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Food Extract Testing for Delayed-Type Hypersensitivity in Eosinophilic Esophagitis
AB94 Abstracts
356
SUNDAY
Food Extract Testing for Delayed-Type Hypersensitivity in Eosinophilic Esophagitis D. M. Robertson, J. L. Baldwin, M. J. Greenhawt; University of Michigan, Ann Arbor, MI. RATIONALE: Puree-food patch testing (PP) can identify cell-mediated hypersensitivity (CMH) to foods in Eosinophilic Esophagitis (EoE), but is not standardized, has variable predictive values for some foods, and patients may find it bothersome. Intradermal testing (IDT) read at 48-72 hrs is another technique to assess cell-mediated hypersensitivity. We explored a pilot feasibility study to determine if IDT with food extracts could also determine CMH in patients with EoE. METHODS: 31 biopsy-proven EoE patients without a history of food anaphylaxis and 10 controls have been enrolled. Patients underwent PST and PP testing to a standard 12-food EoE panel. Dilute IDTs (1:1000 strength) were placed to foods negative on PST. IDTs were read at 20 minutes and 48-72 hours. Subjects completed a written survey detailing their experience. RESULTS: No patients experienced systemic reactions during testing. Among controls, IDT was uniformly negative. 35% of patients had positive patch testing, compared 6.4% of delayed-IDT. All positive delayed-IDT were also positive on PP. There was a 94% concordance between negative tests. 60% had at least one positive immediate IDT. 56% of patients preferred IDT, 12.5% preferred PP. 57% of children reported needle fear was not a major issue. CONCLUSIONS: This ongoing study suggests that in the context of EoE, food IDT appears safe and well tolerated. There was high concordance of negative tests between the two methods. Immediate reactivity to IDT may hold additional significance as a diagnostic test. Further evaluation is needed to better assess the sensitivity of IDT for testing in the context of EoE.
357
Quantifying Allergic Sensitivities among Adults with Eosinophilic Esophagitis E. A. Erwin1, C. B. Cho2, P. U. Ogbogu2, L. Workman3, T. A. E. PlattsMills3; 1Nationwide Children’s Hospital, Columbus, OH, 2The Ohio State University Medical Center, Columbus, OH, 3University of Virginia Asthma and Allergic Diseases Center, Charlottesville, VA. RATIONALE: Eosinophilic esophagitis (EoE) patients have a high prevalence of allergic sensitivities. Our objective was to use serum measurements of specific IgE to food and inhalant allergens to quantify allergic sensitivities in adults with EoE. METHODS: In a cohort of adults with EoE, we performed skin prick testing and measured total IgE and serum levels of specific IgE to a panel of common foods and inhalants (CAP FEIA). RESULTS: The geometric mean (GM) total IgE for the whole group was 68.8 IU/ml. Serum measurements were positive in 78%; total IgE was significantly higher among these patients (GM 115 IU/ml) compared with those who were non-sensitized (13.2 IU/ml) (p50.03). Serum IgE measurements were often different from skin test results. Specific IgE to wheat was found in 56% of patients [geometric mean titer (GMT) 1.28 IU/ml]; none of the patients had a positive skin test to wheat. Peanut and soy sensitivities followed in frequency and were often identified in the same patients. The prevalence of individual inhalant sensitivities ranged from 22-33% except for the most common [weeds (including ragweed) found in 55%]. The sum of specific IgE measurements correlated with total IgE (r50.75, p50.02). CONCLUSIONS: Serum measurements can provide useful clinical information. Because of the large number of adult patients with specific IgE to wheat and negative skin tests, serum IgE measurements may be helpful in planning an avoidance diet. Non-sensitized patients had strikingly low levels of total IgE.
J ALLERGY CLIN IMMUNOL FEBRUARY 2012
358
Evaluation of Skin Testing to Aeroallergens and Foods in the Management of Adults with Eosinophilic Esophagitis and Response to Comprehensive Therapy J. A. Tarbox, M. J. Tang, K. L. McMullan, A. Kulczycki, Jr; Washington University St. Louis, Saint Louis, MO. RATIONALE: Assessment of aeroallergen and food sensitivity in patients with eosinophilic esophagitis and its value in treatment outcomes. METHODS: Retrospective chart review of adult patients with eosinophilic esophagitis from 2007-2011 at an Allergy/Immunology referral _15 eosinophils/hpf center. Clinical history and endoscopic biopsy with > were criteria for diagnosis. RESULTS: Forty-nine patients were Caucasian (96%) and male (63%) with a mean age of 38612 years. Thirty-eight (78%) had a history of atopic disease. Patients were skin tested to a standard panel of 41 aeroallergens; _1 inhalant. Skin testing to 21 (IQR514-24) foods 87% were sensitive to > _1 food, with an average of 2 (1-3) positive showed 28 (58%) reactive to > tests per food-allergic patient. Patients were placed on: 1) swallowed inhaled steroids, 2) PPIs, 3) avoidance of relevant foods, and 4) aeroallergen avoidance plus intranasal/orally inhaled steroids when indicated for 3-4 months. Thirty-four patients followed up: 26 (77%) became asymptomatic, 7 had partial improvement, and 1 had no improvement. Twenty-seven of these patients were atopic, and 21 of these became asymptomatic. Thirteen atopic patients have been followed >4 months after swallowed inhaled steroid cessation. One patient had no improvement, symptoms recurred in 3 patients at 4, 5, and 12 months; three of these four were not fully compliant with therapy. Nine (66.7%) remain asymp_2 years, 2 between 1-2 years and 2 between 4-12 tomatic with 5 for > months. CONCLUSIONS: A combination of swallowed inhaled steroids, PPIs, intranasal/oral steroids and avoidance of food and inhalant allergens appears to offer benefit in the management of eosinophilic esophagitis.
359
Clinical and Laboratory Characteristics of Adults with Eosinophilic Esophagitis M. A. Slack1, C. B. Cho1, R. Raveendran1, E. Erwin2, P. U. Ogbogu1; 1 Ohio State University Medical Center, Columbus, OH, 2Nationwide Children’s Hospital, Columbus, OH. RATIONALE: Understanding characteristics of adult patients with Eosinophilic Esophagitis (EoE) is critical for disease management and treatment advances. The aim of this study was to determine the baseline clinical and laboratory characteristics of adult EoE patients. METHODS: A retrospective review of 49 patients with EoE evaluated in an adult allergy clinic was performed. Patients with suggestive histories and >15 eosinophils/hpf on biopsy were included. Data including baseline demographics, presenting symptoms, endoscopic findings, and available allergy test results were obtained. RESULTS: 40/49 patients had skin prick testing performed (SPT) to both food and aeroallergens. 25/40 (63%) were male. 35/40 (88%) were sensitive to aeroallergens, 25/40 (63%) were sensitive to foods allergens, and 4/40 (10%) had negative SPT. Peanut and treenuts were the most commonly positive foods, 62% and 60% respectively. Total IgE was elevated (mean 204 IU/ml) in patients with both food and aeroallergen sensitivity, compared to those with only food, only aeroallergen, or no SPT sensitivity (p50.006). 35/40 (88%) had dysphagia. 18/40 (45%) had food impactions. 17/40 (43%) reported oral symptoms (e.g. pruritus). 8/40 (20%) required esophageal dilations. There did not appear to be an association with age, gender, or total IgE level with respect to need for esophageal dilation. CONCLUSIONS: To our knowledge, this is the largest descriptive study of adult EoE patients. There is a lack of standardized approach in the evaluation of adult EoE patients. Describing the characteristics of this population will not only aid in better defining this unique group of patients, but also assist in optimizing evaluation and management.
356
SUNDAY
Food Extract Testing for Delayed-Type Hypersensitivity in Eosinophilic Esophagitis D. M. Robertson, J. L. Baldwin, M. J. Greenhawt; University of Michigan, Ann Arbor, MI. RATIONALE: Puree-food patch testing (PP) can identify cell-mediated hypersensitivity (CMH) to foods in Eosinophilic Esophagitis (EoE), but is not standardized, has variable predictive values for some foods, and patients may find it bothersome. Intradermal testing (IDT) read at 48-72 hrs is another technique to assess cell-mediated hypersensitivity. We explored a pilot feasibility study to determine if IDT with food extracts could also determine CMH in patients with EoE. METHODS: 31 biopsy-proven EoE patients without a history of food anaphylaxis and 10 controls have been enrolled. Patients underwent PST and PP testing to a standard 12-food EoE panel. Dilute IDTs (1:1000 strength) were placed to foods negative on PST. IDTs were read at 20 minutes and 48-72 hours. Subjects completed a written survey detailing their experience. RESULTS: No patients experienced systemic reactions during testing. Among controls, IDT was uniformly negative. 35% of patients had positive patch testing, compared 6.4% of delayed-IDT. All positive delayed-IDT were also positive on PP. There was a 94% concordance between negative tests. 60% had at least one positive immediate IDT. 56% of patients preferred IDT, 12.5% preferred PP. 57% of children reported needle fear was not a major issue. CONCLUSIONS: This ongoing study suggests that in the context of EoE, food IDT appears safe and well tolerated. There was high concordance of negative tests between the two methods. Immediate reactivity to IDT may hold additional significance as a diagnostic test. Further evaluation is needed to better assess the sensitivity of IDT for testing in the context of EoE.
357
Quantifying Allergic Sensitivities among Adults with Eosinophilic Esophagitis E. A. Erwin1, C. B. Cho2, P. U. Ogbogu2, L. Workman3, T. A. E. PlattsMills3; 1Nationwide Children’s Hospital, Columbus, OH, 2The Ohio State University Medical Center, Columbus, OH, 3University of Virginia Asthma and Allergic Diseases Center, Charlottesville, VA. RATIONALE: Eosinophilic esophagitis (EoE) patients have a high prevalence of allergic sensitivities. Our objective was to use serum measurements of specific IgE to food and inhalant allergens to quantify allergic sensitivities in adults with EoE. METHODS: In a cohort of adults with EoE, we performed skin prick testing and measured total IgE and serum levels of specific IgE to a panel of common foods and inhalants (CAP FEIA). RESULTS: The geometric mean (GM) total IgE for the whole group was 68.8 IU/ml. Serum measurements were positive in 78%; total IgE was significantly higher among these patients (GM 115 IU/ml) compared with those who were non-sensitized (13.2 IU/ml) (p50.03). Serum IgE measurements were often different from skin test results. Specific IgE to wheat was found in 56% of patients [geometric mean titer (GMT) 1.28 IU/ml]; none of the patients had a positive skin test to wheat. Peanut and soy sensitivities followed in frequency and were often identified in the same patients. The prevalence of individual inhalant sensitivities ranged from 22-33% except for the most common [weeds (including ragweed) found in 55%]. The sum of specific IgE measurements correlated with total IgE (r50.75, p50.02). CONCLUSIONS: Serum measurements can provide useful clinical information. Because of the large number of adult patients with specific IgE to wheat and negative skin tests, serum IgE measurements may be helpful in planning an avoidance diet. Non-sensitized patients had strikingly low levels of total IgE.
J ALLERGY CLIN IMMUNOL FEBRUARY 2012
358
Evaluation of Skin Testing to Aeroallergens and Foods in the Management of Adults with Eosinophilic Esophagitis and Response to Comprehensive Therapy J. A. Tarbox, M. J. Tang, K. L. McMullan, A. Kulczycki, Jr; Washington University St. Louis, Saint Louis, MO. RATIONALE: Assessment of aeroallergen and food sensitivity in patients with eosinophilic esophagitis and its value in treatment outcomes. METHODS: Retrospective chart review of adult patients with eosinophilic esophagitis from 2007-2011 at an Allergy/Immunology referral _15 eosinophils/hpf center. Clinical history and endoscopic biopsy with > were criteria for diagnosis. RESULTS: Forty-nine patients were Caucasian (96%) and male (63%) with a mean age of 38612 years. Thirty-eight (78%) had a history of atopic disease. Patients were skin tested to a standard panel of 41 aeroallergens; _1 inhalant. Skin testing to 21 (IQR514-24) foods 87% were sensitive to > _1 food, with an average of 2 (1-3) positive showed 28 (58%) reactive to > tests per food-allergic patient. Patients were placed on: 1) swallowed inhaled steroids, 2) PPIs, 3) avoidance of relevant foods, and 4) aeroallergen avoidance plus intranasal/orally inhaled steroids when indicated for 3-4 months. Thirty-four patients followed up: 26 (77%) became asymptomatic, 7 had partial improvement, and 1 had no improvement. Twenty-seven of these patients were atopic, and 21 of these became asymptomatic. Thirteen atopic patients have been followed >4 months after swallowed inhaled steroid cessation. One patient had no improvement, symptoms recurred in 3 patients at 4, 5, and 12 months; three of these four were not fully compliant with therapy. Nine (66.7%) remain asymp_2 years, 2 between 1-2 years and 2 between 4-12 tomatic with 5 for > months. CONCLUSIONS: A combination of swallowed inhaled steroids, PPIs, intranasal/oral steroids and avoidance of food and inhalant allergens appears to offer benefit in the management of eosinophilic esophagitis.
359
Clinical and Laboratory Characteristics of Adults with Eosinophilic Esophagitis M. A. Slack1, C. B. Cho1, R. Raveendran1, E. Erwin2, P. U. Ogbogu1; 1 Ohio State University Medical Center, Columbus, OH, 2Nationwide Children’s Hospital, Columbus, OH. RATIONALE: Understanding characteristics of adult patients with Eosinophilic Esophagitis (EoE) is critical for disease management and treatment advances. The aim of this study was to determine the baseline clinical and laboratory characteristics of adult EoE patients. METHODS: A retrospective review of 49 patients with EoE evaluated in an adult allergy clinic was performed. Patients with suggestive histories and >15 eosinophils/hpf on biopsy were included. Data including baseline demographics, presenting symptoms, endoscopic findings, and available allergy test results were obtained. RESULTS: 40/49 patients had skin prick testing performed (SPT) to both food and aeroallergens. 25/40 (63%) were male. 35/40 (88%) were sensitive to aeroallergens, 25/40 (63%) were sensitive to foods allergens, and 4/40 (10%) had negative SPT. Peanut and treenuts were the most commonly positive foods, 62% and 60% respectively. Total IgE was elevated (mean 204 IU/ml) in patients with both food and aeroallergen sensitivity, compared to those with only food, only aeroallergen, or no SPT sensitivity (p50.006). 35/40 (88%) had dysphagia. 18/40 (45%) had food impactions. 17/40 (43%) reported oral symptoms (e.g. pruritus). 8/40 (20%) required esophageal dilations. There did not appear to be an association with age, gender, or total IgE level with respect to need for esophageal dilation. CONCLUSIONS: To our knowledge, this is the largest descriptive study of adult EoE patients. There is a lack of standardized approach in the evaluation of adult EoE patients. Describing the characteristics of this population will not only aid in better defining this unique group of patients, but also assist in optimizing evaluation and management.