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Economic Impact of Childhood Fpies and IgE-Mediated Food Allergies
AB240 Abstracts
783
The Clinical Prehistory of Food-Protein Induced Enterocolitis Syndrome (FPIES)
Valentina Pecora1, Lamia Dahdah2, Oscar Mazzina2, Daniela Vessicchio2, Alessandro G. Fiocchi, MD3; 1Paediatric Hospital Bambino Ges u, Rome, Holy See, 2Pediatric Hospital Bambino Gesu, 3Bambino Gesu Children Hospital, Roma. RATIONALE: Misdiagnosis and delays in diagnosis for children with Food Protein-Induced FPIES is common. We evaluated the diagnostic itinerary of FPIES children before the correct diagnosis. METHODS: A retrospective assessment of clinical records of 23 children diagnosed with FPIES was performed. RESULTS: Between August 2012 and July 2015, twenty-three children (14 males and 9 females) were diagnosed with FPIES (mean age at onset: 3.8562.66 months). The diagnosis was made in seven cases at the first clinical food reaction. In the remaining 16 children, the mean time lapse between the first episode and the diagnosis was 10.026 9.99 months with an average of three events (SD 1.58) before the proper identification. Specialists consulted for differential clinical suspect included: d
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Gastroenterologist (Meckels diverticulum, intussusception, pyloric stenosis, gastroenteritis, celiac disease, megacolon, congenital microvillus atrophy) in 9/23 cases; Cardiologist (congenital cardiopathy) in 6/23; Neurologist (seizures, intracranial hemorrhage) in 6/23; Infectious disease specialist (sepsis) in 6/23; Pediatric Surgeon (pyloric stenosis) in 4/23; Endocrinologist (adrenal insufficiency, diabetes insipidus) in 4/23; Dietician (Enteral nutrition) in 4/23; Anesthetist (hypotension, tachycardia, arrhythmia, hyperpnea) in 3/23; Metabolic disease specialist (acidosis, Hereditary Fructose Intolerance) in 3/23; Nephrologist (urinary infection) in 3/23; Immunologist (IPEX, primary immunodeficiency, hypogammaglobulinaemia) in 2/23; Haematologist (Anemia, methemoglobinemia) in 2/23; Geneticist (Genetic syndrome) in 2/23.
CONCLUSIONS: Delay in FPIES identification incur costs of specialist consultations, unnecessary (often-painful) procedures and the experience of multiple episodes. Educational training courses on FPIES for hospitalbased pediatricians may reduce the diagnostic delay.
784
Factors Affecting the Attainment of Tolerance Status in a Cohort of Food Protein-Induced Enterocolitis Patients
MONDAY
Eric C. K. Lee, BSc (Hons)1,2, Dianne E. Campbell, MD, FRACP, PhD1,2, Sam S. Mehr, MBBS, BMedSci, FRACP, FRCPA1; 1Department of Allergy and Immunology, The Children’s Hospital at Westmead, Westmead, Australia, 2Discipline of Paediatrics and Child Health, The University of Sydney, Sydney, Australia. RATIONALE: The natural history of food protein-induced enterocolitis syndrome (FPIES) is not well understood. We sought to examine factors which may influence time to and age of tolerance in our single-centre, tertiary cohort. METHODS: A retrospective cohort study of children with FPIES (using pre-defined criteria) who underwent observed food challenges (OFC) at The Children’s Hospital at Westmead from 1995-2015 was undertaken. Categorical and non-parametric analyses were performed. RESULTS: We identified 67 OFCs on 59 infants with FPIES (median age at OFC520 months). 14 (26%) reacted on OFC. Common food triggers were grains (n537), cow’s milk (CM) (n526), soy (n512) and egg
J ALLERGY CLIN IMMUNOL FEBRUARY 2016
(n512). There was no significant difference in sex, comorbid atopy, time between initial episodes and OFC or age at OFC between reactors and tolerant children. Of children with grain-FPIES, 90% (34/37) were tolerant at OFC (median age at OFC520 months; median time from initial episode514 months). 88% of children with CM-FPIES (33/36) and 92% with soy-FPIES (11/12) were tolerant at OFC (median age at OFC519 and 21 months; median time from initial episode515 months and 21 months, respectively). By comparison, only 66% of children with egg-FPIES (8/12) and 50% (3/6) with fish-FPIES were tolerant at OFC (median age at OFC536 and 47 months; median time from initial episode533 and 34 months, respectively). CONCLUSIONS: Most children with FPIES from our cohort attained tolerance earlier than 3-4 years. Certain foods were associated with a longer time to tolerance. Well-designed prospective studies are required to ensure children with FPIES do not undergo unnecessary prolonged dietary exclusion.
785
Economic Impact of Childhood Fpies and IgEMediated Food Allergies
Anna H. Nowak-Wegrzyn, MD, FAAAAI1, Zara Atal2; 1Icahn School of Medicine at Mount Sinai, New York, NY, 2Icahn School of Medicine at Mt. Sinai. RATIONALE: FPIES can result in repeated emergency room visits and extensive dietary modifications. Health-care costs for the families with children with FPIES have not been studied before. The primary goal of this survey was to determine the economic impact of FPIES compared to IgEmediated food allergies (IgE-FA). METHODS: Anonymous survey was administered online to the parents of children with FPIES and IgE-FA. The economic impact survey (adapted from Gupta al., 2013), assessed direct medical, out-of-pocket, and indirect costs. RESULTS: Sixty-one FPIES responses and 131 IgE-FA responses were analyzed. In the past year, children with FPIES had 436 outpatient visits, 36 emergency room visits, and 18 hospitalizations versus 290 outpatient visits, 33 emergency room visits, and 2 hospitalizations for children with IgE-FA allergies. Out-of-pocket health-related costs were $7233 per child with FPIES, compared to $5029.8 per child with IgE-FA, P<0.001. The largest expense for FPIES families was special diets, $2583.4 per child, while for the IgE-FA families the largest expense was education and supervision, $1531 per child. In the past year, FPIES families missed an average 8.4 days of school and/or work versus average 4.8 days missed school and/ or work days for IgE-FA families, P50.007. However, four FPIES families stated they had to give up their job in order to look after their child and reported an average salary loss due to FPIES as $75,000/ family. CONCLUSIONS: Childhood FPIES and IgE-FA result in significant selfreported direct and indirect costs for health care systems and families.
783
The Clinical Prehistory of Food-Protein Induced Enterocolitis Syndrome (FPIES)
Valentina Pecora1, Lamia Dahdah2, Oscar Mazzina2, Daniela Vessicchio2, Alessandro G. Fiocchi, MD3; 1Paediatric Hospital Bambino Ges u, Rome, Holy See, 2Pediatric Hospital Bambino Gesu, 3Bambino Gesu Children Hospital, Roma. RATIONALE: Misdiagnosis and delays in diagnosis for children with Food Protein-Induced FPIES is common. We evaluated the diagnostic itinerary of FPIES children before the correct diagnosis. METHODS: A retrospective assessment of clinical records of 23 children diagnosed with FPIES was performed. RESULTS: Between August 2012 and July 2015, twenty-three children (14 males and 9 females) were diagnosed with FPIES (mean age at onset: 3.8562.66 months). The diagnosis was made in seven cases at the first clinical food reaction. In the remaining 16 children, the mean time lapse between the first episode and the diagnosis was 10.026 9.99 months with an average of three events (SD 1.58) before the proper identification. Specialists consulted for differential clinical suspect included: d
d d d d d
d d
d
d d
d d
Gastroenterologist (Meckels diverticulum, intussusception, pyloric stenosis, gastroenteritis, celiac disease, megacolon, congenital microvillus atrophy) in 9/23 cases; Cardiologist (congenital cardiopathy) in 6/23; Neurologist (seizures, intracranial hemorrhage) in 6/23; Infectious disease specialist (sepsis) in 6/23; Pediatric Surgeon (pyloric stenosis) in 4/23; Endocrinologist (adrenal insufficiency, diabetes insipidus) in 4/23; Dietician (Enteral nutrition) in 4/23; Anesthetist (hypotension, tachycardia, arrhythmia, hyperpnea) in 3/23; Metabolic disease specialist (acidosis, Hereditary Fructose Intolerance) in 3/23; Nephrologist (urinary infection) in 3/23; Immunologist (IPEX, primary immunodeficiency, hypogammaglobulinaemia) in 2/23; Haematologist (Anemia, methemoglobinemia) in 2/23; Geneticist (Genetic syndrome) in 2/23.
CONCLUSIONS: Delay in FPIES identification incur costs of specialist consultations, unnecessary (often-painful) procedures and the experience of multiple episodes. Educational training courses on FPIES for hospitalbased pediatricians may reduce the diagnostic delay.
784
Factors Affecting the Attainment of Tolerance Status in a Cohort of Food Protein-Induced Enterocolitis Patients
MONDAY
Eric C. K. Lee, BSc (Hons)1,2, Dianne E. Campbell, MD, FRACP, PhD1,2, Sam S. Mehr, MBBS, BMedSci, FRACP, FRCPA1; 1Department of Allergy and Immunology, The Children’s Hospital at Westmead, Westmead, Australia, 2Discipline of Paediatrics and Child Health, The University of Sydney, Sydney, Australia. RATIONALE: The natural history of food protein-induced enterocolitis syndrome (FPIES) is not well understood. We sought to examine factors which may influence time to and age of tolerance in our single-centre, tertiary cohort. METHODS: A retrospective cohort study of children with FPIES (using pre-defined criteria) who underwent observed food challenges (OFC) at The Children’s Hospital at Westmead from 1995-2015 was undertaken. Categorical and non-parametric analyses were performed. RESULTS: We identified 67 OFCs on 59 infants with FPIES (median age at OFC520 months). 14 (26%) reacted on OFC. Common food triggers were grains (n537), cow’s milk (CM) (n526), soy (n512) and egg
J ALLERGY CLIN IMMUNOL FEBRUARY 2016
(n512). There was no significant difference in sex, comorbid atopy, time between initial episodes and OFC or age at OFC between reactors and tolerant children. Of children with grain-FPIES, 90% (34/37) were tolerant at OFC (median age at OFC520 months; median time from initial episode514 months). 88% of children with CM-FPIES (33/36) and 92% with soy-FPIES (11/12) were tolerant at OFC (median age at OFC519 and 21 months; median time from initial episode515 months and 21 months, respectively). By comparison, only 66% of children with egg-FPIES (8/12) and 50% (3/6) with fish-FPIES were tolerant at OFC (median age at OFC536 and 47 months; median time from initial episode533 and 34 months, respectively). CONCLUSIONS: Most children with FPIES from our cohort attained tolerance earlier than 3-4 years. Certain foods were associated with a longer time to tolerance. Well-designed prospective studies are required to ensure children with FPIES do not undergo unnecessary prolonged dietary exclusion.
785
Economic Impact of Childhood Fpies and IgEMediated Food Allergies
Anna H. Nowak-Wegrzyn, MD, FAAAAI1, Zara Atal2; 1Icahn School of Medicine at Mount Sinai, New York, NY, 2Icahn School of Medicine at Mt. Sinai. RATIONALE: FPIES can result in repeated emergency room visits and extensive dietary modifications. Health-care costs for the families with children with FPIES have not been studied before. The primary goal of this survey was to determine the economic impact of FPIES compared to IgEmediated food allergies (IgE-FA). METHODS: Anonymous survey was administered online to the parents of children with FPIES and IgE-FA. The economic impact survey (adapted from Gupta al., 2013), assessed direct medical, out-of-pocket, and indirect costs. RESULTS: Sixty-one FPIES responses and 131 IgE-FA responses were analyzed. In the past year, children with FPIES had 436 outpatient visits, 36 emergency room visits, and 18 hospitalizations versus 290 outpatient visits, 33 emergency room visits, and 2 hospitalizations for children with IgE-FA allergies. Out-of-pocket health-related costs were $7233 per child with FPIES, compared to $5029.8 per child with IgE-FA, P<0.001. The largest expense for FPIES families was special diets, $2583.4 per child, while for the IgE-FA families the largest expense was education and supervision, $1531 per child. In the past year, FPIES families missed an average 8.4 days of school and/or work versus average 4.8 days missed school and/ or work days for IgE-FA families, P50.007. However, four FPIES families stated they had to give up their job in order to look after their child and reported an average salary loss due to FPIES as $75,000/ family. CONCLUSIONS: Childhood FPIES and IgE-FA result in significant selfreported direct and indirect costs for health care systems and families.