, friend’s home, vacation in a foreign country, and vacation in another country where you speak the same language. The difference in comfort between being in school and in the cafeteria was significant (P <0.0001); the difference in comfort between being in a cafeteria and a nut-free cafeteria was also significant, P<0.0001. The average EpiPen score was 5 out of 8 and average Auvi-Q score was 5 out of 6 (P50.8). The majority (86.5%) preferred the Auvi-Q over EpiPen. CONCLUSIONS: Children and teenagers with food allergies are more comfortable in the presence of adults. The proficiency in auto-injector use was not different; however, the majority preferred Auvi-Q.
MONDAY
702