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Effectiveness of guidelines designed to reduce peanut substances in primary school classrooms in Montreal, Canada
S36 Abstracts
SATURDAY
Predicting the Resolution of Peanut Allergy in Children Using Skin Prick Testing and RAST: A Systematic Review E. C. TePas1, S. J. Bae2; 1Pediatrics, Massachusetts General Hospial, Boston, MA, 2Harvard School of Public Health, Boston, MA. RATIONALE: Up until recently it was assumed that allergy to nuts and shellfish was never outgrown. Recent data suggests that up to 20% of children may outgrow their peanut allergy. The goal of this systematic review was to examine the predictive value of the skin prick test (SPT) and RAST in determining resolution of peanut allergy in children. METHODS: We performed a comprehensive PubMed search and reference list review. To be included, studies had to specifically examine the question of resolution of peanut allergy in children. The subjects had to have a history of a prior reaction and resolution of peanut allergy had to be confirmed by a peanut challenge. The number of resolvers and nonresolvers with test results above or below the chosen cutoffs of <3 mm for SPT and <0.35 kUA/L for RAST had to be available. RESULTS: Of the 567 articles reviewed, only 5 met the selection criteria (4 studies had SPT results and only two had RAST results). Pooled estimates of sensitivity and specificity for the presence of continued clinical reactivity to peanut were 0.94 and 0.55 for SPT and 0.83 and 0.57 for RAST. CONCLUSIONS: These results suggest that a negative SPT is slightly better than a negative RAST at predicting which children have outgrown their peanut allergy. However, using these cutoffs, one misses ~40% of kids who have a positive test but would pass a peanut challenge.
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144
Accidental Ingestions in Peanut Allergic Children
J. W. Yu, A. Clarke, N. Verreault, N. Nicolas, L. Joseph, Y. St. Pierre, R. Kagan; Allergy and Clinical Immunology, McGill University Health Centre, Montreal, PQ, CANADA. RATIONALE: Previous studies report that 50% of peanut allergic patients experience an accidental exposure (AE) annually. Mislabelling and cross-contamination by the food industry, sharing of foods, contamination of utensils or toys and incorrect label reading by parents are possible explanations. Our objective was to characterize AE’s occurring in peanut allergic children over 1 year and to identify best predictors. METHODS: The parents of incident and prevalent cases of peanut allergic children at the Montreal Children’s Hospital completed questionnaires on AE’s over the preceding year. Logistic regression was used to identify associated factors. RESULTS: Of 129 children, 61% were male with a mean age of 8.5 years (range 4-17 years). Twelve children had 15 AE’s, yielding an annual AE rate of 9.3% (95% Confidence Interval [CI] 4.8%, 16.0%). Seven reactions were mild, 5 moderate and 3 severe. 1 mild reaction received adrenaline at home and at the hospital. Out of 8 reactions that were moderate to severe, only 3 went to the hospital and none received adrenaline. No AE’s occurred at school although some attended schools permitting peanuts. The rate of AE’s was associated only with the father having attended university (Odds Ratio 0.04, 95% CI 0.00, 0.35) and the child having chronic sinus or ear infections (OR 7.34, 95% CI 1.41, 38.18). CONCLUSION: AE’s occur at a lower frequency than expected based on previous reports. Lower stress levels, whether socio-economic or healthrelated as well as improved access to safer environments, may also contribute to lower incidence of AE.
Effectiveness of Guidelines Designed to Reduce Peanut Substances in Primary School Classrooms in Montreal, Canada D. K. Banerjee1, R. S. Kagan1, E. Turnbull2, L. Joseph3, Y. St-Pierre2, C. Dufresne4, K. Gray-Donald5, A. E. Clarke6; 1Clinical Immunology/Allergy, McGill University Health Centre, Montreal, PQ, CANADA, 2Clinical Epidemiology, McGill University Health Centre, Montreal, PQ, CANADA, 3Epidemiology and Biostatistics, McGill University, Montreal, PQ, CANADA, 4Association Quebecoise des Allergies Alimentaires, Montreal, PQ, CANADA, 5School of Dietetics and Human Nutrition, McGill
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J ALLERGY CLIN IMMUNOL FEBRUARY 2005
University, Montreal, PQ, CANADA, 6Clinical Immunology/Allergy and Clinical Epidemiology, McGill University Health Centre, Montreal, PQ, CANADA. RATIONALE: Some Canadian primary schools have implemented peanut-free lunch policies in order to address concerns regarding increasing peanut-allergy prevalence and the potential for fatal reactions. We evaluated the effectiveness of peanut-free lunch guidelines by comparing peanut content of lunches in classrooms with and without guidelines. METHODS: A mean of 102.6 days after obtaining parental consent, without other forewarning, a dietician inspected lunches for peanut in 40 randomly selected classrooms with and 40 without peanut-free guidelines. All parents agreeing to inspections and some who refused inspections completed questionnaires regarding knowledge of classroom peanut policy. RESULTS: Parents of 435/796 children in peanut-free classes agreed to inspections and 62 completed questionnaires only. Parents of 527/854 children in non-peanut-free classes agreed to inspections and 78 completed questionnaires only. In peanut-free classes, 1/388 lunches contained peanut (0.3%, 95% CI [0.0, 1.4]) and in non-peanut-free classes, 34/477 lunches contained peanut (7.1%, [5.0, 9.8]), yielding a 6.8% (4.5, 9.2) difference. In peanut-free classes, 86.8% (83.2, 89.8) of parents allowing inspections and 88.7% (78.1, 95.3) of parents only completing questionnaires were aware that peanuts were disallowed. In non-peanut-free classes, only 36% (31.9, 40.3) of parents allowing inspections and 34.2% (23.7, 46.0) of parents only completing questionnaires knew peanuts were permitted. Parents only completing questionnaires were as likely to have a school-going peanut-allergic child as those consenting to inspections (11.5% versus 7.6% in peanut-free classes, and 5.2% versus 3.3% in nonpeanut-free classes). CONCLUSIONS: Peanut-free guidelines achieved significant reduction in lunch peanut content and are potentially useful for decreasing risk of accidental peanut exposure. Funding: CIHR, Montreal Children’s Hospital Foundation Monitoring of Peanut Allergic Patients With Serum PeanutSpecific IgE R. Borici-Mazi1, J. A. Mazza2, D. W. Moote3, K. Payton3; 1Department of Medicine, University of Western Ontario, London, ON, CANADA, 2Department of Medicine, Division Of Allergy and Clinical Immunology, University of Western Ontario, London, ON, CANADA, 3Department of Medicine, Division of Allergy and Clinical Immunology, University of Western Ontario, London, ON, CANADA. RATIONALE: Since serum peanut-specific IgE (PN-IgE) are used in clinical practice to predict symptomatic allergy and screen for developing of tolerance to ingested peanut, we looked at the optimal frequency of measuring PN-IgE levels for monitoring peanut allergic patients. METHODS: Retrospective chart review of peanut allergic patients followed up and serially tested for PN-IgE with a qualitative antibody fluorescent-enzyme immunoassay performed at the Immunology Lab, London Health Sciences Center, from 1997 till present. RESULTS: A total of 118 patients (median age at first reaction to peanut1.5 yrs, median baseline PN-IgE value-18.75) were reviewed. Younger age at first reaction and first PN-IgE measurement predicted slower decline of PN-IgE values (p<0.001 and p=0.044). At 2 and 5 years post initial measurement, 12.9% and 66% of all patients had significant decrease of PN-IgE values. When patients were grouped according to the baseline PN-IgE value, 5 year estimated significant decline rate was 50.3%, 73% and 100% of patients with baseline values PN-IgE<17.5kU A/L , 17.5-100 kU A/L and PN-IgE >100 kUA/L. Moreover, reduction rate of PN-IgE was not significantly determined by baseline values ( p=0.259). CONCLUSIONS: This study suggests that, for most of the patients, it is probably adequate to measure serum peanut-specific IgE levels every 3-5 years as part of screening for developing of tolerance to ingested peanut and predict the results of future peanut challenges.
146
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Predicting the Resolution of Peanut Allergy in Children Using Skin Prick Testing and RAST: A Systematic Review E. C. TePas1, S. J. Bae2; 1Pediatrics, Massachusetts General Hospial, Boston, MA, 2Harvard School of Public Health, Boston, MA. RATIONALE: Up until recently it was assumed that allergy to nuts and shellfish was never outgrown. Recent data suggests that up to 20% of children may outgrow their peanut allergy. The goal of this systematic review was to examine the predictive value of the skin prick test (SPT) and RAST in determining resolution of peanut allergy in children. METHODS: We performed a comprehensive PubMed search and reference list review. To be included, studies had to specifically examine the question of resolution of peanut allergy in children. The subjects had to have a history of a prior reaction and resolution of peanut allergy had to be confirmed by a peanut challenge. The number of resolvers and nonresolvers with test results above or below the chosen cutoffs of <3 mm for SPT and <0.35 kUA/L for RAST had to be available. RESULTS: Of the 567 articles reviewed, only 5 met the selection criteria (4 studies had SPT results and only two had RAST results). Pooled estimates of sensitivity and specificity for the presence of continued clinical reactivity to peanut were 0.94 and 0.55 for SPT and 0.83 and 0.57 for RAST. CONCLUSIONS: These results suggest that a negative SPT is slightly better than a negative RAST at predicting which children have outgrown their peanut allergy. However, using these cutoffs, one misses ~40% of kids who have a positive test but would pass a peanut challenge.
143
144
Accidental Ingestions in Peanut Allergic Children
J. W. Yu, A. Clarke, N. Verreault, N. Nicolas, L. Joseph, Y. St. Pierre, R. Kagan; Allergy and Clinical Immunology, McGill University Health Centre, Montreal, PQ, CANADA. RATIONALE: Previous studies report that 50% of peanut allergic patients experience an accidental exposure (AE) annually. Mislabelling and cross-contamination by the food industry, sharing of foods, contamination of utensils or toys and incorrect label reading by parents are possible explanations. Our objective was to characterize AE’s occurring in peanut allergic children over 1 year and to identify best predictors. METHODS: The parents of incident and prevalent cases of peanut allergic children at the Montreal Children’s Hospital completed questionnaires on AE’s over the preceding year. Logistic regression was used to identify associated factors. RESULTS: Of 129 children, 61% were male with a mean age of 8.5 years (range 4-17 years). Twelve children had 15 AE’s, yielding an annual AE rate of 9.3% (95% Confidence Interval [CI] 4.8%, 16.0%). Seven reactions were mild, 5 moderate and 3 severe. 1 mild reaction received adrenaline at home and at the hospital. Out of 8 reactions that were moderate to severe, only 3 went to the hospital and none received adrenaline. No AE’s occurred at school although some attended schools permitting peanuts. The rate of AE’s was associated only with the father having attended university (Odds Ratio 0.04, 95% CI 0.00, 0.35) and the child having chronic sinus or ear infections (OR 7.34, 95% CI 1.41, 38.18). CONCLUSION: AE’s occur at a lower frequency than expected based on previous reports. Lower stress levels, whether socio-economic or healthrelated as well as improved access to safer environments, may also contribute to lower incidence of AE.
Effectiveness of Guidelines Designed to Reduce Peanut Substances in Primary School Classrooms in Montreal, Canada D. K. Banerjee1, R. S. Kagan1, E. Turnbull2, L. Joseph3, Y. St-Pierre2, C. Dufresne4, K. Gray-Donald5, A. E. Clarke6; 1Clinical Immunology/Allergy, McGill University Health Centre, Montreal, PQ, CANADA, 2Clinical Epidemiology, McGill University Health Centre, Montreal, PQ, CANADA, 3Epidemiology and Biostatistics, McGill University, Montreal, PQ, CANADA, 4Association Quebecoise des Allergies Alimentaires, Montreal, PQ, CANADA, 5School of Dietetics and Human Nutrition, McGill
145
J ALLERGY CLIN IMMUNOL FEBRUARY 2005
University, Montreal, PQ, CANADA, 6Clinical Immunology/Allergy and Clinical Epidemiology, McGill University Health Centre, Montreal, PQ, CANADA. RATIONALE: Some Canadian primary schools have implemented peanut-free lunch policies in order to address concerns regarding increasing peanut-allergy prevalence and the potential for fatal reactions. We evaluated the effectiveness of peanut-free lunch guidelines by comparing peanut content of lunches in classrooms with and without guidelines. METHODS: A mean of 102.6 days after obtaining parental consent, without other forewarning, a dietician inspected lunches for peanut in 40 randomly selected classrooms with and 40 without peanut-free guidelines. All parents agreeing to inspections and some who refused inspections completed questionnaires regarding knowledge of classroom peanut policy. RESULTS: Parents of 435/796 children in peanut-free classes agreed to inspections and 62 completed questionnaires only. Parents of 527/854 children in non-peanut-free classes agreed to inspections and 78 completed questionnaires only. In peanut-free classes, 1/388 lunches contained peanut (0.3%, 95% CI [0.0, 1.4]) and in non-peanut-free classes, 34/477 lunches contained peanut (7.1%, [5.0, 9.8]), yielding a 6.8% (4.5, 9.2) difference. In peanut-free classes, 86.8% (83.2, 89.8) of parents allowing inspections and 88.7% (78.1, 95.3) of parents only completing questionnaires were aware that peanuts were disallowed. In non-peanut-free classes, only 36% (31.9, 40.3) of parents allowing inspections and 34.2% (23.7, 46.0) of parents only completing questionnaires knew peanuts were permitted. Parents only completing questionnaires were as likely to have a school-going peanut-allergic child as those consenting to inspections (11.5% versus 7.6% in peanut-free classes, and 5.2% versus 3.3% in nonpeanut-free classes). CONCLUSIONS: Peanut-free guidelines achieved significant reduction in lunch peanut content and are potentially useful for decreasing risk of accidental peanut exposure. Funding: CIHR, Montreal Children’s Hospital Foundation Monitoring of Peanut Allergic Patients With Serum PeanutSpecific IgE R. Borici-Mazi1, J. A. Mazza2, D. W. Moote3, K. Payton3; 1Department of Medicine, University of Western Ontario, London, ON, CANADA, 2Department of Medicine, Division Of Allergy and Clinical Immunology, University of Western Ontario, London, ON, CANADA, 3Department of Medicine, Division of Allergy and Clinical Immunology, University of Western Ontario, London, ON, CANADA. RATIONALE: Since serum peanut-specific IgE (PN-IgE) are used in clinical practice to predict symptomatic allergy and screen for developing of tolerance to ingested peanut, we looked at the optimal frequency of measuring PN-IgE levels for monitoring peanut allergic patients. METHODS: Retrospective chart review of peanut allergic patients followed up and serially tested for PN-IgE with a qualitative antibody fluorescent-enzyme immunoassay performed at the Immunology Lab, London Health Sciences Center, from 1997 till present. RESULTS: A total of 118 patients (median age at first reaction to peanut1.5 yrs, median baseline PN-IgE value-18.75) were reviewed. Younger age at first reaction and first PN-IgE measurement predicted slower decline of PN-IgE values (p<0.001 and p=0.044). At 2 and 5 years post initial measurement, 12.9% and 66% of all patients had significant decrease of PN-IgE values. When patients were grouped according to the baseline PN-IgE value, 5 year estimated significant decline rate was 50.3%, 73% and 100% of patients with baseline values PN-IgE<17.5kU A/L , 17.5-100 kU A/L and PN-IgE >100 kUA/L. Moreover, reduction rate of PN-IgE was not significantly determined by baseline values ( p=0.259). CONCLUSIONS: This study suggests that, for most of the patients, it is probably adequate to measure serum peanut-specific IgE levels every 3-5 years as part of screening for developing of tolerance to ingested peanut and predict the results of future peanut challenges.
146