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O032 The prevalence of eosinophilic esophagitis in patients with IgE-mediated food allergy: Implications for oral immunotherapy
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Abstracts: Oral Concurrent Sessions / Ann Allergy Asthma Immunol 117 (2016) S1eS21
O032 THE PREVALENCE OF EOSINOPHILIC ESOPHAGITIS IN PATIENTS WITH IGE-MEDIATED FOOD ALLERGY: IMPLICATIONS FOR ORAL IMMUNOTHERAPY D. Hill*1, J. Dudley1, J. Spergel2, 1. Philadelphia, PA; 2. Westfield, NJ. Introduction: Eosinophilic esophagitis (EoE) is an allergic inflammatory disease, that is triggered by food allergens, and is characterized by progressive esophageal dysfunction. Recently, EoE has been identified in patients undergoing oral immunotherapy (OIT) for IgE-mediated food allergy, suggesting a causal relationship. We sought to ascertain whether significant associations exist between IgE-mediated and EoE food allergy. Methods: Utilizing analysis of EMR data and manual chart review, we examined our sub-specialty care network of 35,528 children and adolescents to define and characterize four EMR-based or manual patient cohorts. The most common food allergens were identified, EoE prevalence in patients with IgE-mediated food allergy was determined, and logistic regression was used to measure the extent to which IgE-mediated food allergy to specific foods was associated with a concurrent EoE diagnosis. Results: The most common causes of EoE in our population were milk, grains, meats, peanut, tree nuts, egg, and soy, a pattern that is distinct from that of IgE-mediated food allergy. The prevalence of EoE in patients with IgE-mediated food allergy was 118-fold higher than that of the general population. The distribution of IgE-mediated food allergens in patients with EoE was similar to that of the general population, however, the presence of allergy to egg (OR 2.32; 95% CI 1.96-2.75), milk (OR 4.39; 95% CI 3.70-5.20), or shellfish (OR 1.33; 95% CI 1.07-1.64) was significantly associated with concurrent EoE. Conclusion: Our findings support an important association between these conditions that has broad implications for the management of children with food allergy, and particular relevance to patients undergoing OIT.
O033 BOVINE COLOSTRUM AS AN ADJUNCT THERAPY IN THE CONTROL OF ALLERGIC RESPIRATORY DISEASE IN CHILDREN C. Wong*, Paranaque, Philippines. Introduction: Bovine colostrum contains anti-inflammatory and immunomodulatory properties. Studies show that reduction in proinflammatory cytokines and the presence of IgG-allergen immune complexes in colostrum can prevent subsequent sensitization which may contribute to its beneficial effect in allergic diseases. Methods: A randomized double blinded placebo controlled trial was conducted on 38 children aged 7 to 18 years with bronchial asthma and allergic rhinitis. The patients were randomly assigned
to receive either bovine colostrum (n¼19) or placebo (n¼19) daily for three months. Pulmonary function measurements were obtained. Total nasal symptoms score (TNSS), asthma control test (ACT) and composite asthma severity index (CASI) were used to assess symptom improvement for 6 months. Results: Mean changes in TNSS over 3 months in the bovine colostrum group significantly improved than with placebo group (p¼0.000). Mean changes in symptom score on ACT and severity score on CASI was not significantly different between the two groups. Pulmonary function measurements during bovine colostrum supplementation was significantly higher compared to placebo. FEV1 significantly improved at the 3rd month of supplementation (p¼0.006) and FEV1/FVC at the 2nd and 3rd month of supplementation (p¼0.021 and p¼0.001). Moreover, FEF 25-75 and PEF (p¼ 0.013 and p¼ 0.008, respectively) remained significantly higher until 3 months post supplementation in the bovine colostrum group compared to placebo. Conclusions: Among patients with allergic rhinitis and asthma, use of bovine colostrum supplement compared with placebo significantly reduces nasal allergy symptoms and improves lung function.
O034 EXHANCE-12: FLU-EDS (FLUTICASONE EXHALATION DELIVERY SYSTEM) REDUCES SYMPTOMS, NEED FOR SURGERY IN CHRONIC RHINOSINUSITIS (CRS) K. Jacobson*1, G. Steven2, J. Messina*3, P. Djupesland4, R. Mahmoud5, 1. Eugene, OR; 2. Greenfield, WI; 3. Downingtown, PA; 4. Oslo, Norway; 5. Yardley, PA. Background: FLU-EDS, an investigational new product, delivers topical steroid using an innovative new intranasal delivery technology capable of greater posterior/superior deposition than standard nasal sprays, particularly to the osteomeatal complex where sinus ostia drain/ventilate and polyps typically originate. Methods: Multicenter, 52-week, open-label study with endoscopic assessment. Subjects meeting historical and endoscopic diagnostic criteria for CRS with or without nasal polyps (CRSw/sNP) received FLU-EDS 372mg bid. Secondary outcome variables including patient global impression of change (PGIC) and need for surgery (using standard definition of eligibility requiring physician assessment via endoscopy and symptom severity/duration despite treatment failures) were evaluated over 52-weeks. Results: Of 223 subjects enrolled (189 CRSsNP; 34 CRSwNP), 96% reported prior corticosteroid use, and 29% prior surgery. At the endof-study visit, PGIC showed improvement in 87% of subjects; only 1.5% of subjects reported worsened symptoms. Of those completing 12 months, 80% rated their symptoms as “much” or “very much” improved. CRSwNP and CRSsNP subjects responded similarly. At baseline, 47% of CRSwNP subjects and 11% CRSsNP subjects met a priori criteria for surgery eligibility. Surgical eligibility among subjects with follow-up (and for those completing 12 months of
Abstracts: Oral Concurrent Sessions / Ann Allergy Asthma Immunol 117 (2016) S1eS21
O032 THE PREVALENCE OF EOSINOPHILIC ESOPHAGITIS IN PATIENTS WITH IGE-MEDIATED FOOD ALLERGY: IMPLICATIONS FOR ORAL IMMUNOTHERAPY D. Hill*1, J. Dudley1, J. Spergel2, 1. Philadelphia, PA; 2. Westfield, NJ. Introduction: Eosinophilic esophagitis (EoE) is an allergic inflammatory disease, that is triggered by food allergens, and is characterized by progressive esophageal dysfunction. Recently, EoE has been identified in patients undergoing oral immunotherapy (OIT) for IgE-mediated food allergy, suggesting a causal relationship. We sought to ascertain whether significant associations exist between IgE-mediated and EoE food allergy. Methods: Utilizing analysis of EMR data and manual chart review, we examined our sub-specialty care network of 35,528 children and adolescents to define and characterize four EMR-based or manual patient cohorts. The most common food allergens were identified, EoE prevalence in patients with IgE-mediated food allergy was determined, and logistic regression was used to measure the extent to which IgE-mediated food allergy to specific foods was associated with a concurrent EoE diagnosis. Results: The most common causes of EoE in our population were milk, grains, meats, peanut, tree nuts, egg, and soy, a pattern that is distinct from that of IgE-mediated food allergy. The prevalence of EoE in patients with IgE-mediated food allergy was 118-fold higher than that of the general population. The distribution of IgE-mediated food allergens in patients with EoE was similar to that of the general population, however, the presence of allergy to egg (OR 2.32; 95% CI 1.96-2.75), milk (OR 4.39; 95% CI 3.70-5.20), or shellfish (OR 1.33; 95% CI 1.07-1.64) was significantly associated with concurrent EoE. Conclusion: Our findings support an important association between these conditions that has broad implications for the management of children with food allergy, and particular relevance to patients undergoing OIT.
O033 BOVINE COLOSTRUM AS AN ADJUNCT THERAPY IN THE CONTROL OF ALLERGIC RESPIRATORY DISEASE IN CHILDREN C. Wong*, Paranaque, Philippines. Introduction: Bovine colostrum contains anti-inflammatory and immunomodulatory properties. Studies show that reduction in proinflammatory cytokines and the presence of IgG-allergen immune complexes in colostrum can prevent subsequent sensitization which may contribute to its beneficial effect in allergic diseases. Methods: A randomized double blinded placebo controlled trial was conducted on 38 children aged 7 to 18 years with bronchial asthma and allergic rhinitis. The patients were randomly assigned
to receive either bovine colostrum (n¼19) or placebo (n¼19) daily for three months. Pulmonary function measurements were obtained. Total nasal symptoms score (TNSS), asthma control test (ACT) and composite asthma severity index (CASI) were used to assess symptom improvement for 6 months. Results: Mean changes in TNSS over 3 months in the bovine colostrum group significantly improved than with placebo group (p¼0.000). Mean changes in symptom score on ACT and severity score on CASI was not significantly different between the two groups. Pulmonary function measurements during bovine colostrum supplementation was significantly higher compared to placebo. FEV1 significantly improved at the 3rd month of supplementation (p¼0.006) and FEV1/FVC at the 2nd and 3rd month of supplementation (p¼0.021 and p¼0.001). Moreover, FEF 25-75 and PEF (p¼ 0.013 and p¼ 0.008, respectively) remained significantly higher until 3 months post supplementation in the bovine colostrum group compared to placebo. Conclusions: Among patients with allergic rhinitis and asthma, use of bovine colostrum supplement compared with placebo significantly reduces nasal allergy symptoms and improves lung function.
O034 EXHANCE-12: FLU-EDS (FLUTICASONE EXHALATION DELIVERY SYSTEM) REDUCES SYMPTOMS, NEED FOR SURGERY IN CHRONIC RHINOSINUSITIS (CRS) K. Jacobson*1, G. Steven2, J. Messina*3, P. Djupesland4, R. Mahmoud5, 1. Eugene, OR; 2. Greenfield, WI; 3. Downingtown, PA; 4. Oslo, Norway; 5. Yardley, PA. Background: FLU-EDS, an investigational new product, delivers topical steroid using an innovative new intranasal delivery technology capable of greater posterior/superior deposition than standard nasal sprays, particularly to the osteomeatal complex where sinus ostia drain/ventilate and polyps typically originate. Methods: Multicenter, 52-week, open-label study with endoscopic assessment. Subjects meeting historical and endoscopic diagnostic criteria for CRS with or without nasal polyps (CRSw/sNP) received FLU-EDS 372mg bid. Secondary outcome variables including patient global impression of change (PGIC) and need for surgery (using standard definition of eligibility requiring physician assessment via endoscopy and symptom severity/duration despite treatment failures) were evaluated over 52-weeks. Results: Of 223 subjects enrolled (189 CRSsNP; 34 CRSwNP), 96% reported prior corticosteroid use, and 29% prior surgery. At the endof-study visit, PGIC showed improvement in 87% of subjects; only 1.5% of subjects reported worsened symptoms. Of those completing 12 months, 80% rated their symptoms as “much” or “very much” improved. CRSwNP and CRSsNP subjects responded similarly. At baseline, 47% of CRSwNP subjects and 11% CRSsNP subjects met a priori criteria for surgery eligibility. Surgical eligibility among subjects with follow-up (and for those completing 12 months of