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P294 A high sensitization to food allergens in children and adults with allergic rhinitis and asthma
Abstracts: Poster Sessions / Ann Allergy Asthma Immunol 117 (2016) S22eS124
P294 A HIGH SENSITIZATION TO FOOD ALLERGENS IN CHILDREN AND ADULTS WITH ALLERGIC RHINITIS AND ASTHMA G. Castellanos-Coutino*, E. Mendieta-Flores, M. Becerril-Angeles, Mexico City, DF, Mexico. Background: Allergic respiratory diseases are common in the general population and their morbidity has a negative impact on the patients’ quality of life. The prevalence of food allergy in patients with other allergic diseases is increasing in some countries; therefore it is advantageous to investigate sensitization to food allergens in patients with allergic rhinitis and asthma in Mexico. Methods: An observational, prospective, transversal, descriptive study of patients with allergic asthma and rhinitis was performed. All participants signed a written consent or assent. A medical history was obtained and skin prick tests with food allergen extracts were performed. The information collected was analyzed by descriptive statistics as well as non-parametric statistical X2. Results: Four-hundred patients, 282 pediatric and 118 adults were included. The average age was 17.84 years, SD 15.20. Food sensitization was found in 47.5% in the group of adults and in 42.9% in the group of children; with a prevalence of at least one food in 44.3% of the total sample. Foods with higher prevalence in pediatric patients were: soybean (10.6%), beans (6.7%), shrimp (6%), egg white (5.7%) and wheat (5.3%); and in adults were: soybean (17.8%), almonds (11%), shrimp (8.5%), corn (7.6%) and peas (7.6%). The most common symptom was oral pruritus in 11.7% of cases. Conclusion: The prevalence of food sensitization was high in pediatric and adults with allergic diseases; the main foods causing sensitization differed slightly between each group; soybean was the most frequent positive allergen in both groups. The main clinical manifestation was oral pruritus.
infantis [M-63] for 30 days. Fecal samples at 0, 7, 15, 30, 60 and 90 days were evaluated by specific BL and BB primers. Two control groups of egg/milk IgE-positive infants with negative food challenge (group II) and IgE-negative healthy infants (group III) were evaluated for BL and BB in basal conditions. Results: Of 25 infants (mean age 13.282.13 months), 9 were challenge-positive to egg (5) or milk (4). Group II included 6 infants, group III 10. BL harbours the microflora irrespective of the atopic status; BB was absent in 5/25, all in group I. The peak concentrations of BL were reached at 7 days in 5/9, 15 days in 3/9, and 30 days in 1/9. Using antibiotics determines a dramatic fell of BL concentration. BB peaks at 7 days in 2/9, 15 days in 3/9, 30 days in 3/9. The patients treated with antibiotic during the administration of TribifÒ had BB peaks at 30 days. Conclusions: BL and BB are part of the normal bacterial microflora. Lack of BB colonization may be associated with atopic status. A significant increase in BL and BB concentration suggests that TribifÒ does colonize the intestinal tract. An higher effect when the baseline concentration is low suggests that TribifÒ restores the ecological niche of bifidobacteria when it is depleted.
P296 PERSISTENT FPIES B. Navetta-Modrov*1, A. Jongco1, S. LaBarba1, M. Cavuto-Petrizzo2, 1. Great Neck, NY; 2. Rockville Centre, NY. Introduction: FPIES is a non-immunoglobulin E (IgE) mediated food hypersensitivity which presents with vomiting and diarrhea after ingestion of a food allergen. Cow’s milk is a common allergen and usually resolves by age 3. Oral food challenge (OFC) is the gold standard of diagnosis. We present a case of an 8 year old male with FPIES to cow’s milk. Methods: During infancy he developed vomiting, lethargy and respiratory distress after cow’s milk formula. There was no evidence of cow’s milk-specific IgE on skin prick or ImmunoCAP testing. Despite strictly avoiding cow’s milk, he failed two subsequent OFCs in the intensive are unit at age 4 and 6 years. He continued to avoid cow’s milk until age 8 years, when he decided to undergo another FPIES challenge to cow’s milk. During the OFC, he had vomiting and an increase in the absolute neutrophil count (2.0 to 4.6 x 10 3/mL). Conclusion: The follow-up evaluation for FPIES should include testing for food-specific IgE prior to OFC as patients initially presenting with or later developing food-specific IgE antibodies are at risk for persistent FPIES. Further studies are needed to establish the timing of follow-up challenges. The optimal timing for re-challenge in the setting of persistent IgE negative FPIES is unknown. It is also unclear how many attempts should be made and when to declare that FPIES is unlikely to resolve. ˇ
Results: A self-reported and physician diagnosis of food allergy were reported in 14 children. Children with food allergy were 78% male (NS), 92% white (NS) with a mean age of 38 months (range 675 months). Families with food allergic children had significantly higher mean income (p<0.0001) compared to the atopic controls. Food allergic children had significantly lower mean weight-for-age of 46% (p¼0.0002) compared to 64% in the atopic control group. The food allergic children mean height-for-age percentile was 35% (p<0.0001) compared to 63% in the atopic control group. Conclusions: The pilot data presented in this group of children with food allergy had significantly lower weight-for-age and height-for-age percentiles compared to atopic controls.
S109
P297 ATYPICAL CASE OF EGG-INDUCED FOOD PROTEININDUCED ENTEROCOLITIS SYNDROME IN AN ADULT A. Akenroye*1, D. Ferastraoaru2, 1. Harrison, NY; 2. Bronx, NY.
P295 BIFIDOBACTERIUM LONGUM & BREVE COLONIZE AND PERSIST IN MICROFLORA OF INFANTS WITH FOOD ALLERGY A. Fiocchi*, T. Napolitano, S. Reddel, P. Vernocchi, A. D’Ambrosio, L. Putignani, Rome, Holy See (Vatican City State). Introduction: The probiotic’s ability to alter the intestinal microbiota is controversial. Methods: Infants aged 10-14 months, allergic to egg/milk (group I) received TribifÒ (Bifidobacterium longum [BL], breve [BB] and
Introduction: Food Protein-Induced Enterocolitis Syndrome (FPIES) is a non-IgE mediated reaction which presents with vomiting and lethargy within hours of ingestion of culprit food. Diarrhea, hypotension, and neutrophilia could also occur. FPIES is most common in infancy. To our knowledge, there has been only a single case report of FPIES in an adult. Methods: Single-blind placebo-controlled food challenge (SBPCFC). Results: A 41-year-old woman presented with a 12-year history of repetitive vomiting and fatigue following ingestion of boiled/ scrambled eggs. Symptoms usually lasted 3 days. She could tolerate baked eggs. Skin testing to egg was negative. Serum IgE to egg, ovalbumin, and ovomucoid were <0.35kU/L. SBPCFC to boiled egg was performed using mashed potatoes as vehicle. Complete blood
P294 A HIGH SENSITIZATION TO FOOD ALLERGENS IN CHILDREN AND ADULTS WITH ALLERGIC RHINITIS AND ASTHMA G. Castellanos-Coutino*, E. Mendieta-Flores, M. Becerril-Angeles, Mexico City, DF, Mexico. Background: Allergic respiratory diseases are common in the general population and their morbidity has a negative impact on the patients’ quality of life. The prevalence of food allergy in patients with other allergic diseases is increasing in some countries; therefore it is advantageous to investigate sensitization to food allergens in patients with allergic rhinitis and asthma in Mexico. Methods: An observational, prospective, transversal, descriptive study of patients with allergic asthma and rhinitis was performed. All participants signed a written consent or assent. A medical history was obtained and skin prick tests with food allergen extracts were performed. The information collected was analyzed by descriptive statistics as well as non-parametric statistical X2. Results: Four-hundred patients, 282 pediatric and 118 adults were included. The average age was 17.84 years, SD 15.20. Food sensitization was found in 47.5% in the group of adults and in 42.9% in the group of children; with a prevalence of at least one food in 44.3% of the total sample. Foods with higher prevalence in pediatric patients were: soybean (10.6%), beans (6.7%), shrimp (6%), egg white (5.7%) and wheat (5.3%); and in adults were: soybean (17.8%), almonds (11%), shrimp (8.5%), corn (7.6%) and peas (7.6%). The most common symptom was oral pruritus in 11.7% of cases. Conclusion: The prevalence of food sensitization was high in pediatric and adults with allergic diseases; the main foods causing sensitization differed slightly between each group; soybean was the most frequent positive allergen in both groups. The main clinical manifestation was oral pruritus.
infantis [M-63] for 30 days. Fecal samples at 0, 7, 15, 30, 60 and 90 days were evaluated by specific BL and BB primers. Two control groups of egg/milk IgE-positive infants with negative food challenge (group II) and IgE-negative healthy infants (group III) were evaluated for BL and BB in basal conditions. Results: Of 25 infants (mean age 13.282.13 months), 9 were challenge-positive to egg (5) or milk (4). Group II included 6 infants, group III 10. BL harbours the microflora irrespective of the atopic status; BB was absent in 5/25, all in group I. The peak concentrations of BL were reached at 7 days in 5/9, 15 days in 3/9, and 30 days in 1/9. Using antibiotics determines a dramatic fell of BL concentration. BB peaks at 7 days in 2/9, 15 days in 3/9, 30 days in 3/9. The patients treated with antibiotic during the administration of TribifÒ had BB peaks at 30 days. Conclusions: BL and BB are part of the normal bacterial microflora. Lack of BB colonization may be associated with atopic status. A significant increase in BL and BB concentration suggests that TribifÒ does colonize the intestinal tract. An higher effect when the baseline concentration is low suggests that TribifÒ restores the ecological niche of bifidobacteria when it is depleted.
P296 PERSISTENT FPIES B. Navetta-Modrov*1, A. Jongco1, S. LaBarba1, M. Cavuto-Petrizzo2, 1. Great Neck, NY; 2. Rockville Centre, NY. Introduction: FPIES is a non-immunoglobulin E (IgE) mediated food hypersensitivity which presents with vomiting and diarrhea after ingestion of a food allergen. Cow’s milk is a common allergen and usually resolves by age 3. Oral food challenge (OFC) is the gold standard of diagnosis. We present a case of an 8 year old male with FPIES to cow’s milk. Methods: During infancy he developed vomiting, lethargy and respiratory distress after cow’s milk formula. There was no evidence of cow’s milk-specific IgE on skin prick or ImmunoCAP testing. Despite strictly avoiding cow’s milk, he failed two subsequent OFCs in the intensive are unit at age 4 and 6 years. He continued to avoid cow’s milk until age 8 years, when he decided to undergo another FPIES challenge to cow’s milk. During the OFC, he had vomiting and an increase in the absolute neutrophil count (2.0 to 4.6 x 10 3/mL). Conclusion: The follow-up evaluation for FPIES should include testing for food-specific IgE prior to OFC as patients initially presenting with or later developing food-specific IgE antibodies are at risk for persistent FPIES. Further studies are needed to establish the timing of follow-up challenges. The optimal timing for re-challenge in the setting of persistent IgE negative FPIES is unknown. It is also unclear how many attempts should be made and when to declare that FPIES is unlikely to resolve. ˇ
Results: A self-reported and physician diagnosis of food allergy were reported in 14 children. Children with food allergy were 78% male (NS), 92% white (NS) with a mean age of 38 months (range 675 months). Families with food allergic children had significantly higher mean income (p<0.0001) compared to the atopic controls. Food allergic children had significantly lower mean weight-for-age of 46% (p¼0.0002) compared to 64% in the atopic control group. The food allergic children mean height-for-age percentile was 35% (p<0.0001) compared to 63% in the atopic control group. Conclusions: The pilot data presented in this group of children with food allergy had significantly lower weight-for-age and height-for-age percentiles compared to atopic controls.
S109
P297 ATYPICAL CASE OF EGG-INDUCED FOOD PROTEININDUCED ENTEROCOLITIS SYNDROME IN AN ADULT A. Akenroye*1, D. Ferastraoaru2, 1. Harrison, NY; 2. Bronx, NY.
P295 BIFIDOBACTERIUM LONGUM & BREVE COLONIZE AND PERSIST IN MICROFLORA OF INFANTS WITH FOOD ALLERGY A. Fiocchi*, T. Napolitano, S. Reddel, P. Vernocchi, A. D’Ambrosio, L. Putignani, Rome, Holy See (Vatican City State). Introduction: The probiotic’s ability to alter the intestinal microbiota is controversial. Methods: Infants aged 10-14 months, allergic to egg/milk (group I) received TribifÒ (Bifidobacterium longum [BL], breve [BB] and
Introduction: Food Protein-Induced Enterocolitis Syndrome (FPIES) is a non-IgE mediated reaction which presents with vomiting and lethargy within hours of ingestion of culprit food. Diarrhea, hypotension, and neutrophilia could also occur. FPIES is most common in infancy. To our knowledge, there has been only a single case report of FPIES in an adult. Methods: Single-blind placebo-controlled food challenge (SBPCFC). Results: A 41-year-old woman presented with a 12-year history of repetitive vomiting and fatigue following ingestion of boiled/ scrambled eggs. Symptoms usually lasted 3 days. She could tolerate baked eggs. Skin testing to egg was negative. Serum IgE to egg, ovalbumin, and ovomucoid were <0.35kU/L. SBPCFC to boiled egg was performed using mashed potatoes as vehicle. Complete blood