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Comparison between Allergists and Non-allergists on Issues Related to Food-induced Anaphylaxis
Abstracts AB183
J ALLERGY CLIN IMMUNOL VOLUME 129, NUMBER 2
Food-dependent Exercise-induced Anaphylaxis (fdeia) And Sensitization To Omega-5-gliadin D. Guillen1, C. Gomez-Traseira1, R. Cabanas1, N. Prior1, S. Quirce1,2, T. Caballero1; 1Hospital Universitario La Paz, Madrid, SPAIN, 2Spanish network of centers for biomedical research on respiratory diseases (CibeRes), Madrid, SPAIN. RATIONALE: Description of an adult patient case series with fooddependent exercise-induced anaphylaxis (FDEIA) and sensitization to gluten. METHODS: Patients older than 14 years old with FDEIA and the detection of IgE antibodies to gluten and/or omega-5-gliadin by ImmunoCAP and/or Microarrays-ISAC (Phadia, Uppsala, Sweden) were included. Demographic, clinical and laboratory data were collected. RESULTS: Seven patients, 5 male and 2 female, with a mean age of 48.7 years and positive specific IgE to omega-gliadin were included. There was no clear food involved in the reaction after detailed anamnesis at first visit. The reason for consultation was FDEIA in 6 patient and postprandial exercise-induced urticaria in 1 patient. The geometric mean of total IgE was 174.23 UI/mL. The geometric mean of specific IgE (kU/L) was 6.76 to omega- 5-gliadin, 2.99 to gluten and 0.9 to wheat. The measurements of IgE to gluten and wheat were positive in 86% and 57% of cases respectively. Alcohol consumption was involved as trigger factor in 1 patient and NSAIDs in 6 patients. We confirmed tolerance to the NSAID involved in the reaction in 5 patients, and only to selective type 2 ciclooxygenase inhibitors in 1 patient. CONCLUSIONS: The detection of specific IgE to wheat and gluten has lower sensitivity than specific IgE antibodies to omega-5-gliadin for the diagnosis of FDEIA. NSAIDs can provoke the symptoms in combination with food intake, even without exercise and no proven sensitivity to these drugs.
694
From 2000-2008, Statewide Hospital Admission Rates for Allergic Reaction Increased More Rapidly in the Northeast United States When Compared to Other Regions of the United States R. C. Van Winkle1,2, J. Hossain1, C. C. Chang1,2, S. J. McGeady1,2; 1A.I. duPont Hospital for Children, Wilmington, DE, 2Thomas Jefferson University, Philadelphia, PA. RATIONALE: Previous studies have identified geographic differences in EpiPen prescriptions, incidence of pediatric anaphylaxis, and ED visits for allergic reactions. This study compares statewide hospital admission rates for allergic reactions in specific geographic regions of the United States (US) between 2000 and 2008. METHODS: Hospital discharges reported by the 2000-2008 Healthcare Cost and Utilization Project (HCUP) were reviewed for numbers of discharges with ‘‘allergic reaction’’ as the principal diagnosis by state. Census Bureau data provided geographic regions and state population. Hospitalization rates were calculated by ‘‘allergic reaction’’ discharge numbers divided by state population and combined into geographic regions. A mixed effect model (SAS software, version 9.2) was used to provide statistical analysis. RESULTS: From 2000-2008, admission rates in the Northeast significantly increased (p50.0003) but admission rates for the South, Midwest and West did not. Compared with other regions, the trend for ‘‘allergic reaction’’ discharge rates in the Northeast was significantly greater (p<0.05). CONCLUSIONS: Discharge rates for ‘‘allergic reactions’’ increased dramatically in the Northeast US between 2000 and 2008, but remained stable in other regions. Possible explanations for these differences include physician coding practices, environmental changes, demographic shifts and climate variations.
695
Comparison between Allergists and Non-allergists on Issues Related to Food-induced Anaphylaxis M. Desjardins1, A. Clarke2, R. Alizadehfar1, D. Grenier3, H. Eisman4, S. Carr5, T. Vander Leek5, L. Teperman6, N. Higgins7, L. Joseph8, G. Shand7, M. Ben-Shoshan1; 1Division of Peadiatric Allergy and Clinical Immunology, Department of Peadiatrics, McGill University Health Center, Montreal, QC, CANADA, 2Division of Allergy and Clinical Immunology & Division of Clinical Epidemiology, Department of Medicine, McGill University Health Center, Montreal, QC, CANADA, 3Canadian Peadiatric Society, Ottawa, ON, CANADA, 4Montreal Children’s Hospital, Emergency Department, McGill University Health Center, Montreal, QC, CANADA, 5 Division of Peadiatric Allergy and Clinical Immunology, Department of Peadiatrics, University of Alberta, Edmonton, AB, CANADA, 6Society of Rural Physician of Canada, Shawville, QC, CANADA, 7Department of Epidemiology, McGill University Health Center, Montreal, QC, CANADA, 8Department of Epidemiology and Biostatistics, McGill University, Montreal, QC, CANADA. RATIONALE: To compare the opinions of Canadian allergists and nonallergists on issues related to food-induced anaphylaxis. METHODS: We recruited Canadian allergists, paediatricians, general practitioners(GP), and emergency room physicians(ERP) through medical associations and through the Canadian Paediatric Surveillance Program. We compared responses to surveyed questions. Multivariate-logisticregression models were used to identify predictors of specific responses. RESULTS: One hundred and fourteen allergists and 613 non-allergists participated. Allergists were less likely to recommend delayed introduction of egg white to 1-3 years in children with and without family history of atopy (difference (d)5-17.10%, 95% CI, -28.20, -5.91%) and (-26.20%, -36.00%, -16.50%), respectively). Among allergists 51.51% indicated that patients with egg allergy can receive MMR vaccine safely in a community facility vs. 21.19% of non-allergists (d530.32%, 19.26%, 41.38%). Allergists were less likely to recommend avoidance of influenza vaccine in those with egg allergy (d5-18.86%, -26.17%, -11.54%) and more likely to recommend IM epinephrine use (d523.13%, 15.91%, 30.35%) for anaphylaxis. Regarding issues for which no clear guidelines exist, allergists were less likely to give epinephrine for isolated cutaneous reactions (d5-8.47%, -14.23%, -2.71%). Surprisingly, 26% of allergists and 27% of non-allergists would not give epinephrine for patients presenting with breathing difficulties. Among non-allergists, paediatricians (OR515.086, 1.565, 145.443) and ERP (OR51.975, 1.146, 3.406) were more likely to recommend delayed egg introduction and ERP (OR51.98, 1.00, 3.93) were more likely to administer epinephrine for respiratory symptoms. CONCLUSIONS: For non-controversial issues, a greater proportion of allergists adhere to current guidelines; however, over 25% of physicians would still not administer epinephrine for severe anaphylaxis.
MONDAY
693
J ALLERGY CLIN IMMUNOL VOLUME 129, NUMBER 2
Food-dependent Exercise-induced Anaphylaxis (fdeia) And Sensitization To Omega-5-gliadin D. Guillen1, C. Gomez-Traseira1, R. Cabanas1, N. Prior1, S. Quirce1,2, T. Caballero1; 1Hospital Universitario La Paz, Madrid, SPAIN, 2Spanish network of centers for biomedical research on respiratory diseases (CibeRes), Madrid, SPAIN. RATIONALE: Description of an adult patient case series with fooddependent exercise-induced anaphylaxis (FDEIA) and sensitization to gluten. METHODS: Patients older than 14 years old with FDEIA and the detection of IgE antibodies to gluten and/or omega-5-gliadin by ImmunoCAP and/or Microarrays-ISAC (Phadia, Uppsala, Sweden) were included. Demographic, clinical and laboratory data were collected. RESULTS: Seven patients, 5 male and 2 female, with a mean age of 48.7 years and positive specific IgE to omega-gliadin were included. There was no clear food involved in the reaction after detailed anamnesis at first visit. The reason for consultation was FDEIA in 6 patient and postprandial exercise-induced urticaria in 1 patient. The geometric mean of total IgE was 174.23 UI/mL. The geometric mean of specific IgE (kU/L) was 6.76 to omega- 5-gliadin, 2.99 to gluten and 0.9 to wheat. The measurements of IgE to gluten and wheat were positive in 86% and 57% of cases respectively. Alcohol consumption was involved as trigger factor in 1 patient and NSAIDs in 6 patients. We confirmed tolerance to the NSAID involved in the reaction in 5 patients, and only to selective type 2 ciclooxygenase inhibitors in 1 patient. CONCLUSIONS: The detection of specific IgE to wheat and gluten has lower sensitivity than specific IgE antibodies to omega-5-gliadin for the diagnosis of FDEIA. NSAIDs can provoke the symptoms in combination with food intake, even without exercise and no proven sensitivity to these drugs.
694
From 2000-2008, Statewide Hospital Admission Rates for Allergic Reaction Increased More Rapidly in the Northeast United States When Compared to Other Regions of the United States R. C. Van Winkle1,2, J. Hossain1, C. C. Chang1,2, S. J. McGeady1,2; 1A.I. duPont Hospital for Children, Wilmington, DE, 2Thomas Jefferson University, Philadelphia, PA. RATIONALE: Previous studies have identified geographic differences in EpiPen prescriptions, incidence of pediatric anaphylaxis, and ED visits for allergic reactions. This study compares statewide hospital admission rates for allergic reactions in specific geographic regions of the United States (US) between 2000 and 2008. METHODS: Hospital discharges reported by the 2000-2008 Healthcare Cost and Utilization Project (HCUP) were reviewed for numbers of discharges with ‘‘allergic reaction’’ as the principal diagnosis by state. Census Bureau data provided geographic regions and state population. Hospitalization rates were calculated by ‘‘allergic reaction’’ discharge numbers divided by state population and combined into geographic regions. A mixed effect model (SAS software, version 9.2) was used to provide statistical analysis. RESULTS: From 2000-2008, admission rates in the Northeast significantly increased (p50.0003) but admission rates for the South, Midwest and West did not. Compared with other regions, the trend for ‘‘allergic reaction’’ discharge rates in the Northeast was significantly greater (p<0.05). CONCLUSIONS: Discharge rates for ‘‘allergic reactions’’ increased dramatically in the Northeast US between 2000 and 2008, but remained stable in other regions. Possible explanations for these differences include physician coding practices, environmental changes, demographic shifts and climate variations.
695
Comparison between Allergists and Non-allergists on Issues Related to Food-induced Anaphylaxis M. Desjardins1, A. Clarke2, R. Alizadehfar1, D. Grenier3, H. Eisman4, S. Carr5, T. Vander Leek5, L. Teperman6, N. Higgins7, L. Joseph8, G. Shand7, M. Ben-Shoshan1; 1Division of Peadiatric Allergy and Clinical Immunology, Department of Peadiatrics, McGill University Health Center, Montreal, QC, CANADA, 2Division of Allergy and Clinical Immunology & Division of Clinical Epidemiology, Department of Medicine, McGill University Health Center, Montreal, QC, CANADA, 3Canadian Peadiatric Society, Ottawa, ON, CANADA, 4Montreal Children’s Hospital, Emergency Department, McGill University Health Center, Montreal, QC, CANADA, 5 Division of Peadiatric Allergy and Clinical Immunology, Department of Peadiatrics, University of Alberta, Edmonton, AB, CANADA, 6Society of Rural Physician of Canada, Shawville, QC, CANADA, 7Department of Epidemiology, McGill University Health Center, Montreal, QC, CANADA, 8Department of Epidemiology and Biostatistics, McGill University, Montreal, QC, CANADA. RATIONALE: To compare the opinions of Canadian allergists and nonallergists on issues related to food-induced anaphylaxis. METHODS: We recruited Canadian allergists, paediatricians, general practitioners(GP), and emergency room physicians(ERP) through medical associations and through the Canadian Paediatric Surveillance Program. We compared responses to surveyed questions. Multivariate-logisticregression models were used to identify predictors of specific responses. RESULTS: One hundred and fourteen allergists and 613 non-allergists participated. Allergists were less likely to recommend delayed introduction of egg white to 1-3 years in children with and without family history of atopy (difference (d)5-17.10%, 95% CI, -28.20, -5.91%) and (-26.20%, -36.00%, -16.50%), respectively). Among allergists 51.51% indicated that patients with egg allergy can receive MMR vaccine safely in a community facility vs. 21.19% of non-allergists (d530.32%, 19.26%, 41.38%). Allergists were less likely to recommend avoidance of influenza vaccine in those with egg allergy (d5-18.86%, -26.17%, -11.54%) and more likely to recommend IM epinephrine use (d523.13%, 15.91%, 30.35%) for anaphylaxis. Regarding issues for which no clear guidelines exist, allergists were less likely to give epinephrine for isolated cutaneous reactions (d5-8.47%, -14.23%, -2.71%). Surprisingly, 26% of allergists and 27% of non-allergists would not give epinephrine for patients presenting with breathing difficulties. Among non-allergists, paediatricians (OR515.086, 1.565, 145.443) and ERP (OR51.975, 1.146, 3.406) were more likely to recommend delayed egg introduction and ERP (OR51.98, 1.00, 3.93) were more likely to administer epinephrine for respiratory symptoms. CONCLUSIONS: For non-controversial issues, a greater proportion of allergists adhere to current guidelines; however, over 25% of physicians would still not administer epinephrine for severe anaphylaxis.
MONDAY
693