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Food Diversity, Breastfeeding Frequency, and the Incidence of Food Allergy and Eczema in the First Year of Life
Abstracts AB147
J ALLERGY CLIN IMMUNOL VOLUME 137, NUMBER 2
The Effect of Prenatal Exposure to Heavy Metals on Atopic Dermatitis: A Population-Based, Prospective Birth Cohort Study (COCOA)
Jihyun Kim, MD1,2, Sook-young Woo3, Sun-Woo Kim3, Jaehee Choi4, Jin-Yong Chung5, Young-Seoub Hong5,6, Youngshin Han, PhD1, SeYoung Oh7, Suk-Joo Choi8, Soo-Young Oh8, Kyung Won Kim9, Youn Ho Shin, MD10, Hye-Sung Won11, Kyung-Ju Lee12, Hee Jin Park12, Soo-Jong Hong, MD, PhD13, Kangmo Ahn, MD, PhD1,2; 1Environmental Health Center for Atopic Diseases, Seoul, South Korea, 2Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea, 3Biostatistics Team, Samsung Biomedical Research Institute, Seoul, South Korea, 4Department of Pediatrics, Samyook Medical Center, Seoul, South Korea, 5Heavy Metal Exposure Environmental Health Center, Dong-A University, Busan, South Korea, 6 Department of Preventive Medicine, Dong-A University College of Medicine, 7Department of Food and Nutrition, College of Human Ecology, Kyung Hee University, Seoul, South Korea, 8Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea, 9Department of Pediatrics, Yonsei University College of Medicine, Seoul, South Korea, 10Department of Pediatrics, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, Korea, South Korea, 11Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea, 12Department of Obstetrics and Gynecology, CHA University College of Medicine, Seoul, South Korea, 13Department of Pediatrics, Childhood Asthma Atopy Center, Research Center for Standization of Allergic Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. RATIONALE: We aimed to evaluate whether prenatal exposure to heavy metals affects the development, severity, and persistence of atopic dermatitis (AD) in a birth cohort study. METHODS: A total of 312 subjects from the Cohort for Childhood Origin of Asthma and allergic diseases (COCOA) were followed from birth for a mean duration of 35.5 months. The presence and the severity of AD was evaluated at ages of 6 and 12 months, and regularly once a year thereafter. The concentrations of lead, mercury, chromium, and cadmium in cord blood were measured by inductively coupled plasma mass spectrometry (ICP-MS). Cord blood mononuclear cells (CBMC) were isolated and stimulated to analyze cytokine production by using ELISA. RESULTS: AD developed in 121 (38.8%) children, and heavy metal levels in cord blood were not different between subjects with and without AD. However, the duration of AD was linearly associated with lead levels in cord blood (P50.002). A positive correlation was also observed between AD severity and mercury concentrations (P5 0.004). IL-13 production in CBMC showed positive correlation with lead levels in cord blood (P50.026), while there were no associations between mercury, chromium, and cadmium levels and IL-13 levels. CONCLUSIONS: Our findings suggest that prenatal exposure to lead and mercury is associated with persistence and severity of AD.
481
Food Diversity, Breastfeeding Frequency, and the Incidence of Food Allergy and Eczema in the First Year of Life
Ernest K. Kwegyir-Afful, PhD1, Emma Westermann-Clark, MD, MA2, Yuanting Zhang, PhD1, Stefano Luccioli, MD1; 1Center for Food Safety and Applied Nutrition, U.S. Food and Drug Administration, College Park, MD, 2Department of Internal Medicine, University of South Florida Morsani College of Medicine, Tampa, FL. RATIONALE: The goal of this study was to examine the relationship between maternally reported eczema and food allergy among infants aged _ 1 year, and determine the impact of breastfeeding and food diversity on < maternally reported eczema and food allergy at one year. METHODS: Data were analyzed from the Infant Feeding Practices Study II, a longitudinal survey of US mothers of healthy singletons from
pregnancy through the infant’s first year. The survey gathered detailed information on infant dietary intake and health outcomes. A Cox regression model was used to examine the relationship between reported incidence of eczema and food allergy and other risk factors (breastfeeding, food diversity, family history of eczema, food allergy, lifestyle and demographic factors). RESULTS: Mother’s education, family history of eczema and gender were significant (p<0.01) risk factors for maternally reported eczema. Mother’s education, family history of food allergy and prior report of eczema were significant (p<0.05) risk factors for maternally reported food allergy. Mothers who reported eczema were more likely (p50.0004; HR53.5) to report food allergy in later months. Food diversity and breastfeeding do not appear to impact the onset of food allergy or eczema outcomes. CONCLUSIONS: This study of a large cohort of US children provides further evidence that reports of eczema precedes food allergy. This may support emerging evidence regarding cutaneous sensitization as a risk factor for food allergy, or may reflect the natural history of these diseases.
482
Severe Anaphylaxis in Non-Atopic Teenager Due to Carmine Allergic: A Detective Work
Inmaculada Sanchez-Machin, MD1, Borja Bartolome2, Paloma Poza Guedes, MD3, Ruperto Gonzalez, MD, PhD3, Victor Matheu, MD, PhD4; 1Hospital Quiron, Santa Cruz de Tenerife, Spain, 2Research & Development Department, Bial-Aristegui, Bilbao, Spain, 3Alergocan, Santa Cruz de Tenerife, Spain, 4Hospital Quiron Tenerife, Santa Cruz de Tenerife, Spain. RATIONALE: Searching for hidden allergens in foodstuffs can be sometimes very complicated and challenging. METHODS: A non atopic girl, consulted in early 2013 by an episode of anaphylaxis with urticaria, angioedema, dyspnea, dysphagia and disphonia treated and solved with epinephrine. Over 2013 and 2014 patient suffered 4 similar episodes. Every single episode started 10-30 minutes after take some food. RESULTS: Skin prick tests (SPT) with commercial extracts of every foodstuff involved in all episodes were all negative. Study of idiopathic anaphylaxis was also negative. Basal tryptase was 3.27mg/L (1-15.0). Late 2014, patient suffered a new similar episode 10 minutes after taken some candies. Autoinjector of epinephrine was used by patient and was later assisted in Emergency Department. Tryptase after 120 minutes was 22.6mg/L. Study in Allergy Office by prick-prick with candies was positive with reddish candies and negative with other colored ones. Specific IgE with carmine (ImmunoCap, Phadia, Sweden) was negative. Prick-prick with the insect Dactylopius coccus, collected from the cactus Opuntia coccinellifera, was positive. A protein extract with cochineal and one with carminic acid were made. SPT with both extracts resulted positive and negative in 20 atopic controls. An IgE western-blot was performed. Two bands were recognized (1618kDa, 38-40kDa) with the cochineal insect extract. One band was recognized with carmine extract (38-45kDa). CONCLUSIONS: Cochineal carmine (E120) is used as a biologic dye in food, cosmetics and drugs. In this case, we can provide evidence of an IgEmediated reaction.
SUNDAY
480
J ALLERGY CLIN IMMUNOL VOLUME 137, NUMBER 2
The Effect of Prenatal Exposure to Heavy Metals on Atopic Dermatitis: A Population-Based, Prospective Birth Cohort Study (COCOA)
Jihyun Kim, MD1,2, Sook-young Woo3, Sun-Woo Kim3, Jaehee Choi4, Jin-Yong Chung5, Young-Seoub Hong5,6, Youngshin Han, PhD1, SeYoung Oh7, Suk-Joo Choi8, Soo-Young Oh8, Kyung Won Kim9, Youn Ho Shin, MD10, Hye-Sung Won11, Kyung-Ju Lee12, Hee Jin Park12, Soo-Jong Hong, MD, PhD13, Kangmo Ahn, MD, PhD1,2; 1Environmental Health Center for Atopic Diseases, Seoul, South Korea, 2Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea, 3Biostatistics Team, Samsung Biomedical Research Institute, Seoul, South Korea, 4Department of Pediatrics, Samyook Medical Center, Seoul, South Korea, 5Heavy Metal Exposure Environmental Health Center, Dong-A University, Busan, South Korea, 6 Department of Preventive Medicine, Dong-A University College of Medicine, 7Department of Food and Nutrition, College of Human Ecology, Kyung Hee University, Seoul, South Korea, 8Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea, 9Department of Pediatrics, Yonsei University College of Medicine, Seoul, South Korea, 10Department of Pediatrics, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, Korea, South Korea, 11Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea, 12Department of Obstetrics and Gynecology, CHA University College of Medicine, Seoul, South Korea, 13Department of Pediatrics, Childhood Asthma Atopy Center, Research Center for Standization of Allergic Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. RATIONALE: We aimed to evaluate whether prenatal exposure to heavy metals affects the development, severity, and persistence of atopic dermatitis (AD) in a birth cohort study. METHODS: A total of 312 subjects from the Cohort for Childhood Origin of Asthma and allergic diseases (COCOA) were followed from birth for a mean duration of 35.5 months. The presence and the severity of AD was evaluated at ages of 6 and 12 months, and regularly once a year thereafter. The concentrations of lead, mercury, chromium, and cadmium in cord blood were measured by inductively coupled plasma mass spectrometry (ICP-MS). Cord blood mononuclear cells (CBMC) were isolated and stimulated to analyze cytokine production by using ELISA. RESULTS: AD developed in 121 (38.8%) children, and heavy metal levels in cord blood were not different between subjects with and without AD. However, the duration of AD was linearly associated with lead levels in cord blood (P50.002). A positive correlation was also observed between AD severity and mercury concentrations (P5 0.004). IL-13 production in CBMC showed positive correlation with lead levels in cord blood (P50.026), while there were no associations between mercury, chromium, and cadmium levels and IL-13 levels. CONCLUSIONS: Our findings suggest that prenatal exposure to lead and mercury is associated with persistence and severity of AD.
481
Food Diversity, Breastfeeding Frequency, and the Incidence of Food Allergy and Eczema in the First Year of Life
Ernest K. Kwegyir-Afful, PhD1, Emma Westermann-Clark, MD, MA2, Yuanting Zhang, PhD1, Stefano Luccioli, MD1; 1Center for Food Safety and Applied Nutrition, U.S. Food and Drug Administration, College Park, MD, 2Department of Internal Medicine, University of South Florida Morsani College of Medicine, Tampa, FL. RATIONALE: The goal of this study was to examine the relationship between maternally reported eczema and food allergy among infants aged _ 1 year, and determine the impact of breastfeeding and food diversity on < maternally reported eczema and food allergy at one year. METHODS: Data were analyzed from the Infant Feeding Practices Study II, a longitudinal survey of US mothers of healthy singletons from
pregnancy through the infant’s first year. The survey gathered detailed information on infant dietary intake and health outcomes. A Cox regression model was used to examine the relationship between reported incidence of eczema and food allergy and other risk factors (breastfeeding, food diversity, family history of eczema, food allergy, lifestyle and demographic factors). RESULTS: Mother’s education, family history of eczema and gender were significant (p<0.01) risk factors for maternally reported eczema. Mother’s education, family history of food allergy and prior report of eczema were significant (p<0.05) risk factors for maternally reported food allergy. Mothers who reported eczema were more likely (p50.0004; HR53.5) to report food allergy in later months. Food diversity and breastfeeding do not appear to impact the onset of food allergy or eczema outcomes. CONCLUSIONS: This study of a large cohort of US children provides further evidence that reports of eczema precedes food allergy. This may support emerging evidence regarding cutaneous sensitization as a risk factor for food allergy, or may reflect the natural history of these diseases.
482
Severe Anaphylaxis in Non-Atopic Teenager Due to Carmine Allergic: A Detective Work
Inmaculada Sanchez-Machin, MD1, Borja Bartolome2, Paloma Poza Guedes, MD3, Ruperto Gonzalez, MD, PhD3, Victor Matheu, MD, PhD4; 1Hospital Quiron, Santa Cruz de Tenerife, Spain, 2Research & Development Department, Bial-Aristegui, Bilbao, Spain, 3Alergocan, Santa Cruz de Tenerife, Spain, 4Hospital Quiron Tenerife, Santa Cruz de Tenerife, Spain. RATIONALE: Searching for hidden allergens in foodstuffs can be sometimes very complicated and challenging. METHODS: A non atopic girl, consulted in early 2013 by an episode of anaphylaxis with urticaria, angioedema, dyspnea, dysphagia and disphonia treated and solved with epinephrine. Over 2013 and 2014 patient suffered 4 similar episodes. Every single episode started 10-30 minutes after take some food. RESULTS: Skin prick tests (SPT) with commercial extracts of every foodstuff involved in all episodes were all negative. Study of idiopathic anaphylaxis was also negative. Basal tryptase was 3.27mg/L (1-15.0). Late 2014, patient suffered a new similar episode 10 minutes after taken some candies. Autoinjector of epinephrine was used by patient and was later assisted in Emergency Department. Tryptase after 120 minutes was 22.6mg/L. Study in Allergy Office by prick-prick with candies was positive with reddish candies and negative with other colored ones. Specific IgE with carmine (ImmunoCap, Phadia, Sweden) was negative. Prick-prick with the insect Dactylopius coccus, collected from the cactus Opuntia coccinellifera, was positive. A protein extract with cochineal and one with carminic acid were made. SPT with both extracts resulted positive and negative in 20 atopic controls. An IgE western-blot was performed. Two bands were recognized (1618kDa, 38-40kDa) with the cochineal insect extract. One band was recognized with carmine extract (38-45kDa). CONCLUSIONS: Cochineal carmine (E120) is used as a biologic dye in food, cosmetics and drugs. In this case, we can provide evidence of an IgEmediated reaction.
SUNDAY
480