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Do Peanut Oral Food Challenges Produce More Stress? Self-reported Anxiety Measurement Of Food Allergic Children And Their Parents Prior To Oral Food Challenges
AB76 Abstracts
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Cross-linking FceRI Alters Interferon Responses to Rhinovirus Infection S. R. Durrani1, D. J. Montville1, V. Rajamanickam1, N. C. Levinsky1, C. J. Tisler1, R. E. Gangnon1, M. A. Gill2, D. J. Jackson1; 1University of Wisconsin School of Medicine and Public Health, Madison, WI, 2 University of Texas Southwestern Medical Center at Dallas and Children’s Medical Center, Dallas, TX. RATIONALE: Interferons (IFN) are thought to play an important role in host susceptibility to respiratory illnesses. Allergic sensitization has been associated with decreased interferons (a and l) and more pronounced reductions in FEV1 during asthma exacerbations caused by rhinovirus (HRV). Therefore, a series of experiments were performed to determine if IgE cross-linking of FceRI, the high-affinity IgE receptor, in peripheral blood mononuclear cells (PBMCs) affects important virus-induced interferon responses. METHODS: Peripheral blood samples were obtained from 16 subjects enrolled in the Childhood Origins of ASThma (COAST) project. PBMCs were separated by Ficoll density gradient centrifugation. PBMCs were pretreated with or without rabbit anti-human IgE (1 mg/ml; Bethyl Laboratories, Montgomery, TX) for 2 hours and then stimulated for 24 hours with HRV. Supernatants were obtained and IFN-g, -a, and -l measured by multiplex assay (LuminexÒ). RESULTS: Compared to controls (no anti-IgE pretreatment), anti-IgE pretreatment of PBMCs resulted in significantly decreased HRV-induced IFN-a (2367 vs. 1373 pg/ml, p 5 0.0005) and IFN-l (398 vs. 79 pg/ml, p < 0.0001) responses. In contrast, compared to controls, anti-IgE pretreatment significantly increased HRV-induced interferon-g (512 vs. 3327 pg/ ml, p 5 0.003) responses. CONCLUSIONS: Using anti-IgE, as a surrogate for allergens, to crosslink FceRI in PBMCs leads to differential effects on RV-induced interferon responses that may have important clinical implications. Reductions in interferon-a and interferon-l may increase severity of viral illnesses, while increases in interferon-g may lead to increased virus-induced inflammation. These findings suggest a potential mechanism leading to increased severity of viral respiratory illnesses in allergic individuals.
285
Evaluation of Itching Alleviating Strategies after Skin Testing: Single Blind Placebo-Controlled Randomized Study S. M. Stewart1, E. Yousef1,2, S. Strader1, S. J. McGeady1,2, J. Boscher1, J. Hossain1, A. Haque1,2, D. Schuster1, K. Gorny1; 1Division of Allergy/Immunology, Alfred I. duPont Hospital for Children, Nemours Children’s Clinic, Wilmington, DE, 2Thomas Jefferson University, Philadelphia, PA. RATIONALE: To evaluate common practices for itch relief following percutaneous allergy skin test in children and determine the most effective. METHODS: Subjects were 146 patients, ages 5-18, with >3 positive skin test (wheal > 3mm larger than negative control) of percutaneous prick testing. Subjects were randomly assigned to one of six groups: hydrocortisone cream 2.5%, hydrocortisone cream 1%, eucerin cream, ice application, tap water application and no intervention. Utilizing an analog scale of 1-100, baseline itch intensity ratings were obtained, as skin tests were interpreted. Interventions were then applied and further ratings obtained at 5 and 15 minutes respectively. RESULTS: The mean itch severity reduction between the individual interventions was highly significant at 5 and 15 minutes (P<0.001). Mean reduction of analog scale points and significance of each intervention, versus baseline in order of efficacy are: ice application at 5 min 37.4pts, P<0.05; 15 min 49.7pts, P<0.05; hydrocortisone cream 2.5% at 5min 29.5pts, P<0.05; 15 min 42.3pts, P<0.05; hydrocortisone cream 1% at 5 min 28.3pts, P<0.05; 15min 40.7pts, P<0.05; tap water at 5min 26.4pts, P<0.05; 15min 41.9pts, <0.05; Eucerin at 5min 18.7pts, P<0.05;15min 26.9pts, P<0.05; no intervention at 5 min 18.2pts, P<0.05; at 15min 29.7, P<0.05. CONCLUSION: The application of ice in the immediate period following percutaneous skin testing appears to be the most effective form of itch relief, followed by hydrocortisone creams and tap water. All interventions in this study, including none, had significant reductions of itch versus baseline at 5 and 15 minutes.
J ALLERGY CLIN IMMUNOL FEBRUARY 2011
286
Do Peanut Oral Food Challenges Produce More Stress? Selfreported Anxiety Measurement Of Food Allergic Children And Their Parents Prior To Oral Food Challenges M. Paterakis1, K. Mudd1, T. Holbrook1, G. Page2, D. Gross2, R. Wood1; 1 Johns Hopkins University, Baltimore, MD, 2Johns Hopkins University School of Nursing, Baltimore, MD. RATIONALE: Families and patients undergoing Oral Food Challenges (OFCs) experience stress and anxiety. This study seeks to measure that anxiety and compare the anxiety of peanut challenges to other foods. METHODS: Children (ages 6-12) and an accompanying parent were consented and completed an age appropriate 20-item anxiety measurement questionnaire (State Trait Anxiety Inventory) during a scheduled OFC clinic visit. Parental scores ranged between 20 and 80 and children’s scores ranged from 20 to 60. Questionnaires were also completed 5 days later in the participants’ home. Scores pre-OFC and post-OFC, as well as between peanut and non-peanut challenges, were compared. RESULTS: Data was collected on 22 OFCs (10 peanut, 12 non-peanut). Parental anxiety pre-OFC (mean 36.6, range 20-64) was higher than post-OFC (mean 27.7, range 20-41, p<0.001). Children also reported higher anxiety pre-OFC (mean 33.1, range 22-54) than post-OFC (mean 28.0, range 20-52, p<0.001). There was a trend toward increased anxiety among parents of children undergoing peanut challenges on the day of the OFC (mean 41.9, range 20-63) compared to those undergoing OFCs to other foods (mean 32.2, range 22-48, p50.0675). Children undergoing peanut and non-peanut challenges reported similar anxiety on the day of OFC (mean 32.9 vs. 33.3). Post OFC, parents and children undergoing peanut challenges children had similar self-reported anxiety to those challenged to other foods. CONCLUSIONS: Parents and children self report higher levels of anxiety on the day of the OFC. Parents of children undergoing peanut challenges had slightly higher levels of anxiety on OFC days than those for other foods.
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Cross-linking FceRI Alters Interferon Responses to Rhinovirus Infection S. R. Durrani1, D. J. Montville1, V. Rajamanickam1, N. C. Levinsky1, C. J. Tisler1, R. E. Gangnon1, M. A. Gill2, D. J. Jackson1; 1University of Wisconsin School of Medicine and Public Health, Madison, WI, 2 University of Texas Southwestern Medical Center at Dallas and Children’s Medical Center, Dallas, TX. RATIONALE: Interferons (IFN) are thought to play an important role in host susceptibility to respiratory illnesses. Allergic sensitization has been associated with decreased interferons (a and l) and more pronounced reductions in FEV1 during asthma exacerbations caused by rhinovirus (HRV). Therefore, a series of experiments were performed to determine if IgE cross-linking of FceRI, the high-affinity IgE receptor, in peripheral blood mononuclear cells (PBMCs) affects important virus-induced interferon responses. METHODS: Peripheral blood samples were obtained from 16 subjects enrolled in the Childhood Origins of ASThma (COAST) project. PBMCs were separated by Ficoll density gradient centrifugation. PBMCs were pretreated with or without rabbit anti-human IgE (1 mg/ml; Bethyl Laboratories, Montgomery, TX) for 2 hours and then stimulated for 24 hours with HRV. Supernatants were obtained and IFN-g, -a, and -l measured by multiplex assay (LuminexÒ). RESULTS: Compared to controls (no anti-IgE pretreatment), anti-IgE pretreatment of PBMCs resulted in significantly decreased HRV-induced IFN-a (2367 vs. 1373 pg/ml, p 5 0.0005) and IFN-l (398 vs. 79 pg/ml, p < 0.0001) responses. In contrast, compared to controls, anti-IgE pretreatment significantly increased HRV-induced interferon-g (512 vs. 3327 pg/ ml, p 5 0.003) responses. CONCLUSIONS: Using anti-IgE, as a surrogate for allergens, to crosslink FceRI in PBMCs leads to differential effects on RV-induced interferon responses that may have important clinical implications. Reductions in interferon-a and interferon-l may increase severity of viral illnesses, while increases in interferon-g may lead to increased virus-induced inflammation. These findings suggest a potential mechanism leading to increased severity of viral respiratory illnesses in allergic individuals.
285
Evaluation of Itching Alleviating Strategies after Skin Testing: Single Blind Placebo-Controlled Randomized Study S. M. Stewart1, E. Yousef1,2, S. Strader1, S. J. McGeady1,2, J. Boscher1, J. Hossain1, A. Haque1,2, D. Schuster1, K. Gorny1; 1Division of Allergy/Immunology, Alfred I. duPont Hospital for Children, Nemours Children’s Clinic, Wilmington, DE, 2Thomas Jefferson University, Philadelphia, PA. RATIONALE: To evaluate common practices for itch relief following percutaneous allergy skin test in children and determine the most effective. METHODS: Subjects were 146 patients, ages 5-18, with >3 positive skin test (wheal > 3mm larger than negative control) of percutaneous prick testing. Subjects were randomly assigned to one of six groups: hydrocortisone cream 2.5%, hydrocortisone cream 1%, eucerin cream, ice application, tap water application and no intervention. Utilizing an analog scale of 1-100, baseline itch intensity ratings were obtained, as skin tests were interpreted. Interventions were then applied and further ratings obtained at 5 and 15 minutes respectively. RESULTS: The mean itch severity reduction between the individual interventions was highly significant at 5 and 15 minutes (P<0.001). Mean reduction of analog scale points and significance of each intervention, versus baseline in order of efficacy are: ice application at 5 min 37.4pts, P<0.05; 15 min 49.7pts, P<0.05; hydrocortisone cream 2.5% at 5min 29.5pts, P<0.05; 15 min 42.3pts, P<0.05; hydrocortisone cream 1% at 5 min 28.3pts, P<0.05; 15min 40.7pts, P<0.05; tap water at 5min 26.4pts, P<0.05; 15min 41.9pts, <0.05; Eucerin at 5min 18.7pts, P<0.05;15min 26.9pts, P<0.05; no intervention at 5 min 18.2pts, P<0.05; at 15min 29.7, P<0.05. CONCLUSION: The application of ice in the immediate period following percutaneous skin testing appears to be the most effective form of itch relief, followed by hydrocortisone creams and tap water. All interventions in this study, including none, had significant reductions of itch versus baseline at 5 and 15 minutes.
J ALLERGY CLIN IMMUNOL FEBRUARY 2011
286
Do Peanut Oral Food Challenges Produce More Stress? Selfreported Anxiety Measurement Of Food Allergic Children And Their Parents Prior To Oral Food Challenges M. Paterakis1, K. Mudd1, T. Holbrook1, G. Page2, D. Gross2, R. Wood1; 1 Johns Hopkins University, Baltimore, MD, 2Johns Hopkins University School of Nursing, Baltimore, MD. RATIONALE: Families and patients undergoing Oral Food Challenges (OFCs) experience stress and anxiety. This study seeks to measure that anxiety and compare the anxiety of peanut challenges to other foods. METHODS: Children (ages 6-12) and an accompanying parent were consented and completed an age appropriate 20-item anxiety measurement questionnaire (State Trait Anxiety Inventory) during a scheduled OFC clinic visit. Parental scores ranged between 20 and 80 and children’s scores ranged from 20 to 60. Questionnaires were also completed 5 days later in the participants’ home. Scores pre-OFC and post-OFC, as well as between peanut and non-peanut challenges, were compared. RESULTS: Data was collected on 22 OFCs (10 peanut, 12 non-peanut). Parental anxiety pre-OFC (mean 36.6, range 20-64) was higher than post-OFC (mean 27.7, range 20-41, p<0.001). Children also reported higher anxiety pre-OFC (mean 33.1, range 22-54) than post-OFC (mean 28.0, range 20-52, p<0.001). There was a trend toward increased anxiety among parents of children undergoing peanut challenges on the day of the OFC (mean 41.9, range 20-63) compared to those undergoing OFCs to other foods (mean 32.2, range 22-48, p50.0675). Children undergoing peanut and non-peanut challenges reported similar anxiety on the day of OFC (mean 32.9 vs. 33.3). Post OFC, parents and children undergoing peanut challenges children had similar self-reported anxiety to those challenged to other foods. CONCLUSIONS: Parents and children self report higher levels of anxiety on the day of the OFC. Parents of children undergoing peanut challenges had slightly higher levels of anxiety on OFC days than those for other foods.