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FOOD ALLERGEN COMPOSITION IN MAJOR RESTAURANTS
Abstracts: Poster Sessions / Ann Allergy Asthma Immunol 121 (2018) S22−S62
P301 PREVENTING FOOD ALLERGY REACTIONS AT RESTAURANTS: COMPARING STRATEGIES USED BETWEEN REACTORS AND NON-REACTORS J. Ade*, L. Kerns, C. Apperson-Hansen, A. Glick, Cleveland, OH Introduction: Food allergies significantly diminish quality of life and consumption of food outside the home has resulted in numerous food allergy related deaths. The purpose of this study was to investigate strategies used by food allergic individuals to reduce the risk of having reactions at restaurants. Methods: A 25-question survey assessing specific dining preparation behaviors was distributed to members of a regional food allergy network in Ohio. Both reactors and non-reactors were surveyed. Data were analyzed to determine association among risk mitigating behaviors while dining out and reported reactions. Results: Out of 39 respondents, 19 reactions were identified that occurred while dining in restaurants. The most utilized preventative strategies were speaking to a waiter (79.5%) and ordering food with simple ingredients (76.92%). The least utilized strategies were placing food allergy orders separately (23.1%) and using a personal allergy card (25.6%). Reactors used an average of 6 strategies prior to their most severe reaction compared to an average of 15 strategies used by never-reactors (p Conclusions: Those who have never reacted in restaurants use on average more total risk reducing strategies. After experiencing a reaction, reactors subsequently increased the number of strategies to similar numbers as non-reactors. No significant differences in individual strategies used between reactors and non-reactors were observed.
P302 FOOD ALLERGEN COMPOSITION IN MAJOR RESTAURANTS M. Whylly*, Peoria, AZ Introduction: There is no clear research on the percentage of allergens in foods at restaurants. Heavy focus is given to nut allergies when in fact nuts are one of the least common ingredients found in restaurants. This also proves the need for resources to cater to individuals with Gluten, Dairy, Egg, and Soy Allergies. Methods: Restaurant allergen information was collected online and from the restaurant sources. This data was then imported into R and using various statistical methods the allergen composition of foods was analyzed. Results: Results were recorded. Dairy was the most common allergy found in restaurants, shockingly present in 62 - 74% of all food items. Gluten was second with a presence of 56 - 70% of all food items. Soy was third with a presence of 52 - 65% of food items. Egg was fourth with a presence of 33-45% of food items. Peanuts, Tree Nuts, Shellfish, and Fish had a presence of, 2%,3%,5%,7% respectively. These results are with a 95% confidence interval, and do not include restaurants that specifically cater to those with food allergies as these are not always known or accessible to people. Conclusions: This highlights the need to focus on treatments and resources for those with Gluten, Dairy, Egg, and Soy allergies specifically as those are the most impactful on day to day eating life.
P303 A CASE OF FOOD-PROTEIN-INDUCED ENTEROCOLITIS SYNDROME WITH JAPANESE CLAM K. Kuzume*,1, M. Koizumi2, Y. Yagi3, 1. Ehime, Japan; 2. To-on city, Japan; 3. To-on, Ehime, Japan Introduction: Food-protein-induced enterocolitis syndrome (FPIES) with solid food is rare, and the appropriate diagnostic laboratory test
S51
has not been established. We evaluated the usefulness of lymphocyte proliferating response (LPR) with clam extract for scratch test in FPIES. Methods: A 5-year-old girl with a history of severe vomiting and abdominal pain following clam ingestion was evaluated. Her clamspecific IgE was Results: LPR using boiled clam showed false positive even in normal subjects because of Lipopolysaccharide in the clam. Therefore we used a Torii scratch solution of clam to stimulate lymphocytes. The highest stimulation index (SI = 3H-incorporation in stimulated cultures / 3H-incorporation in unstimulated cultures) was 27.1 in the patient and 3.2-3.9 in normal subjects. Proinflammatory cytokines and Th1 cytokines were induced in the culture supernatant of the patient’s sample. Conclusions: LPR with clam scratch solution is useful to diagnose FPIES with clam.
P304 SELF-REPORTED ASTHMA AND FOOD ALLERGY, BUT NOT SENSITIZATION, ARE INCREASED IN CHILDREN WITH DEVELOPMENTAL DELAY J. Sohn*,1, C. Keet2, E. McGowan2, 1. Charlottesville, VA; 2. Baltimore, MD Introduction: Recent studies have shown an association between self-reported allergic diseases and autism spectrum disorder in children. However, associations with developmental delay (DD) and allergic sensitization have not yet been described. Here we report on the association between DD and allergic disease in a nationallyrepresentative sample. Methods: We performed a cross-sectional study of children ages 1-17 years enrolled in the National Health and Nutrition Examination Survey (NHANES). DD was defined as having received special education or early intervention services. Allergic outcomes were defined as self-reported physician diagnosed asthma (NHANES 2005-2010), food allergy (2007-2010), and sensitization (sIgE ≥ 0.35 kU/L) to aeroallergen or foods (2005-2006). Multivariable logistic regression was used to examine the association between DD and individual allergic outcomes, adjusting for race, age, sex, income, and low birth weight ( Results: A total of 10,185 children were included in these analyses. Among those with DD, the mean age was 10 years, and 67% were male. There were increased odds of self-reported asthma (OR 1.74; 95% CI 1.34-2.26; p However, these findings were not accompanied by an increase in sIgE to aeroallergens or foods. Conclusions: In this population-based, cross-sectional survey, we report an increased risk of self-reported asthma and food allergies among children with developmental delay. However, there was no increased risk for food sensitization, suggesting that the self-reported food allergy may represent non-IgE mediated responses.
P305 CONTINUOUS LIKELIHOOD RATIOS TO PREDICT THE PROBABILITY OF A PEANUT REACTION J. Portnoy*, J. Shroba, Kansas City, MO Introduction: Peanut-specific IgE (PsIgE) is used to predict the probability of a reaction using likelihood ratios (LR) which convert pretest to posttest probabilities. While dichotomous (positive or negative) LRs are defined using a cutoff of 0.35, it is better to use a continuous LR which corresponds to each value of PsIgE. This is particularly important when there is only a PsIgE and no history of prior ingestion to rely on. Methods: PsIgEs were measured and oral peanut challenges performed on 58 children ages 9 months to 18 years. An ROC curve was
P301 PREVENTING FOOD ALLERGY REACTIONS AT RESTAURANTS: COMPARING STRATEGIES USED BETWEEN REACTORS AND NON-REACTORS J. Ade*, L. Kerns, C. Apperson-Hansen, A. Glick, Cleveland, OH Introduction: Food allergies significantly diminish quality of life and consumption of food outside the home has resulted in numerous food allergy related deaths. The purpose of this study was to investigate strategies used by food allergic individuals to reduce the risk of having reactions at restaurants. Methods: A 25-question survey assessing specific dining preparation behaviors was distributed to members of a regional food allergy network in Ohio. Both reactors and non-reactors were surveyed. Data were analyzed to determine association among risk mitigating behaviors while dining out and reported reactions. Results: Out of 39 respondents, 19 reactions were identified that occurred while dining in restaurants. The most utilized preventative strategies were speaking to a waiter (79.5%) and ordering food with simple ingredients (76.92%). The least utilized strategies were placing food allergy orders separately (23.1%) and using a personal allergy card (25.6%). Reactors used an average of 6 strategies prior to their most severe reaction compared to an average of 15 strategies used by never-reactors (p Conclusions: Those who have never reacted in restaurants use on average more total risk reducing strategies. After experiencing a reaction, reactors subsequently increased the number of strategies to similar numbers as non-reactors. No significant differences in individual strategies used between reactors and non-reactors were observed.
P302 FOOD ALLERGEN COMPOSITION IN MAJOR RESTAURANTS M. Whylly*, Peoria, AZ Introduction: There is no clear research on the percentage of allergens in foods at restaurants. Heavy focus is given to nut allergies when in fact nuts are one of the least common ingredients found in restaurants. This also proves the need for resources to cater to individuals with Gluten, Dairy, Egg, and Soy Allergies. Methods: Restaurant allergen information was collected online and from the restaurant sources. This data was then imported into R and using various statistical methods the allergen composition of foods was analyzed. Results: Results were recorded. Dairy was the most common allergy found in restaurants, shockingly present in 62 - 74% of all food items. Gluten was second with a presence of 56 - 70% of all food items. Soy was third with a presence of 52 - 65% of food items. Egg was fourth with a presence of 33-45% of food items. Peanuts, Tree Nuts, Shellfish, and Fish had a presence of, 2%,3%,5%,7% respectively. These results are with a 95% confidence interval, and do not include restaurants that specifically cater to those with food allergies as these are not always known or accessible to people. Conclusions: This highlights the need to focus on treatments and resources for those with Gluten, Dairy, Egg, and Soy allergies specifically as those are the most impactful on day to day eating life.
P303 A CASE OF FOOD-PROTEIN-INDUCED ENTEROCOLITIS SYNDROME WITH JAPANESE CLAM K. Kuzume*,1, M. Koizumi2, Y. Yagi3, 1. Ehime, Japan; 2. To-on city, Japan; 3. To-on, Ehime, Japan Introduction: Food-protein-induced enterocolitis syndrome (FPIES) with solid food is rare, and the appropriate diagnostic laboratory test
S51
has not been established. We evaluated the usefulness of lymphocyte proliferating response (LPR) with clam extract for scratch test in FPIES. Methods: A 5-year-old girl with a history of severe vomiting and abdominal pain following clam ingestion was evaluated. Her clamspecific IgE was Results: LPR using boiled clam showed false positive even in normal subjects because of Lipopolysaccharide in the clam. Therefore we used a Torii scratch solution of clam to stimulate lymphocytes. The highest stimulation index (SI = 3H-incorporation in stimulated cultures / 3H-incorporation in unstimulated cultures) was 27.1 in the patient and 3.2-3.9 in normal subjects. Proinflammatory cytokines and Th1 cytokines were induced in the culture supernatant of the patient’s sample. Conclusions: LPR with clam scratch solution is useful to diagnose FPIES with clam.
P304 SELF-REPORTED ASTHMA AND FOOD ALLERGY, BUT NOT SENSITIZATION, ARE INCREASED IN CHILDREN WITH DEVELOPMENTAL DELAY J. Sohn*,1, C. Keet2, E. McGowan2, 1. Charlottesville, VA; 2. Baltimore, MD Introduction: Recent studies have shown an association between self-reported allergic diseases and autism spectrum disorder in children. However, associations with developmental delay (DD) and allergic sensitization have not yet been described. Here we report on the association between DD and allergic disease in a nationallyrepresentative sample. Methods: We performed a cross-sectional study of children ages 1-17 years enrolled in the National Health and Nutrition Examination Survey (NHANES). DD was defined as having received special education or early intervention services. Allergic outcomes were defined as self-reported physician diagnosed asthma (NHANES 2005-2010), food allergy (2007-2010), and sensitization (sIgE ≥ 0.35 kU/L) to aeroallergen or foods (2005-2006). Multivariable logistic regression was used to examine the association between DD and individual allergic outcomes, adjusting for race, age, sex, income, and low birth weight ( Results: A total of 10,185 children were included in these analyses. Among those with DD, the mean age was 10 years, and 67% were male. There were increased odds of self-reported asthma (OR 1.74; 95% CI 1.34-2.26; p However, these findings were not accompanied by an increase in sIgE to aeroallergens or foods. Conclusions: In this population-based, cross-sectional survey, we report an increased risk of self-reported asthma and food allergies among children with developmental delay. However, there was no increased risk for food sensitization, suggesting that the self-reported food allergy may represent non-IgE mediated responses.
P305 CONTINUOUS LIKELIHOOD RATIOS TO PREDICT THE PROBABILITY OF A PEANUT REACTION J. Portnoy*, J. Shroba, Kansas City, MO Introduction: Peanut-specific IgE (PsIgE) is used to predict the probability of a reaction using likelihood ratios (LR) which convert pretest to posttest probabilities. While dichotomous (positive or negative) LRs are defined using a cutoff of 0.35, it is better to use a continuous LR which corresponds to each value of PsIgE. This is particularly important when there is only a PsIgE and no history of prior ingestion to rely on. Methods: PsIgEs were measured and oral peanut challenges performed on 58 children ages 9 months to 18 years. An ROC curve was