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Nutritional Status Impairment In Patients With Food Allergies
Abstracts AB211
J ALLERGY CLIN IMMUNOL VOLUME 133, NUMBER 2
Impact Of Formula Containing Docosahexaenoic Acid, Prebiotics, and Beta-Glucan On Allergic Manifestations In Young Children Dr. Deolinda Scalabrin, MD, PhD1, Suzanne Stolz1, Weihong Zhuang1, Mariana Pontes2, Angela de Mattos2, Indhira Almeida2, Carolina Godoy2, Sara Gatto2, Vivian Leal2, Gabriela Cabral2, Tereza Ribeiro2, Hugo Ribeiro2; 1Mead Johnson Nutrition, Evansville, IN, 2Federal University of Bahia, Brazil. RATIONALE: Nutrients such as docosahexaenoic acid (DHA), prebiotics, and beta-glucan have been associated with reduced incidence of respiratory illnesses and allergic manifestations. Our objective was to assess if a cow’s milk-based formula enriched with these and other nutrients, including zinc, vitamin A, and iron, reduced the incidence of respiratory infections and diarrheal disease and secondarily the occurrence of allergic manifestations (AM) in healthy children. METHODS: In this double-blind, randomized, controlled trial, healthy children (1-4yrs) from 2 daycare centers in Brazil were fed 3 servings per day of a follow-up formula (FF; n5125) containing DHA, the prebiotics polydextrose (PDX) and galactooligosaccharides (GOS), and beta-glucan, or a control cow’s milk (C; n5131) for up to 28 weeks. The occurrence of respiratory infection, diarrheal disease, and allergic manifestation was assessed by study pediatricians and analyzed with the Cochran-MantelHaenszel test. RESULTS: The FF group had fewer episodes of AM, which included allergic rhinitis, conjunctivitis, wheezing, allergic cough, eczema, and urticaria, compared to the C group (p50.021). The hazard ratio for AM was lower in the FF group compared to control (HR, 0.64; 95% CI 0.470.89; p50.007). There was no difference in the incidence of respiratory infections and diarrheal disease between groups. CONCLUSIONS: A cow’s milk-based formula containing DHA, PDX/ GOS, and beta-glucan, and enriched with micronutrients including zinc, vitamin A, and iron, when consumed 3 times per day for 28 weeks by 1-to-4 year-old children, was associated with fewer episodes of allergic manifestations in the skin and the respiratory tract, as compared to cow’s milk.
Can Training Improve Allergists' Ability To Accurately Identify Anxiety In Children With Food Allergy? Melissa Rubes1, Anna Podolsky2, Nicole Caso1, Rachel Annunziato1, Dr. Amanda L. Cox, MD2, Dr. Jennifer S. Kim, MD, FAAAAI2, Dr. Anna H. Nowak-Wegrzyn, MD, FAAAAI2, Dr. Julie Wang, MD, FAAAAI2, Scott H. Sicherer, MD, FAAAAI3, Eyal Shemesh2; 1Fordham University, NY, 2Icahn School of Medicine at Mount Sinai, NY, 3Mount Sinai School of Medicine, New York, NY. RATIONALE: Anxiety is common in children with food allergy and is associated with decreased quality of life; we therefore evaluated a brief workshop to improve allergists’ detection of anxiety. METHODS: 39 food-allergic children aged 8-17 years and their allergists separately completed the Screen for Child Anxiety Related Disorders (SCARED), a validated questionnaire. The 5 participating allergists attempted to estimate their patient’s responses. We analyzed the differences between patients’ and allergists’ reports. A child psychiatrist and a psychologist delivered a 60-minute workshop, in which four items with the highest rate of discrepant answers were discussed, and specific verbal screening questions were suggested. Following the workshop, the same allergists completed the SCARED for a different cohort of 39 children. RESULTS: Following the workshop, clinicians’ ‘‘do not know’’ responses to questionnaire items decreased from 70% to 5%. However, the correlation between clinician and child responses remained insignificant (r 5 .31, p 5 .32, before workshop; r5.30, p 5.068, after). 20% (8 patients) of the first cohort exceeded the SCARED threshold score for clinically meaningful anxiety, 10% (4 patients) met that threshold in the second cohort. Clinicians identified 1/8 of the cases in the first; and 1/4 of the cases in the second. Two clinicians reported that evaluating anxiety interfered with their practice and 3 of 5 indicated they would not continue to use the screen. CONCLUSIONS: This brief educational workshop was neither useful nor acceptable in improving allergists’ ability to screen for anxiety, and different modalities, such as self-administered screens, are likely needed.
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Parents' Perception Of The Likelihood Of Future LifeThreatening Events In Their Children With Food Allergies Dr. Peter Arkwright, MD, PhD, FAAAAI1, Ms. Jennifer Ogg1, Dr. Naomi Davis2, Dr. Ming Wan1; 1University of Manchester, Manchester, United Kingdom, 2Royal Manchester Children’s Hospital, United Kingdom. RATIONALE: In children suffering from food allergies, factors determining parents’ perception of future risk of life-threatening events are largely unknown. A better understanding of this will help to tailor advice and support to parents who are most in need. METHODS: Questionnaires were completed by parents bringing their children to regional pediatric allergy outpatient clinics with food allergies, and for comparison, parents of children attending an adjoining pediatric orthopaedic clinic after sustaining a fracture. Data were collected on parents’ demographics and the nature of the allergy or injury. Using validated scoring systems, parents’ perceived risk and severity of future events, as well as anxiety and depression scores were also assessed. RESULTS: Data were collated from 69 parents of children with food (38% nut) allergy and 73 parents of children with fractures. There was no difference in educational level, depression or anxiety scores between the two groups. Compared with parents of children suffering from fractures, parents of children with food allergies perceived a significantly higher risk of future severe (59% versus 10%, P < 0.05) and fatal events (28% versus 3%; P < 0.02). Parents of children with food allergies who had higher anxiety scores perceived a greater risk their child dying from their allergy (40% versus 7%; P < 0.05). CONCLUSIONS: Parents of children suffering from food allergies, particularly those with higher anxiety scores, are significantly more likely to be concerned that their child may die of future events than those whose children have suffered a fracture.
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Nutritional Status Impairment In Patients With Food Allergies Dr. Gesmar Segundo, Mrs. Larissa Costa, Mrs. Erica Rezende; Universidade Federal de Uberlandia, Uberlandia, Brazil. RATIONALE: Food allergy (FA) is a common disease that is rapidly increasing in prevalence for reasons that remain unknown. The aim of this study was to analyse the clinical characteristics and nutritional status of patients with food allergies followed in a tertiary centre of allergy and immunology. METHODS: A retrospective study was performed that assessed the data records of patients with food allergy diagnosis, covering a period from February 2009 to February 2012. 354 patients were evaluated in the period; 228 (69.1%) patients had a confirmed FA diagnosis, while the remaining 126 (30.9%) had a diagnosis of FA excluded. RESULTS: The age of patients with an FA diagnosis was lower (median510 months, IC51-193 months) than the group without FA (median536.5 months, IC51-216 months). There were no statistical differences in sex, gestational age, birth type, breastfeeding period and age of introduction of complementary formulas based on cow milk protein. The z-scores for weight-for-age, height-for-age, and body mass indices-for-age showed lower significant values in the FA group compared with the non-FA group by Mann Whitney test, with significance values of p50.0005, p50.0030, and p50.0066, respectively. CONCLUSIONS: FA patients had a lower growth rate in comparison with patients without FA. The early recognition of food allergies with the establishment of protein-implicated diet exclusion, in association with an adequate nutrient replenishment, is important to reduce the nutritional impact of food allergies.
MONDAY
731
J ALLERGY CLIN IMMUNOL VOLUME 133, NUMBER 2
Impact Of Formula Containing Docosahexaenoic Acid, Prebiotics, and Beta-Glucan On Allergic Manifestations In Young Children Dr. Deolinda Scalabrin, MD, PhD1, Suzanne Stolz1, Weihong Zhuang1, Mariana Pontes2, Angela de Mattos2, Indhira Almeida2, Carolina Godoy2, Sara Gatto2, Vivian Leal2, Gabriela Cabral2, Tereza Ribeiro2, Hugo Ribeiro2; 1Mead Johnson Nutrition, Evansville, IN, 2Federal University of Bahia, Brazil. RATIONALE: Nutrients such as docosahexaenoic acid (DHA), prebiotics, and beta-glucan have been associated with reduced incidence of respiratory illnesses and allergic manifestations. Our objective was to assess if a cow’s milk-based formula enriched with these and other nutrients, including zinc, vitamin A, and iron, reduced the incidence of respiratory infections and diarrheal disease and secondarily the occurrence of allergic manifestations (AM) in healthy children. METHODS: In this double-blind, randomized, controlled trial, healthy children (1-4yrs) from 2 daycare centers in Brazil were fed 3 servings per day of a follow-up formula (FF; n5125) containing DHA, the prebiotics polydextrose (PDX) and galactooligosaccharides (GOS), and beta-glucan, or a control cow’s milk (C; n5131) for up to 28 weeks. The occurrence of respiratory infection, diarrheal disease, and allergic manifestation was assessed by study pediatricians and analyzed with the Cochran-MantelHaenszel test. RESULTS: The FF group had fewer episodes of AM, which included allergic rhinitis, conjunctivitis, wheezing, allergic cough, eczema, and urticaria, compared to the C group (p50.021). The hazard ratio for AM was lower in the FF group compared to control (HR, 0.64; 95% CI 0.470.89; p50.007). There was no difference in the incidence of respiratory infections and diarrheal disease between groups. CONCLUSIONS: A cow’s milk-based formula containing DHA, PDX/ GOS, and beta-glucan, and enriched with micronutrients including zinc, vitamin A, and iron, when consumed 3 times per day for 28 weeks by 1-to-4 year-old children, was associated with fewer episodes of allergic manifestations in the skin and the respiratory tract, as compared to cow’s milk.
Can Training Improve Allergists' Ability To Accurately Identify Anxiety In Children With Food Allergy? Melissa Rubes1, Anna Podolsky2, Nicole Caso1, Rachel Annunziato1, Dr. Amanda L. Cox, MD2, Dr. Jennifer S. Kim, MD, FAAAAI2, Dr. Anna H. Nowak-Wegrzyn, MD, FAAAAI2, Dr. Julie Wang, MD, FAAAAI2, Scott H. Sicherer, MD, FAAAAI3, Eyal Shemesh2; 1Fordham University, NY, 2Icahn School of Medicine at Mount Sinai, NY, 3Mount Sinai School of Medicine, New York, NY. RATIONALE: Anxiety is common in children with food allergy and is associated with decreased quality of life; we therefore evaluated a brief workshop to improve allergists’ detection of anxiety. METHODS: 39 food-allergic children aged 8-17 years and their allergists separately completed the Screen for Child Anxiety Related Disorders (SCARED), a validated questionnaire. The 5 participating allergists attempted to estimate their patient’s responses. We analyzed the differences between patients’ and allergists’ reports. A child psychiatrist and a psychologist delivered a 60-minute workshop, in which four items with the highest rate of discrepant answers were discussed, and specific verbal screening questions were suggested. Following the workshop, the same allergists completed the SCARED for a different cohort of 39 children. RESULTS: Following the workshop, clinicians’ ‘‘do not know’’ responses to questionnaire items decreased from 70% to 5%. However, the correlation between clinician and child responses remained insignificant (r 5 .31, p 5 .32, before workshop; r5.30, p 5.068, after). 20% (8 patients) of the first cohort exceeded the SCARED threshold score for clinically meaningful anxiety, 10% (4 patients) met that threshold in the second cohort. Clinicians identified 1/8 of the cases in the first; and 1/4 of the cases in the second. Two clinicians reported that evaluating anxiety interfered with their practice and 3 of 5 indicated they would not continue to use the screen. CONCLUSIONS: This brief educational workshop was neither useful nor acceptable in improving allergists’ ability to screen for anxiety, and different modalities, such as self-administered screens, are likely needed.
732
734
Parents' Perception Of The Likelihood Of Future LifeThreatening Events In Their Children With Food Allergies Dr. Peter Arkwright, MD, PhD, FAAAAI1, Ms. Jennifer Ogg1, Dr. Naomi Davis2, Dr. Ming Wan1; 1University of Manchester, Manchester, United Kingdom, 2Royal Manchester Children’s Hospital, United Kingdom. RATIONALE: In children suffering from food allergies, factors determining parents’ perception of future risk of life-threatening events are largely unknown. A better understanding of this will help to tailor advice and support to parents who are most in need. METHODS: Questionnaires were completed by parents bringing their children to regional pediatric allergy outpatient clinics with food allergies, and for comparison, parents of children attending an adjoining pediatric orthopaedic clinic after sustaining a fracture. Data were collected on parents’ demographics and the nature of the allergy or injury. Using validated scoring systems, parents’ perceived risk and severity of future events, as well as anxiety and depression scores were also assessed. RESULTS: Data were collated from 69 parents of children with food (38% nut) allergy and 73 parents of children with fractures. There was no difference in educational level, depression or anxiety scores between the two groups. Compared with parents of children suffering from fractures, parents of children with food allergies perceived a significantly higher risk of future severe (59% versus 10%, P < 0.05) and fatal events (28% versus 3%; P < 0.02). Parents of children with food allergies who had higher anxiety scores perceived a greater risk their child dying from their allergy (40% versus 7%; P < 0.05). CONCLUSIONS: Parents of children suffering from food allergies, particularly those with higher anxiety scores, are significantly more likely to be concerned that their child may die of future events than those whose children have suffered a fracture.
733
Nutritional Status Impairment In Patients With Food Allergies Dr. Gesmar Segundo, Mrs. Larissa Costa, Mrs. Erica Rezende; Universidade Federal de Uberlandia, Uberlandia, Brazil. RATIONALE: Food allergy (FA) is a common disease that is rapidly increasing in prevalence for reasons that remain unknown. The aim of this study was to analyse the clinical characteristics and nutritional status of patients with food allergies followed in a tertiary centre of allergy and immunology. METHODS: A retrospective study was performed that assessed the data records of patients with food allergy diagnosis, covering a period from February 2009 to February 2012. 354 patients were evaluated in the period; 228 (69.1%) patients had a confirmed FA diagnosis, while the remaining 126 (30.9%) had a diagnosis of FA excluded. RESULTS: The age of patients with an FA diagnosis was lower (median510 months, IC51-193 months) than the group without FA (median536.5 months, IC51-216 months). There were no statistical differences in sex, gestational age, birth type, breastfeeding period and age of introduction of complementary formulas based on cow milk protein. The z-scores for weight-for-age, height-for-age, and body mass indices-for-age showed lower significant values in the FA group compared with the non-FA group by Mann Whitney test, with significance values of p50.0005, p50.0030, and p50.0066, respectively. CONCLUSIONS: FA patients had a lower growth rate in comparison with patients without FA. The early recognition of food allergies with the establishment of protein-implicated diet exclusion, in association with an adequate nutrient replenishment, is important to reduce the nutritional impact of food allergies.
MONDAY
731