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ORAL DESENSITIZATION TO PEANUT USING AR101 PEANUT ORAL IMMUNOTHERAPY IN A ROLL-OVER SAFETY STUDY ARC002
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Abstracts: Oral Concurrent Sessions / Ann Allergy Asthma Immunol 121 (2018) S1−S17
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PREVALENCE, SEVERITY, AND DISTRIBUTION OF ADULT-ONSET FOOD ALLERGY C. Warren1, C. Stankey2, J. Jiang2, J. Blumenstock2, B. Smith2, R. Gupta*,2, 1. Los Angeles, CA; 2. Chicago, IL.
ORAL DESENSITIZATION TO PEANUT USING AR101 PEANUT ORAL IMMUNOTHERAPY IN A ROLL-OVER SAFETY STUDY ARC002 J. Bird*,1, M. Welch2, J. Spergel3, S. Jones4, R. Rachid5, J. Wang6, A. Assa'ad7, B. Vickery8, N. Griffin9, K. Brown9, T. Pham9, J. Matthews9, A. Burks10, 1. Dallas, TX; 2. San Diego, CA; 3. Philadelphia, PA; 4. Little Rock, AR; 5. Boston, MA; 6. New York, NY; 7. Cincinnati, OH; 8. Atlanta, GA; 9. Brisbane, CA; 10. Chapel Hill, NC
Introduction: While much attention has been devoted to food allergy in children, little is known about the prevalence and characteristics of food allergy in adults. Moreover, recent research has shown that increasing numbers of individuals are developing food allergy in adulthood. This population-based study was conducted to examine the prevalence, severity, and distribution of adult-onset food allergy. Methods: A survey was administered to 40,443 adult United States residents between 2015 and 2016. Population-level prevalence was estimated using complex survey weighting. Demographics, history of reactions and diagnosis for each allergen, and comorbid conditions were analyzed. Self-reported food allergies were considered convincing if symptoms were consistent with IgE-mediated reactions. Results: Among all adults with food allergy, 45.3% reported developing at least one food allergy after 18 years of age. Of these, 24.9% only experienced onset of food allergy in adulthood, and 54.7% only experienced onset of food allergy in childhood. The five most prevalent adult-onset food allergies included shellfish (13.3% of adults), milk (6.0%), wheat (5.6%), tree nut (4.8%), and soy (3.9%). More than half of individuals with adult-onset allergy to peanut, tree nut, fin fish, or shellfish reported a prior severe reaction to the allergen. Factors associated with development of adult-onset food allergy include female sex, increasing age, and a history of multiple food allergies, allergic rhinitis, or medication allergy. Conclusions: One in four adults with food allergy develop a food allergy for the first time as an adult. Further study is necessary to understand potential predictors of adult-onset food allergy.
A312 UPDATED PEDIATRIC PEANUT ALLERGY PREVALENCE IN THE UNITED STATES J. Jiang*,1, O. Bushara1, J. Ponczek1, C. Warren2, J. Blumenstock1, B. Smith1, R. Gupta1, 1. Chicago, IL; 2. Los Angeles, CA Introduction: Peanut allergy is the most prevalent food allergy in the United States. Furthermore, peanut allergy comprises a high proportion of fatal food-allergic reactions. Peanut allergies are also rarely outgrown, resulting in chronic food allergy management and decreased quality of life. This study aims to further elucidate the current state of peanut allergy in the United States. Methods: A food allergy survey was administered to 51,819 households in the US between 2015-2016. This survey inquired demographics, allergens, history of allergic reactions, food allergy diagnosis, reaction management, food allergy severity, and chronic comorbidities. Children with suspected oral allergy syndrome and/or food intolerances were excluded. Complex survey weighting methods were utilized for valid population-level inferences. To estimate food allergy prevalence, weighted proportions were calculated with cluster robust standard errors at the household level. Results: An estimated 2.2% (95% CI:2.0-2.5) of children have a peanut allergy, with 80.9% (77.0-84.4) of the allergies having been physician diagnosed. Of those with peanut allergy, 59.2% (53.6-64.6) had experienced a severe reaction. Furthermore, 54.8% (49.1-60.3) of children with peanut allergy have multiple food allergies. 73.0% (68.0-77.5) of those with peanut allergy also have a current epinephrine prescription, and 50.4% (44.9-55.0) have had at least one lifetime ED visit, with 22.9% (19.1-27.2) having had an ED visit this past year. Conclusions: These findings suggest that continued development of treatments and wider implementation of preventive measures outlined by the 2017 National Institute of Allergy and Infectious Diseases guidelines are important to reduce both the incidence and morbidity of peanut allergy.
Introduction: This phase 2, open-label trial was designed to study the safety and tolerability of long-term AR101 exposure in peanutallergic subjects. Methods: Treatment consisted of continued AR101 maintenance for previously treated PA subjects (group 1) or dose escalation over »6 months to 300 mg/day maintenance for placebo crossovers (group 2). After 3 months’ maintenance, all subjects underwent a double-blind, placebo-controlled food challenge (DBPCFC); those who tolerated ≥300 mg peanut protein could elect to continue with AR101 300 mg/day or up-dose to a maximum of 2000 mg/day. Results: Forty-seven subjects were enrolled. The median overall exposure to AR101 was 3.0 and 2.3 years in groups 1 (21 subjects) and 2 (26 subjects), respectively. In the DBPCFC, group 1 subjects who continued maintenance treatment (300 mg/day), 95.2% (95% CI: 77.3, 99.2) tolerated 300 mg; 85.7% (95% CI: 65.4, 95.0) tolerated 600 mg; and 66.7% (95% CI: 45.4, 82.8) tolerated 1000 mg as the single highest dose of peanut protein with no more than mild symptoms. Similar efficacy was observed in group 2. Overall, adverse events (AEs) were primarily mild and moderate allergy symptoms, mainly reported in the up-dosing period (group 2 and 2000mg group) and consistent with the expected safety profile of initiating AR101 treatment. AR101 treatment continued to be generally well tolerated for up to 3 years in subjects receiving 300mg dose with higher numbers of AEs reported in subjects receiving 2000 mg/day. Conclusions: Long-term treatment with 300mg/day AR101 appears to maintain desensitization and is well tolerated. Higher doses are associated with more AEs.
Other
A350 METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS AND CLOSTRIDIUM DIFFICILE INFECTIONS AMONG PENICILLIN-ALLERGIC PATIENTS IN A UNIVERSITY HOSPITAL J. Galant-Swafford*,1, T. Lin2, X. Tu2, S. Christiansen2, A. Kim2, 1. Poway, CA; 2. San Diego, CA Introduction: Following penicillin skin testing and oral challenge, up to 90% of individuals reporting a PCN allergy are not found to be allergic. Patients with a PCN “allergy” are exposed to more and broader antibiotics, increasing their risk of developing antibiotic-associated and antibiotic-resistant infections. In this study, we compare the prevalence of Methicillin-resistant Staphylococcus aureus (MRSA) and Clostridium difficile infections among patients with a reported PCN allergy to that of PCN non-allergic patients. Methods: In this retrospective study, PCN-allergic and control cohorts were created using the EPIC electronic medical record (EMR) database to investigate patients admitted to a university hospital between 2014-2017. Discharge diagnoses were extracted by ICD-10 codes. The primary outcome included infections with C. difficile and MRSA. The secondary outcome was hospital length of stay (LOS). We compared the two groups controlling for differences through a set of confounders. Results: The rate of MRSA infection was significantly increased among PCN-allergic patients compared to PCN non-allergic patients
Abstracts: Oral Concurrent Sessions / Ann Allergy Asthma Immunol 121 (2018) S1−S17
A311
A313
PREVALENCE, SEVERITY, AND DISTRIBUTION OF ADULT-ONSET FOOD ALLERGY C. Warren1, C. Stankey2, J. Jiang2, J. Blumenstock2, B. Smith2, R. Gupta*,2, 1. Los Angeles, CA; 2. Chicago, IL.
ORAL DESENSITIZATION TO PEANUT USING AR101 PEANUT ORAL IMMUNOTHERAPY IN A ROLL-OVER SAFETY STUDY ARC002 J. Bird*,1, M. Welch2, J. Spergel3, S. Jones4, R. Rachid5, J. Wang6, A. Assa'ad7, B. Vickery8, N. Griffin9, K. Brown9, T. Pham9, J. Matthews9, A. Burks10, 1. Dallas, TX; 2. San Diego, CA; 3. Philadelphia, PA; 4. Little Rock, AR; 5. Boston, MA; 6. New York, NY; 7. Cincinnati, OH; 8. Atlanta, GA; 9. Brisbane, CA; 10. Chapel Hill, NC
Introduction: While much attention has been devoted to food allergy in children, little is known about the prevalence and characteristics of food allergy in adults. Moreover, recent research has shown that increasing numbers of individuals are developing food allergy in adulthood. This population-based study was conducted to examine the prevalence, severity, and distribution of adult-onset food allergy. Methods: A survey was administered to 40,443 adult United States residents between 2015 and 2016. Population-level prevalence was estimated using complex survey weighting. Demographics, history of reactions and diagnosis for each allergen, and comorbid conditions were analyzed. Self-reported food allergies were considered convincing if symptoms were consistent with IgE-mediated reactions. Results: Among all adults with food allergy, 45.3% reported developing at least one food allergy after 18 years of age. Of these, 24.9% only experienced onset of food allergy in adulthood, and 54.7% only experienced onset of food allergy in childhood. The five most prevalent adult-onset food allergies included shellfish (13.3% of adults), milk (6.0%), wheat (5.6%), tree nut (4.8%), and soy (3.9%). More than half of individuals with adult-onset allergy to peanut, tree nut, fin fish, or shellfish reported a prior severe reaction to the allergen. Factors associated with development of adult-onset food allergy include female sex, increasing age, and a history of multiple food allergies, allergic rhinitis, or medication allergy. Conclusions: One in four adults with food allergy develop a food allergy for the first time as an adult. Further study is necessary to understand potential predictors of adult-onset food allergy.
A312 UPDATED PEDIATRIC PEANUT ALLERGY PREVALENCE IN THE UNITED STATES J. Jiang*,1, O. Bushara1, J. Ponczek1, C. Warren2, J. Blumenstock1, B. Smith1, R. Gupta1, 1. Chicago, IL; 2. Los Angeles, CA Introduction: Peanut allergy is the most prevalent food allergy in the United States. Furthermore, peanut allergy comprises a high proportion of fatal food-allergic reactions. Peanut allergies are also rarely outgrown, resulting in chronic food allergy management and decreased quality of life. This study aims to further elucidate the current state of peanut allergy in the United States. Methods: A food allergy survey was administered to 51,819 households in the US between 2015-2016. This survey inquired demographics, allergens, history of allergic reactions, food allergy diagnosis, reaction management, food allergy severity, and chronic comorbidities. Children with suspected oral allergy syndrome and/or food intolerances were excluded. Complex survey weighting methods were utilized for valid population-level inferences. To estimate food allergy prevalence, weighted proportions were calculated with cluster robust standard errors at the household level. Results: An estimated 2.2% (95% CI:2.0-2.5) of children have a peanut allergy, with 80.9% (77.0-84.4) of the allergies having been physician diagnosed. Of those with peanut allergy, 59.2% (53.6-64.6) had experienced a severe reaction. Furthermore, 54.8% (49.1-60.3) of children with peanut allergy have multiple food allergies. 73.0% (68.0-77.5) of those with peanut allergy also have a current epinephrine prescription, and 50.4% (44.9-55.0) have had at least one lifetime ED visit, with 22.9% (19.1-27.2) having had an ED visit this past year. Conclusions: These findings suggest that continued development of treatments and wider implementation of preventive measures outlined by the 2017 National Institute of Allergy and Infectious Diseases guidelines are important to reduce both the incidence and morbidity of peanut allergy.
Introduction: This phase 2, open-label trial was designed to study the safety and tolerability of long-term AR101 exposure in peanutallergic subjects. Methods: Treatment consisted of continued AR101 maintenance for previously treated PA subjects (group 1) or dose escalation over »6 months to 300 mg/day maintenance for placebo crossovers (group 2). After 3 months’ maintenance, all subjects underwent a double-blind, placebo-controlled food challenge (DBPCFC); those who tolerated ≥300 mg peanut protein could elect to continue with AR101 300 mg/day or up-dose to a maximum of 2000 mg/day. Results: Forty-seven subjects were enrolled. The median overall exposure to AR101 was 3.0 and 2.3 years in groups 1 (21 subjects) and 2 (26 subjects), respectively. In the DBPCFC, group 1 subjects who continued maintenance treatment (300 mg/day), 95.2% (95% CI: 77.3, 99.2) tolerated 300 mg; 85.7% (95% CI: 65.4, 95.0) tolerated 600 mg; and 66.7% (95% CI: 45.4, 82.8) tolerated 1000 mg as the single highest dose of peanut protein with no more than mild symptoms. Similar efficacy was observed in group 2. Overall, adverse events (AEs) were primarily mild and moderate allergy symptoms, mainly reported in the up-dosing period (group 2 and 2000mg group) and consistent with the expected safety profile of initiating AR101 treatment. AR101 treatment continued to be generally well tolerated for up to 3 years in subjects receiving 300mg dose with higher numbers of AEs reported in subjects receiving 2000 mg/day. Conclusions: Long-term treatment with 300mg/day AR101 appears to maintain desensitization and is well tolerated. Higher doses are associated with more AEs.
Other
A350 METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS AND CLOSTRIDIUM DIFFICILE INFECTIONS AMONG PENICILLIN-ALLERGIC PATIENTS IN A UNIVERSITY HOSPITAL J. Galant-Swafford*,1, T. Lin2, X. Tu2, S. Christiansen2, A. Kim2, 1. Poway, CA; 2. San Diego, CA Introduction: Following penicillin skin testing and oral challenge, up to 90% of individuals reporting a PCN allergy are not found to be allergic. Patients with a PCN “allergy” are exposed to more and broader antibiotics, increasing their risk of developing antibiotic-associated and antibiotic-resistant infections. In this study, we compare the prevalence of Methicillin-resistant Staphylococcus aureus (MRSA) and Clostridium difficile infections among patients with a reported PCN allergy to that of PCN non-allergic patients. Methods: In this retrospective study, PCN-allergic and control cohorts were created using the EPIC electronic medical record (EMR) database to investigate patients admitted to a university hospital between 2014-2017. Discharge diagnoses were extracted by ICD-10 codes. The primary outcome included infections with C. difficile and MRSA. The secondary outcome was hospital length of stay (LOS). We compared the two groups controlling for differences through a set of confounders. Results: The rate of MRSA infection was significantly increased among PCN-allergic patients compared to PCN non-allergic patients