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Dietary Advice and Accidental Exposures to Egg in Allergic Children
AB32 Abstracts
SATURDAY
121
Administration Of Influenza Vaccine To Pediatric Patients With Egg Anaphylaxis I. Fung, J. M. Spergel; Children’s Hospital of Philadelphia, Philadelphia, PA. RATIONALE: While evidence grows that most egg allergic patients can safely receive influenza vaccination, there is less known about influenza vaccination safety in patients with severe allergy to egg. We evaluated the safety of influenza vaccination in children with egg anaphylaxis. METHODS: A retrospective study was conducted on patients with egg allergy who received the influenza vaccine from 2007-2009 at our institution. Egg anaphylaxis was confirmed by chart review. We reviewed results of egg and influenza skin prick testing (SPT) and if there were any adverse reactions to influenza vaccination. RESULTS: Of 576 patients with egg allergy who received the influenza vaccine, 56 patients with history of egg anaphylaxis were found. Fortythree (77%) were male and 40 (71%) had asthma. Mean age at time of vaccination was 6 y 7mo (range: 7 mo - 13 y 9 mo). Within this group there were 120 cases of influenza vaccination. One hundred and thirteen of these vaccinations were preceded by influenza vaccine SPT of which 14 (12%) cases had wheal size of 3 mm or more. There were two reported vaccine reactions: (1) isolated hive at a non-injection site, and (2) eczema flare and local hives. Both resolved with oral antihistamine. The remaining 118 doses of influenza vaccination were tolerated without any symptoms including cutaneous or respiratory reactions. CONCLUSIONS: Influenza vaccine SPT results in a high number of false positive results. Children with egg anaphylaxis can undergo influenza vaccination without issue.
122
Parental Perceptions of Anaphylaxis in Children with Egg Allergy L. E. Howe, M. J. Greenhawt, G. Sanders; University of Michigan, ANN ARBOR, MI. RATIONALE: Accurate diagnosis of food-related anaphylaxis is important. We compared responses of parent’s perceptions of anaphylaxis to established diagnostic criteria defining anaphylaxis to assess if parents could accurately recognize anaphylaxis in their own child. METHODS: Parents of egg allergic children receiving the influenza or H1N1 vaccines at the University of Michigan Allergy and Immunology Clinic between 2009-2011 completed a questionnaire assessing symptoms of their child’s most severe reaction to egg, and rated if they felt anaphylaxis had occurred. The investigators reviewed the questionnaire, verified symptom presentation through chart review, scored for symptoms constituting anaphylaxis according to FAAN/NIAID criteria, and compared the results. RESULTS: Among 108 parents, 78% (84/108) correctly identified symptoms of anaphylaxis to egg, and 22% (24/108) of parents did not. Among those failing to correctly identify anaphylaxis, 25% (6/24) falsely believed anaphylaxis had occurred when it had not. Conversely, 75% (18/ 24) of parents with a child actually suffering an anaphylactic episode were not identified as such. Symptom patterns among those overestimating anaphylaxis included 4 with isolated skin findings, 1 with isolated GI symptoms, and 1 with a large ImmunoCAP test only. Symptoms most underestimated included 14/18 with skin/GI (77.7%), 9/18 (50%) with skin/respiratory, and 5/18 (27.8%) with 3 organ system involvement. CONCLUSIONS: Among this population of egg allergic individuals, symptoms of anaphylaxis were underestimated. These findings suggest additional educational efforts in parents are needed to improve identification of anaphylaxis, and identify risk factors that may pre-dispose misidentification.
J ALLERGY CLIN IMMUNOL FEBRUARY 2012
123
Dietary Advice and Accidental Exposures to Egg in Allergic Children C. A. Filion, L. Paradis, A. Des Roches; University of Montreal, Montreal, QC, CANADA. RATIONALE: Treatment of egg allergy relies on dietary avoidance of egg-containing foods. To our knowledge, the benefit of dietary advice by dieticians has never been clinically quantified. We hypothesized that dietary advice would be associated with a decrease in accidental exposures to egg in allergic children. METHODS: During 2009 and 2010 influenza vaccination clinics, parents of 303 egg allergic or sensitized children filled a form about occurrence and clinical management of reactions secondary to accidental exposures to egg in their child. In addition, they were asked whether they had met a dietician at the moment of diagnosis for advice on eviction diet. Logistic regression was used for analyses. Models controlled for gender, comorbidities such as asthma and atopic dermatitis, coexisting food allergies, sensitization vs. IgE-mediated allergy. RESULTS: 152/303 (50%) patients presented accidental reactions to egg allergens and 51/152 (34%) met a dietician at diagnosis. 98/151 (65%) patients who did not manifest accidental reactions received dietary advice at the moment of diagnosis. Egg-eviction diet teaching was associated with decreased odds in accidental reactions to egg in allergic children (n5303, OR 0.27, 95% CI (0.16, 0.44), p<0.0000001). No statistically significant association was found between dietary advice and the use of adrenaline, visits to a clinic or an emergency ward, or hospitalizations. CONCLUSIONS: Dietary advice by a dietician reduces reactions secondary to accidental exposures to egg in allergic children. We believe that parents of egg allergic children should systematically meet a dietician at the moment of diagnosis for advice on egg eviction from the diet.
SATURDAY
121
Administration Of Influenza Vaccine To Pediatric Patients With Egg Anaphylaxis I. Fung, J. M. Spergel; Children’s Hospital of Philadelphia, Philadelphia, PA. RATIONALE: While evidence grows that most egg allergic patients can safely receive influenza vaccination, there is less known about influenza vaccination safety in patients with severe allergy to egg. We evaluated the safety of influenza vaccination in children with egg anaphylaxis. METHODS: A retrospective study was conducted on patients with egg allergy who received the influenza vaccine from 2007-2009 at our institution. Egg anaphylaxis was confirmed by chart review. We reviewed results of egg and influenza skin prick testing (SPT) and if there were any adverse reactions to influenza vaccination. RESULTS: Of 576 patients with egg allergy who received the influenza vaccine, 56 patients with history of egg anaphylaxis were found. Fortythree (77%) were male and 40 (71%) had asthma. Mean age at time of vaccination was 6 y 7mo (range: 7 mo - 13 y 9 mo). Within this group there were 120 cases of influenza vaccination. One hundred and thirteen of these vaccinations were preceded by influenza vaccine SPT of which 14 (12%) cases had wheal size of 3 mm or more. There were two reported vaccine reactions: (1) isolated hive at a non-injection site, and (2) eczema flare and local hives. Both resolved with oral antihistamine. The remaining 118 doses of influenza vaccination were tolerated without any symptoms including cutaneous or respiratory reactions. CONCLUSIONS: Influenza vaccine SPT results in a high number of false positive results. Children with egg anaphylaxis can undergo influenza vaccination without issue.
122
Parental Perceptions of Anaphylaxis in Children with Egg Allergy L. E. Howe, M. J. Greenhawt, G. Sanders; University of Michigan, ANN ARBOR, MI. RATIONALE: Accurate diagnosis of food-related anaphylaxis is important. We compared responses of parent’s perceptions of anaphylaxis to established diagnostic criteria defining anaphylaxis to assess if parents could accurately recognize anaphylaxis in their own child. METHODS: Parents of egg allergic children receiving the influenza or H1N1 vaccines at the University of Michigan Allergy and Immunology Clinic between 2009-2011 completed a questionnaire assessing symptoms of their child’s most severe reaction to egg, and rated if they felt anaphylaxis had occurred. The investigators reviewed the questionnaire, verified symptom presentation through chart review, scored for symptoms constituting anaphylaxis according to FAAN/NIAID criteria, and compared the results. RESULTS: Among 108 parents, 78% (84/108) correctly identified symptoms of anaphylaxis to egg, and 22% (24/108) of parents did not. Among those failing to correctly identify anaphylaxis, 25% (6/24) falsely believed anaphylaxis had occurred when it had not. Conversely, 75% (18/ 24) of parents with a child actually suffering an anaphylactic episode were not identified as such. Symptom patterns among those overestimating anaphylaxis included 4 with isolated skin findings, 1 with isolated GI symptoms, and 1 with a large ImmunoCAP test only. Symptoms most underestimated included 14/18 with skin/GI (77.7%), 9/18 (50%) with skin/respiratory, and 5/18 (27.8%) with 3 organ system involvement. CONCLUSIONS: Among this population of egg allergic individuals, symptoms of anaphylaxis were underestimated. These findings suggest additional educational efforts in parents are needed to improve identification of anaphylaxis, and identify risk factors that may pre-dispose misidentification.
J ALLERGY CLIN IMMUNOL FEBRUARY 2012
123
Dietary Advice and Accidental Exposures to Egg in Allergic Children C. A. Filion, L. Paradis, A. Des Roches; University of Montreal, Montreal, QC, CANADA. RATIONALE: Treatment of egg allergy relies on dietary avoidance of egg-containing foods. To our knowledge, the benefit of dietary advice by dieticians has never been clinically quantified. We hypothesized that dietary advice would be associated with a decrease in accidental exposures to egg in allergic children. METHODS: During 2009 and 2010 influenza vaccination clinics, parents of 303 egg allergic or sensitized children filled a form about occurrence and clinical management of reactions secondary to accidental exposures to egg in their child. In addition, they were asked whether they had met a dietician at the moment of diagnosis for advice on eviction diet. Logistic regression was used for analyses. Models controlled for gender, comorbidities such as asthma and atopic dermatitis, coexisting food allergies, sensitization vs. IgE-mediated allergy. RESULTS: 152/303 (50%) patients presented accidental reactions to egg allergens and 51/152 (34%) met a dietician at diagnosis. 98/151 (65%) patients who did not manifest accidental reactions received dietary advice at the moment of diagnosis. Egg-eviction diet teaching was associated with decreased odds in accidental reactions to egg in allergic children (n5303, OR 0.27, 95% CI (0.16, 0.44), p<0.0000001). No statistically significant association was found between dietary advice and the use of adrenaline, visits to a clinic or an emergency ward, or hospitalizations. CONCLUSIONS: Dietary advice by a dietician reduces reactions secondary to accidental exposures to egg in allergic children. We believe that parents of egg allergic children should systematically meet a dietician at the moment of diagnosis for advice on egg eviction from the diet.