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Prevalence of food allergy in children from East Harlem allergy clinic
S240 Abstracts
Prevalence of Food Allergy in Children From East Harlem Allergy Clinic J. M. Maloney, A. Nowak-Wegrzyn; Allergy/Immunology, Mount Sinai Medical Center, New York, NY. RATIONALE: The prevalence of food allergy has doubled in the past decade but little information exists regarding food allergy among inner city children. Our objective was to define the prevalence of food allergy in patients from an East Harlem Pediatric Allergy/Immunology clinic. METHODS: Records of patients seen at A/I clinic were reviewed. Food hypersensitivity was defined as clinical reactivity or evidence of IgE sensitization documented by a positive prick skin test or detectable serum food-specific IgE antibody. RESULTS: A total of 483 patients were evaluated from 2000 to 2004; 45% were Hispanic, 39% African American; 77% had asthma and/or allergic rhinitis and/or atopic dermatitis. The prevalence of food allergy was 42%. Clinical reactivity or evidence of IgE-sensitization to specific foods were as follows: peanut - 13.3%, milk - 11.8%, egg - 11%, shellfish - 8.7%, soy - 8.5%, tree nuts - 7.7%, seeds - 5.6%, wheat - 5.6%, and fish - 4.1%. The percentages of patients with serum food-specific IgE antibody levels highly predictive of clinical reactivity were as follows: egg - 7%, peanut - 6.8%, milk - 4.3%, and fish - 1.2%. Two percent of patients reported pollen-food allergy syndrome. Allergic proctocolitis occurred in 1%, allergic eosinophilic gastroenteritis in 0.8% (two patients associated with protein-losing gastroenteropathy), and food protein-induced enterocolitis syndrome in 0.4% of patients. CONCLUSIONS: Food hypersensitivity is prevalent among inner city children. Clinicians caring for this population should maintain a high index of suspicion for food allergy. Food allergy education materials directed at the inner city population are needed.
954
A Comprehensive Analysis of Peptide Match Frequencies as They Relate to the Assessment of Protein Allergenicity A. Silvanovich, M. A. Nemeth, G. A. Bannon; Regulatory, Monsanto Company, St Louis, MO. RATIONALE: The proteins introduced into all genetically engineered plants that have been put into commerce in the U.S. have been screened by comparing their amino acid sequence to those of known allergens and gliadins as one of many assessments performed to evaluate product safety. It has been suggested that potential allergen cross-reactivity of transgene encoded proteins found in crops that have been improved through genetic modification may be predicted by identifying matches as short as six amino acids in length between a transgene protein of interest and a known allergen. METHODS: Using UNIX-based tools, a comprehensive analysis of all peptides 5 to 9 amino acids in length derived from ~1.4 million nonredundant protein sequences contained in GenBank and TREMBL, and 752 non-redundant protein sequences contained in an allergen database was performed. Using peptide frequencies derived from the database analyses, peptide match probabilities were determined. RESULTS: Depending on the method chosen to calculate probabilities; a match between a 6 amino acid peptide derived from a test protein and a 6 amino acid peptide derived from the allergen database could occur as frequently as 1 in every 138 comparisons. Similar probability analyses revealed match frequencies of 1 in 539 for 7 amino acid peptide and 1 in 865 for 8 amino acid peptides. CONCLUSIONS: Given that the aforementioned match frequencies are based strictly on chance and length of the protein, the utility of short peptide searches for identifying proteins as potential cross-reactive allergens is questionable.
955
J ALLERGY CLIN IMMUNOL FEBRUARY 2005
Idiopathic Eosinophilic Esophagitis (EE): Clinical and Histologic Correlates F. M. Schaffer1, K. A. Hetherington2, R. Shannon3, T. C. Hulsey4, D. Lewin5, R. Bhanu Pillai3; 1Pediatric Pulmonary, Allergy and Immunology, Medical University of South Carolina, Charleston, SC, 2Pediatrics, Medical University of South Carolina, Charleston, SC, 3Pediatric Gastroenterology, Medical University of South Carolina, Charleston, SC, 4Pediatric Epidemiology, Medical University of South Carolina, Charleston, SC, 5Pathology, Medical University of South Carolina, Charleston, SC. RATIONALE: We present the clinical/histologic findings of 16 patients with EE in order to obtain a better understanding of disease pathogenesis. METHODS: Serial esophageal biopsies were performed on 10/16 patients. Clinical scores (0 to 5) were based upon presence/absence of Abd pain, Vomiting, Dysphagia, Wt loss/gain, and Chest pain. RESULTS: Presenting symptoms/findings- Abd pain 9/16; Vomiting 9/16; Chest pain 6/16; Dysphagia 5/16; FTT 3/16; peripheral eosinophilia 9/16; esophageal stricture 1/16. Comparison of clinical scores from baseline until after 3 to 12 months of treatment demonstrated that 9/10 patients had significant clinical improvement (p = 0.0001). There is a correlation between the peripheral eosinophilia and the presenting clinical score (p = 0.02). Treatment: 9/16 patients were treated with elimination diets (ED) plus swallowed flovent; 3/16 received oral steroids + ED and 4/16 were treated with an ED only. Repeat Biopsy: 10/16 underwent repeat esophageal biopsy and 6/10 showed a decrease in esophageal eosinophilic cell number. 4/6 were treated with oral steroids + ED, 2/6 were treated with ED or ED + flovent. For the 4/10 without decreased esophageal eosinophilic infiltration, 1 was noncompliant, 1 was treated with ED and 2 were treated with flovent + ED. Of these 4 patients, 2 had improved clinical scores, 1 had no change in clinical score, and 1 was lost to follow-up. CONCLUSIONS: Clinical improvement is dependent upon compliance with the ED. Oral steroids are more effective than topical in diminishing esophageal eosinophilic infiltration. Clinical improvement does not necessarily correlate with diminished esophageal eosinophilic infiltration.
956
TUESDAY
Mucosal Mast Cell Protease-1 (MMCP-1) as a Marker of Intestinal Immunopathology in Food Allergy Model K. Vaali1, T. Puumalainen1, H. Wolff2, H. Alenius2, T. Palosuo1; 1National Public Health Institute, Helsinki, FINLAND, 2Finnish Institute of Occupational Health, Helsinki, FINLAND. RATIONALE: We produced a physiological model of food allergy without an adjuvant. To date no physiological food allergy model that would mimic human situation has been introduced, neither convincing pathological findings in the gastrointestinal system in the previous models. METHODS: We sensitized Balb/c mice intradermally by 100g ovalbumin or saline once a week 4 times and challenged both groups intragastrically with ovalbumin (6 x 50mg). Immunohistochemical staining of paraffin embedded samples was done with HRP-conjugated MMCP-1 antibody and cells were counted from 10 longitudinal villi from 4 different areas. RESULTS: Serum MMCP-1 values were negative after sensitization (day 32), but increased after the first intragastric dose (day 37) as function of time in allergic mice at 6 and 20 min. By day 49 serum MMCP-1 (ng/ml) were in ovalbumin- and in sham-sensitized mice 9724 ± 4814 and 29 ± 71, serum ovalbumin-specific IgE (OD 405 nm) were 0.796 ± 0.236 and 0.053 ± 0.001, respectively. Immunohistochemical staining of MMCP-1 in ovalbumin and sham-sensitized mice was 67.2 ± 27.4 and 3.0 ± 2.8 in duodenum, 47.5 ± 34.6 and 4.1 ± 3.2 in ileum, 0.5 ± 0.2 and 0.38 ± 0.58 in colon, respectively. CONCLUSIONS: This clinically relevant food allergy model showed intestinal pathology with activated mucosal mast cells, revealed also by high amounts of blood MMCP-1.
957
Prevalence of Food Allergy in Children From East Harlem Allergy Clinic J. M. Maloney, A. Nowak-Wegrzyn; Allergy/Immunology, Mount Sinai Medical Center, New York, NY. RATIONALE: The prevalence of food allergy has doubled in the past decade but little information exists regarding food allergy among inner city children. Our objective was to define the prevalence of food allergy in patients from an East Harlem Pediatric Allergy/Immunology clinic. METHODS: Records of patients seen at A/I clinic were reviewed. Food hypersensitivity was defined as clinical reactivity or evidence of IgE sensitization documented by a positive prick skin test or detectable serum food-specific IgE antibody. RESULTS: A total of 483 patients were evaluated from 2000 to 2004; 45% were Hispanic, 39% African American; 77% had asthma and/or allergic rhinitis and/or atopic dermatitis. The prevalence of food allergy was 42%. Clinical reactivity or evidence of IgE-sensitization to specific foods were as follows: peanut - 13.3%, milk - 11.8%, egg - 11%, shellfish - 8.7%, soy - 8.5%, tree nuts - 7.7%, seeds - 5.6%, wheat - 5.6%, and fish - 4.1%. The percentages of patients with serum food-specific IgE antibody levels highly predictive of clinical reactivity were as follows: egg - 7%, peanut - 6.8%, milk - 4.3%, and fish - 1.2%. Two percent of patients reported pollen-food allergy syndrome. Allergic proctocolitis occurred in 1%, allergic eosinophilic gastroenteritis in 0.8% (two patients associated with protein-losing gastroenteropathy), and food protein-induced enterocolitis syndrome in 0.4% of patients. CONCLUSIONS: Food hypersensitivity is prevalent among inner city children. Clinicians caring for this population should maintain a high index of suspicion for food allergy. Food allergy education materials directed at the inner city population are needed.
954
A Comprehensive Analysis of Peptide Match Frequencies as They Relate to the Assessment of Protein Allergenicity A. Silvanovich, M. A. Nemeth, G. A. Bannon; Regulatory, Monsanto Company, St Louis, MO. RATIONALE: The proteins introduced into all genetically engineered plants that have been put into commerce in the U.S. have been screened by comparing their amino acid sequence to those of known allergens and gliadins as one of many assessments performed to evaluate product safety. It has been suggested that potential allergen cross-reactivity of transgene encoded proteins found in crops that have been improved through genetic modification may be predicted by identifying matches as short as six amino acids in length between a transgene protein of interest and a known allergen. METHODS: Using UNIX-based tools, a comprehensive analysis of all peptides 5 to 9 amino acids in length derived from ~1.4 million nonredundant protein sequences contained in GenBank and TREMBL, and 752 non-redundant protein sequences contained in an allergen database was performed. Using peptide frequencies derived from the database analyses, peptide match probabilities were determined. RESULTS: Depending on the method chosen to calculate probabilities; a match between a 6 amino acid peptide derived from a test protein and a 6 amino acid peptide derived from the allergen database could occur as frequently as 1 in every 138 comparisons. Similar probability analyses revealed match frequencies of 1 in 539 for 7 amino acid peptide and 1 in 865 for 8 amino acid peptides. CONCLUSIONS: Given that the aforementioned match frequencies are based strictly on chance and length of the protein, the utility of short peptide searches for identifying proteins as potential cross-reactive allergens is questionable.
955
J ALLERGY CLIN IMMUNOL FEBRUARY 2005
Idiopathic Eosinophilic Esophagitis (EE): Clinical and Histologic Correlates F. M. Schaffer1, K. A. Hetherington2, R. Shannon3, T. C. Hulsey4, D. Lewin5, R. Bhanu Pillai3; 1Pediatric Pulmonary, Allergy and Immunology, Medical University of South Carolina, Charleston, SC, 2Pediatrics, Medical University of South Carolina, Charleston, SC, 3Pediatric Gastroenterology, Medical University of South Carolina, Charleston, SC, 4Pediatric Epidemiology, Medical University of South Carolina, Charleston, SC, 5Pathology, Medical University of South Carolina, Charleston, SC. RATIONALE: We present the clinical/histologic findings of 16 patients with EE in order to obtain a better understanding of disease pathogenesis. METHODS: Serial esophageal biopsies were performed on 10/16 patients. Clinical scores (0 to 5) were based upon presence/absence of Abd pain, Vomiting, Dysphagia, Wt loss/gain, and Chest pain. RESULTS: Presenting symptoms/findings- Abd pain 9/16; Vomiting 9/16; Chest pain 6/16; Dysphagia 5/16; FTT 3/16; peripheral eosinophilia 9/16; esophageal stricture 1/16. Comparison of clinical scores from baseline until after 3 to 12 months of treatment demonstrated that 9/10 patients had significant clinical improvement (p = 0.0001). There is a correlation between the peripheral eosinophilia and the presenting clinical score (p = 0.02). Treatment: 9/16 patients were treated with elimination diets (ED) plus swallowed flovent; 3/16 received oral steroids + ED and 4/16 were treated with an ED only. Repeat Biopsy: 10/16 underwent repeat esophageal biopsy and 6/10 showed a decrease in esophageal eosinophilic cell number. 4/6 were treated with oral steroids + ED, 2/6 were treated with ED or ED + flovent. For the 4/10 without decreased esophageal eosinophilic infiltration, 1 was noncompliant, 1 was treated with ED and 2 were treated with flovent + ED. Of these 4 patients, 2 had improved clinical scores, 1 had no change in clinical score, and 1 was lost to follow-up. CONCLUSIONS: Clinical improvement is dependent upon compliance with the ED. Oral steroids are more effective than topical in diminishing esophageal eosinophilic infiltration. Clinical improvement does not necessarily correlate with diminished esophageal eosinophilic infiltration.
956
TUESDAY
Mucosal Mast Cell Protease-1 (MMCP-1) as a Marker of Intestinal Immunopathology in Food Allergy Model K. Vaali1, T. Puumalainen1, H. Wolff2, H. Alenius2, T. Palosuo1; 1National Public Health Institute, Helsinki, FINLAND, 2Finnish Institute of Occupational Health, Helsinki, FINLAND. RATIONALE: We produced a physiological model of food allergy without an adjuvant. To date no physiological food allergy model that would mimic human situation has been introduced, neither convincing pathological findings in the gastrointestinal system in the previous models. METHODS: We sensitized Balb/c mice intradermally by 100g ovalbumin or saline once a week 4 times and challenged both groups intragastrically with ovalbumin (6 x 50mg). Immunohistochemical staining of paraffin embedded samples was done with HRP-conjugated MMCP-1 antibody and cells were counted from 10 longitudinal villi from 4 different areas. RESULTS: Serum MMCP-1 values were negative after sensitization (day 32), but increased after the first intragastric dose (day 37) as function of time in allergic mice at 6 and 20 min. By day 49 serum MMCP-1 (ng/ml) were in ovalbumin- and in sham-sensitized mice 9724 ± 4814 and 29 ± 71, serum ovalbumin-specific IgE (OD 405 nm) were 0.796 ± 0.236 and 0.053 ± 0.001, respectively. Immunohistochemical staining of MMCP-1 in ovalbumin and sham-sensitized mice was 67.2 ± 27.4 and 3.0 ± 2.8 in duodenum, 47.5 ± 34.6 and 4.1 ± 3.2 in ileum, 0.5 ± 0.2 and 0.38 ± 0.58 in colon, respectively. CONCLUSIONS: This clinically relevant food allergy model showed intestinal pathology with activated mucosal mast cells, revealed also by high amounts of blood MMCP-1.
957