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Premedication with Montelukast Reduces Local Reactions of Allergen Immunotherapy
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Premedication with Montelukast Reduces Local Reactions of Allergen Immunotherapy S. Wohrl1, W. Hemmer2, G. Heinze3, G. Stingl1, T. Kinaciyan1; 1Medical University of Vienna, Department of Dermatology, Division of Immunology, Allergy and Infectious Diseases (DIAID), Vienna, AUSTRIA, 2Floridsdorf Allergy Center (FAZ), Vienna, AUSTRIA, 3Medical University of Vienna, Core unit for Medical Statistics and Informatics, Section on Medical Statistics, Vienna, AUSTRIA. RATIONALE: Subcutaneous specific immunotherapy with allergen frequently causes local reactions. Antihistamine pretreatment - originally introduced as a safety measure to reduce anaphylactic side effects - has been the only treatment option for local reactions so far, although these swellings are usually not appearing immediately but after hours. We were interested whether pretreatment with the leukotriene antagonist montelukast would be better suited for preventing those reactions than pretreatment with the antihistamine desloratadine. METHODS: 15 patients with a history of severe anaphylactic reactions to hymenoptera stings were enrolled into a prospective, double-blind, randomized, placebo-controlled study. We selected a RUSH-immunotherapy-protocol consisting of 19 injections of venom administered over 5 consecutive days, where the majority is developing local reactions, and counted the number of injections until a local reaction of > 3 cm occurred. The patients were randomised to the 3 treatment groups: premedication with either placebo, montelukast or the antihistamine desloratadine. RESULTS: Compared with placebo, the occurrence of local reactions >3 cm was significantly delayed by montelukast (p < 0.01, ANOVA) but not by desloratadine (p 5 0.19). The difference between montelukast and desloratadine was close to significance (p 5 0.054). Itching, recorded by visual analogue score, did not differ between the 3 groups. CONCLUSIONS: Montelukast may be useful in the prevention of local reactions caused by allergen-specific immunotherapy. Funding: MSD Austria, Vienna
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Subcutaneous Immunotherapy with Single and Mix Insect Allergens - A Double Blind Controlled Trial S. N. Gaur, IV1, D. Srivastava2, N. Arora2, B. P. Singh2; 1Vallabhbhai Patel Chest Institute, Delhi, INDIA, 2Institute of Genomics and Integrative Biology, Delhi - 110007, INDIA. RATIONALE: To compare the efficacy of Specific immunotherapy (SIT) with single and mixed allergen of same group (Insects). METHODS: One hundred allergic patients of asthma, screened by history, skin tests and specific IgE levels were randomly divided into active and placebo groups. Active group received SIT with either single insect allergen (mosquito-20, Cockroach-20) or a mixture of 2-3 insect allergens (Mosquito, Cockroach, Housefly - 30). In vivo (skin test, bronchial hyper-reactivity) and In vitro (allergen specific IgE, IgG1 and IgG4) tests were done initially and after 1 year of SIT. Symptom and drug score cards were scrutinized every 3 month. RESULTS: Patients in both active groups of single and multiple insect allergen showed significant improvement (p < 0.05) in disease state in comparison to placebo group. Decreased skin reactivity was noted in 95% and 84%, symptom score reduction in 85% and 78%, bronchial hyperreactivity showed improvement in 76% and 67% respectively for single and mix allergen immunotherapy groups. respectively for single and mix allergen immunotherapy groups. IgE values however showed non-significant reduction whereas IgG4 levels showed significant increase in both the active groups (p < 0.05). A good correlation was also observed between symptoms reduction and increased IgG4 levels. Changes in all the above parameters were non-significant in the placebo group. Symptom score was reduced more in single allergen group than in multiple allergen SIT group. However, these inter-group differences were not statistically significant. CONCLUSIONS: SIT with single as well as mixed insect allergens is almost equally effective and is definitely better than placebo and is well tolerated. Funding: Department of Science and Technology, Govt. of India
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Total and Specific IgE are elevated in Atopic March (AM) M. Boguniewicz1, D. Y. N. Leung1, J. Orange2,3, K. Pinzone2, R. Harbeck1, S. B. Leung1, J. Spergel2,3; 1National Jewish Medical and Research Center, Denver, CO, 2The Children’s Hospital of Philadelphia, Philadelphia, PA, 3Univ of Pennsylvania, Philadelphia, PA. RATIONALE: To examine the immunologic phenotype of 104 children with atopic dermatitis (AD) during the development of asthma and allergies. METHODS: 104 children ages, 3-18 months, with AD were enrolled within 3 months of AD diagnosis in a 6-year prospective trial to examine the impact of early intervention with a topical calcineurin inhibitor versus conventional therapy on the AM (Study of Atopic March). These patients are part of a larger cohort of 1091 children in a multi-center trial that included CHOP and NJMRC. At 18 and 30 months, disease severity, total IgE, and specific IgE to 14 aeroallergens were assessed. RESULTS: After 30 months of follow-up, 48 children had progressed in the AM to develop food allergy (n 5 25), asthma (n 5 10), allergic rhinitis (n 5 26), or allergic conjunctivitis (n 5 10). Eczema severity measured by EASI (eczema area severity index) did not differ in the two groups at 18 and 30 months. The AM group had significantly higher IgE (mean: 256 kU/L at 18 months and 495 kU/L at 30 month) compared to the 56 non-AM group (mean 73 kU/L at 18 months and 48 kU/L at 30 months) (p < 0.05). AM patients had significantly more positive IgE (2.46 at 18 months; 2.95 at 30 months) compared to 1.04 in non-AM at 18 months and 0.96 at 30 months (p < 0.01). The most common specific IgE in the entire population was to cat and dog at 18 months and cat and alternaria at 30 months. CONCLUSION: Children that progress in the AM have increased total and specific IgE expression. Funding: NIH
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Increased Risk of Invasive Pneumococcal Disease in Atopic Patients J. A. Jung1, H. Kita1, B. P. Yawn2, M. E. Mc Gree1, A. L. Weaver1, K. H. Yoo1,3, P. Wollan2, T. G. Boyce1, R. M. Jacobson1, Y. J. Juhn1; 1Mayo Clinic, Rochester, MN, 2Olmsted Medical Center, Rochester, MN, 3Kunkook University School of Medicine, Seoul, REPUBLIC OF KOREA. RATIONALE: A previous study reported an increased risk of invasive pneumococcal disease (IPD) among asthmatic patients. It is not known whether this is true for patients with other atopic conditions. We determined the relationship between atopy and IPD. METHODS: The study subjects were Rochester, Minnesota residents who developed IPD between 1964 and 1983 and their 1:2 gender- and agematched controls. We used a population-based computer-linked medical diagnosis system to identify all individuals with diagnoses potentially including IPD. All records were reviewed using explicit predetermined criteria for IPD. All individuals with atopy were identified by physician diagnoses including atopic dermatitis or eczema, allergic rhinitis, and hay fever documented in medical records between 1964 and 1983. Associations between atopy and IPD were assessed using conditional logistic regression. RESULTS: A total of 3,941 records were reviewed and we identified 174 IPD cases. Of these 174 cases, 50.6% were male and 94.3% were Caucasians. Twenty-six (14.9%) of the IPD cases and 29 (8.3%) of the controls had atopy. Patients with atopy (versus without) were 2.1 times (95% CI: 1.04-4.35, p 5 0.04) more likely to develop IPD, after for smoking status, high-risk conditions for IPD, educational status, and ethnicity. CONCLUSIONS: Like asthmatic patients, individuals with other atopic conditions have also increased risk of developing IPD. Pneumococcal vaccination should be considered for individuals with atopy. There may be a common immunogenetic mechanism underlying increased risk of IPD among individuals with either asthma or other atopic conditions which needs to be elucidated.
SATURDAY
Abstracts S31
J ALLERGY CLIN IMMUNOL VOLUME 121, NUMBER 2
Premedication with Montelukast Reduces Local Reactions of Allergen Immunotherapy S. Wohrl1, W. Hemmer2, G. Heinze3, G. Stingl1, T. Kinaciyan1; 1Medical University of Vienna, Department of Dermatology, Division of Immunology, Allergy and Infectious Diseases (DIAID), Vienna, AUSTRIA, 2Floridsdorf Allergy Center (FAZ), Vienna, AUSTRIA, 3Medical University of Vienna, Core unit for Medical Statistics and Informatics, Section on Medical Statistics, Vienna, AUSTRIA. RATIONALE: Subcutaneous specific immunotherapy with allergen frequently causes local reactions. Antihistamine pretreatment - originally introduced as a safety measure to reduce anaphylactic side effects - has been the only treatment option for local reactions so far, although these swellings are usually not appearing immediately but after hours. We were interested whether pretreatment with the leukotriene antagonist montelukast would be better suited for preventing those reactions than pretreatment with the antihistamine desloratadine. METHODS: 15 patients with a history of severe anaphylactic reactions to hymenoptera stings were enrolled into a prospective, double-blind, randomized, placebo-controlled study. We selected a RUSH-immunotherapy-protocol consisting of 19 injections of venom administered over 5 consecutive days, where the majority is developing local reactions, and counted the number of injections until a local reaction of > 3 cm occurred. The patients were randomised to the 3 treatment groups: premedication with either placebo, montelukast or the antihistamine desloratadine. RESULTS: Compared with placebo, the occurrence of local reactions >3 cm was significantly delayed by montelukast (p < 0.01, ANOVA) but not by desloratadine (p 5 0.19). The difference between montelukast and desloratadine was close to significance (p 5 0.054). Itching, recorded by visual analogue score, did not differ between the 3 groups. CONCLUSIONS: Montelukast may be useful in the prevention of local reactions caused by allergen-specific immunotherapy. Funding: MSD Austria, Vienna
120
Subcutaneous Immunotherapy with Single and Mix Insect Allergens - A Double Blind Controlled Trial S. N. Gaur, IV1, D. Srivastava2, N. Arora2, B. P. Singh2; 1Vallabhbhai Patel Chest Institute, Delhi, INDIA, 2Institute of Genomics and Integrative Biology, Delhi - 110007, INDIA. RATIONALE: To compare the efficacy of Specific immunotherapy (SIT) with single and mixed allergen of same group (Insects). METHODS: One hundred allergic patients of asthma, screened by history, skin tests and specific IgE levels were randomly divided into active and placebo groups. Active group received SIT with either single insect allergen (mosquito-20, Cockroach-20) or a mixture of 2-3 insect allergens (Mosquito, Cockroach, Housefly - 30). In vivo (skin test, bronchial hyper-reactivity) and In vitro (allergen specific IgE, IgG1 and IgG4) tests were done initially and after 1 year of SIT. Symptom and drug score cards were scrutinized every 3 month. RESULTS: Patients in both active groups of single and multiple insect allergen showed significant improvement (p < 0.05) in disease state in comparison to placebo group. Decreased skin reactivity was noted in 95% and 84%, symptom score reduction in 85% and 78%, bronchial hyperreactivity showed improvement in 76% and 67% respectively for single and mix allergen immunotherapy groups. respectively for single and mix allergen immunotherapy groups. IgE values however showed non-significant reduction whereas IgG4 levels showed significant increase in both the active groups (p < 0.05). A good correlation was also observed between symptoms reduction and increased IgG4 levels. Changes in all the above parameters were non-significant in the placebo group. Symptom score was reduced more in single allergen group than in multiple allergen SIT group. However, these inter-group differences were not statistically significant. CONCLUSIONS: SIT with single as well as mixed insect allergens is almost equally effective and is definitely better than placebo and is well tolerated. Funding: Department of Science and Technology, Govt. of India
121
Total and Specific IgE are elevated in Atopic March (AM) M. Boguniewicz1, D. Y. N. Leung1, J. Orange2,3, K. Pinzone2, R. Harbeck1, S. B. Leung1, J. Spergel2,3; 1National Jewish Medical and Research Center, Denver, CO, 2The Children’s Hospital of Philadelphia, Philadelphia, PA, 3Univ of Pennsylvania, Philadelphia, PA. RATIONALE: To examine the immunologic phenotype of 104 children with atopic dermatitis (AD) during the development of asthma and allergies. METHODS: 104 children ages, 3-18 months, with AD were enrolled within 3 months of AD diagnosis in a 6-year prospective trial to examine the impact of early intervention with a topical calcineurin inhibitor versus conventional therapy on the AM (Study of Atopic March). These patients are part of a larger cohort of 1091 children in a multi-center trial that included CHOP and NJMRC. At 18 and 30 months, disease severity, total IgE, and specific IgE to 14 aeroallergens were assessed. RESULTS: After 30 months of follow-up, 48 children had progressed in the AM to develop food allergy (n 5 25), asthma (n 5 10), allergic rhinitis (n 5 26), or allergic conjunctivitis (n 5 10). Eczema severity measured by EASI (eczema area severity index) did not differ in the two groups at 18 and 30 months. The AM group had significantly higher IgE (mean: 256 kU/L at 18 months and 495 kU/L at 30 month) compared to the 56 non-AM group (mean 73 kU/L at 18 months and 48 kU/L at 30 months) (p < 0.05). AM patients had significantly more positive IgE (2.46 at 18 months; 2.95 at 30 months) compared to 1.04 in non-AM at 18 months and 0.96 at 30 months (p < 0.01). The most common specific IgE in the entire population was to cat and dog at 18 months and cat and alternaria at 30 months. CONCLUSION: Children that progress in the AM have increased total and specific IgE expression. Funding: NIH
122
Increased Risk of Invasive Pneumococcal Disease in Atopic Patients J. A. Jung1, H. Kita1, B. P. Yawn2, M. E. Mc Gree1, A. L. Weaver1, K. H. Yoo1,3, P. Wollan2, T. G. Boyce1, R. M. Jacobson1, Y. J. Juhn1; 1Mayo Clinic, Rochester, MN, 2Olmsted Medical Center, Rochester, MN, 3Kunkook University School of Medicine, Seoul, REPUBLIC OF KOREA. RATIONALE: A previous study reported an increased risk of invasive pneumococcal disease (IPD) among asthmatic patients. It is not known whether this is true for patients with other atopic conditions. We determined the relationship between atopy and IPD. METHODS: The study subjects were Rochester, Minnesota residents who developed IPD between 1964 and 1983 and their 1:2 gender- and agematched controls. We used a population-based computer-linked medical diagnosis system to identify all individuals with diagnoses potentially including IPD. All records were reviewed using explicit predetermined criteria for IPD. All individuals with atopy were identified by physician diagnoses including atopic dermatitis or eczema, allergic rhinitis, and hay fever documented in medical records between 1964 and 1983. Associations between atopy and IPD were assessed using conditional logistic regression. RESULTS: A total of 3,941 records were reviewed and we identified 174 IPD cases. Of these 174 cases, 50.6% were male and 94.3% were Caucasians. Twenty-six (14.9%) of the IPD cases and 29 (8.3%) of the controls had atopy. Patients with atopy (versus without) were 2.1 times (95% CI: 1.04-4.35, p 5 0.04) more likely to develop IPD, after for smoking status, high-risk conditions for IPD, educational status, and ethnicity. CONCLUSIONS: Like asthmatic patients, individuals with other atopic conditions have also increased risk of developing IPD. Pneumococcal vaccination should be considered for individuals with atopy. There may be a common immunogenetic mechanism underlying increased risk of IPD among individuals with either asthma or other atopic conditions which needs to be elucidated.
SATURDAY
Abstracts S31
J ALLERGY CLIN IMMUNOL VOLUME 121, NUMBER 2