- Email: [email protected]
Comparison of Three Independently Produced Alternaria r Alt a1
Abstracts S221
J ALLERGY CLIN IMMUNOL VOLUME 117, NUMBER 2
New Onset Vaccine Hypersensitivity in a Child after Liver Transplant P. P. Ponda1, A. Nowak-Wegrzyn2; 1Clinical Immunology, Mount Sinai Medical Center, New York, NY, 2Pediatric Allergy and Immunology, Mount Sinai Medical Center, New York, NY. RATIONALE: Approximately 10% of children develop food allergy post liver transplant. Occurrence of new allergic disease may not be limited to food hypersensitivity. METHODS: The case history of a patient who developed vaccine hypersensitivity post liver transplant is reviewed. RESULTS: The patient is a 41/2-year-old girl who underwent a liver transplant, at ten months of age, from her non-atopic mother. She was maintained on tacrolimus and prednisone for immunosuppression. Six months post-transplant, she was diagnosed with new-onset milk and soy allergy. She also experienced hives, facial erythema, and lip edema within 30 minutes after receiving DTaP and IPV vaccines at 31/2-years of age. She tolerated three DTaP and IPV vaccines pre-transplant. Prick skin and serum specific IgE testing to gelatin were negative. Following negative skin tests to IPV, she tolerated a full dose of IPV as an outpatient. Her skin test to DTaP, however, revealed a 5/21 mm wheal/flare. Due to non-protective tetanus and diphtheria IgG titers, she received a dose of DTaP via a graded dose administration in a monitored setting. She developed hives at the injection site after a dose but completed the entire protocol after receiving diphenhydramine. Two hours following the final dose, lip and eye edema and upper body scratching developed. She was treated with cetirizine and prednisone daily for three days and had no additional symptoms. CONCLUSIONS: Development of vaccine hypersensitivity is a potential complication of liver transplantation in children and can be effectively managed via a graded dose administration of the vaccine.
852
Local Reactions and Pain to Trivalent Inactivated Influenza Vaccine (TIV): Impact of Gender and Dose/Volume (DV) M. M. Klote, M. R. Nelson, R. J. M. Engler; Allergy Immunology, Walter Reed Army Medical Center, Washington, DC. RATIONALE: Vaccine acceptability may be improved by measures to reduce local reaction side effects. There is limited data on the frequency and severity of vaccine associated local reactions as related to DV or gender. METHODS: In a randomized, single-blind study, a full or half DV (15/7.5 mcg/each strain, 0.5/0.25 ml) of influenza vaccine was administered to healthy adults in the Fall of 2004. An online diary noting symptoms was completed for day 0 to 3 after vaccination. Variables assessed included any local reaction, redness, swelling, nodules, numbness, burning, arm weakness, and injection site pain (visual analog scale of 0-5). RESULTS: Diary cards were completed by 1,258 vaccinees (mean age 49, 44% women). Rates of any local reaction (p<0.001, OR 1.5), injection site pain (p<0.001, OR 1.5), redness (p=0.02), and swelling (p=0.03) were significantly less for half versus full DV. Pain severity > 2/5 for 1 or more days occurred in 56% versus 43% receiving 0.5ml versus 0.25ml (p<0.05, OR 1.3). Significant differences in gender responses (F>M) were identified: any local reaction (p<0.001, OR 2), any injection site pain (p<0.001, OR 1.9), pain > 2/5 (p<0.001, OR 2.9), burning (p=0.01), and arm weakness (p<0.001). CONCLUSIONS: The report of any local reaction, pain >2/5, and redness or swelling is significantly reduced by decreasing the standard DV by half. Women report more local reactions to vaccination than men
853
regardless of DV. More research is needed on modified vaccine dosing as well as volume of administration to reduce local reactions, particularly for women. Funding: Department of Defense Comparison of Three Independently Produced Alternaria r Alt a1 H. Sanchez, M. Opsahl, R. K. Bush; Research, William S. Middleton VA Hospital, Madison, WI. RATIONALE: Alternaria Alt a1 allergen has been identified as a major Alternaria allergen. Quantitative assays has been developed to detect Alt a1 in allergenic extracts for standardization, and environmental samples for exposure assessment and monitoring the efficacy of avoidance measures. These assays are critical in the understanding of Alternaria sensitivity. METHODS: In this study we sought to compare the monoclonal antibody and Human IgE binding profile to three independently produced recombinant Alt a1. rAlt a1 was secured from three different sources, Bial-Aristegui, Spain, Indoor Biotechnologies, VA, USA, and our own laboratory. The material was quantitated and an equal amount of rAlt a1 was Electrophoresed in a 15 % SDS-PAGE, then transferred onto PVDF membrane. RESULTS: A murine monoclonal antibody was used to probe the membrane for binding to rAlt a1. We also probed with IgE from pooled sera from 15 Alternaria sensitive individuals. Both blots showed antibody binding to Alt a1 but at different intensities. CONCLUSIONS: We concluded that the manner in which r Alt a1 is produced and purified may affect its biological activity. Funding: US Department of Veterans Affairs
854
Real Time Monitoring of IgE Sensitization (ReTiME): A New Module of the Allergome Platform for Web-based Studies A. Mari1, E. Scala2, G. Carabella3; 1Allergy Data Laboratories, s.c., Latina, ITALY, 2Experimental Allergology Unit, IDI-IRCCS, Rome, ITALY, 3Panservice, SAS, Latina, ITALY. RATIONALE: The Allergome database (http://www.allergome.org/) has been created to acquire and store the current knowledge on allergenic molecules. Software has been developed using World Wide Web tools. It is now active since year 2003 and contains info and data on 1473 allergens including isoforms. It also contain 1013 monographs describing allergenic sources. The aim of this study is to transform a documentary database in an active tool for allergy research, using information technology resources. METHODS: A database and software for on line data uploading has been created. Data from allergic sensitization studies produced during routine allergy testing with current or novel diagnostic methods have been used to feed the database. RESULTS: On the basis of the Allergome list of allergens we defined the selection criteria to feed the ReTiME module. The ReTiME database allows contributors to supply de-identified information from allergic patients, including demographics and clinical data. Data can be uploaded by single contributors or by networked centers under the form of research projects. Different levels of contribution are allowed. The search engine is allergen-centered and allows retrieving data using several parameters. Search results can be refined, and geographical distribution of the data can be obtained. Data are presented in tables, graphs, and maps. CONCLUSIONS: The ReTiME module of the Allergome platform seems to be a promising new way to perform studies aiming to define allergen sensitization on a global basis. The ReTiME module will be far more powerful if fed by automatic laboratory systems and by using advanced molecule- and microarray-based diagnostic systems.
855
MONDAY
SQ-T administrated as once daily self-medication prior to and during the grass pollen season. Funding: ALK-Abelló
J ALLERGY CLIN IMMUNOL VOLUME 117, NUMBER 2
New Onset Vaccine Hypersensitivity in a Child after Liver Transplant P. P. Ponda1, A. Nowak-Wegrzyn2; 1Clinical Immunology, Mount Sinai Medical Center, New York, NY, 2Pediatric Allergy and Immunology, Mount Sinai Medical Center, New York, NY. RATIONALE: Approximately 10% of children develop food allergy post liver transplant. Occurrence of new allergic disease may not be limited to food hypersensitivity. METHODS: The case history of a patient who developed vaccine hypersensitivity post liver transplant is reviewed. RESULTS: The patient is a 41/2-year-old girl who underwent a liver transplant, at ten months of age, from her non-atopic mother. She was maintained on tacrolimus and prednisone for immunosuppression. Six months post-transplant, she was diagnosed with new-onset milk and soy allergy. She also experienced hives, facial erythema, and lip edema within 30 minutes after receiving DTaP and IPV vaccines at 31/2-years of age. She tolerated three DTaP and IPV vaccines pre-transplant. Prick skin and serum specific IgE testing to gelatin were negative. Following negative skin tests to IPV, she tolerated a full dose of IPV as an outpatient. Her skin test to DTaP, however, revealed a 5/21 mm wheal/flare. Due to non-protective tetanus and diphtheria IgG titers, she received a dose of DTaP via a graded dose administration in a monitored setting. She developed hives at the injection site after a dose but completed the entire protocol after receiving diphenhydramine. Two hours following the final dose, lip and eye edema and upper body scratching developed. She was treated with cetirizine and prednisone daily for three days and had no additional symptoms. CONCLUSIONS: Development of vaccine hypersensitivity is a potential complication of liver transplantation in children and can be effectively managed via a graded dose administration of the vaccine.
852
Local Reactions and Pain to Trivalent Inactivated Influenza Vaccine (TIV): Impact of Gender and Dose/Volume (DV) M. M. Klote, M. R. Nelson, R. J. M. Engler; Allergy Immunology, Walter Reed Army Medical Center, Washington, DC. RATIONALE: Vaccine acceptability may be improved by measures to reduce local reaction side effects. There is limited data on the frequency and severity of vaccine associated local reactions as related to DV or gender. METHODS: In a randomized, single-blind study, a full or half DV (15/7.5 mcg/each strain, 0.5/0.25 ml) of influenza vaccine was administered to healthy adults in the Fall of 2004. An online diary noting symptoms was completed for day 0 to 3 after vaccination. Variables assessed included any local reaction, redness, swelling, nodules, numbness, burning, arm weakness, and injection site pain (visual analog scale of 0-5). RESULTS: Diary cards were completed by 1,258 vaccinees (mean age 49, 44% women). Rates of any local reaction (p<0.001, OR 1.5), injection site pain (p<0.001, OR 1.5), redness (p=0.02), and swelling (p=0.03) were significantly less for half versus full DV. Pain severity > 2/5 for 1 or more days occurred in 56% versus 43% receiving 0.5ml versus 0.25ml (p<0.05, OR 1.3). Significant differences in gender responses (F>M) were identified: any local reaction (p<0.001, OR 2), any injection site pain (p<0.001, OR 1.9), pain > 2/5 (p<0.001, OR 2.9), burning (p=0.01), and arm weakness (p<0.001). CONCLUSIONS: The report of any local reaction, pain >2/5, and redness or swelling is significantly reduced by decreasing the standard DV by half. Women report more local reactions to vaccination than men
853
regardless of DV. More research is needed on modified vaccine dosing as well as volume of administration to reduce local reactions, particularly for women. Funding: Department of Defense Comparison of Three Independently Produced Alternaria r Alt a1 H. Sanchez, M. Opsahl, R. K. Bush; Research, William S. Middleton VA Hospital, Madison, WI. RATIONALE: Alternaria Alt a1 allergen has been identified as a major Alternaria allergen. Quantitative assays has been developed to detect Alt a1 in allergenic extracts for standardization, and environmental samples for exposure assessment and monitoring the efficacy of avoidance measures. These assays are critical in the understanding of Alternaria sensitivity. METHODS: In this study we sought to compare the monoclonal antibody and Human IgE binding profile to three independently produced recombinant Alt a1. rAlt a1 was secured from three different sources, Bial-Aristegui, Spain, Indoor Biotechnologies, VA, USA, and our own laboratory. The material was quantitated and an equal amount of rAlt a1 was Electrophoresed in a 15 % SDS-PAGE, then transferred onto PVDF membrane. RESULTS: A murine monoclonal antibody was used to probe the membrane for binding to rAlt a1. We also probed with IgE from pooled sera from 15 Alternaria sensitive individuals. Both blots showed antibody binding to Alt a1 but at different intensities. CONCLUSIONS: We concluded that the manner in which r Alt a1 is produced and purified may affect its biological activity. Funding: US Department of Veterans Affairs
854
Real Time Monitoring of IgE Sensitization (ReTiME): A New Module of the Allergome Platform for Web-based Studies A. Mari1, E. Scala2, G. Carabella3; 1Allergy Data Laboratories, s.c., Latina, ITALY, 2Experimental Allergology Unit, IDI-IRCCS, Rome, ITALY, 3Panservice, SAS, Latina, ITALY. RATIONALE: The Allergome database (http://www.allergome.org/) has been created to acquire and store the current knowledge on allergenic molecules. Software has been developed using World Wide Web tools. It is now active since year 2003 and contains info and data on 1473 allergens including isoforms. It also contain 1013 monographs describing allergenic sources. The aim of this study is to transform a documentary database in an active tool for allergy research, using information technology resources. METHODS: A database and software for on line data uploading has been created. Data from allergic sensitization studies produced during routine allergy testing with current or novel diagnostic methods have been used to feed the database. RESULTS: On the basis of the Allergome list of allergens we defined the selection criteria to feed the ReTiME module. The ReTiME database allows contributors to supply de-identified information from allergic patients, including demographics and clinical data. Data can be uploaded by single contributors or by networked centers under the form of research projects. Different levels of contribution are allowed. The search engine is allergen-centered and allows retrieving data using several parameters. Search results can be refined, and geographical distribution of the data can be obtained. Data are presented in tables, graphs, and maps. CONCLUSIONS: The ReTiME module of the Allergome platform seems to be a promising new way to perform studies aiming to define allergen sensitization on a global basis. The ReTiME module will be far more powerful if fed by automatic laboratory systems and by using advanced molecule- and microarray-based diagnostic systems.
855
MONDAY
SQ-T administrated as once daily self-medication prior to and during the grass pollen season. Funding: ALK-Abelló