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Response to Nasal Challenge Correlates with Seasonal Outcomes during Grass Pollen Immunotherapy with Either Subcutaneous or Sublingual Immunotherapy
Abstracts AB385
J ALLERGY CLIN IMMUNOL VOLUME 139, NUMBER 2
L31
Understanding Anaphylaxis in Camps: A Study Measuring Demographics, Knowledge, and Incidence of Allergic Reactions
Dr Margaret Redmond, MD1, Dr Michael Pistiner, MD, MMSc2, Dr Rebecca Scherzer, MD, FAAAAI1, Dr Frank J. Twarog, MD, PhD, FAAAAI3, Dr David R. Stukus, MD, FAAAAI1, and Dr John Lee, MD3; 1Nationwide Children’s Hospital, Columbus, OH, 2Harvard Vanguard Medical Associates, Boston, MA, 3Boston Children’s Hospital, Boston, MA. RATIONALE: Little data is available regarding food allergy training and rates of epinephrine use at camps. METHODS: De-identified online survey data was collected from camps. 158 Directors and 141 medical personnel were asked about food allergy and epinephrine policies. 211 staff were asked about food allergy training and knowledge. Fifty-seven camps reported number of epinephrine administrations that occurred during the 2016 summer session. RESULTS: Of camps surveyed: 99% report at least one camper with food allergies; 35% require food allergy action plans; 81% carry stock epinephrine (62% auto-injector, 5.5% vial/ampule, 12.4% both); 17% estimate the longest time for medical personnel to reach a camper in anaphylaxis is over 10 minutes; and 34% of staff reported never receiving any food allergy training. Eighty-seven (41%) staff reported being authorized to administer epinephrine. In this group, 55% received training in the past 12 months, 49% were confident in their ability to treat anaphylaxis, 43% recognized transportation to a hospital should occur after all anaphylactic events, 68% properly identified the thigh for injection location, and 52% responded that administering epinephrine then calling 911 were appropriate first actions for anaphylaxis. Rate of epinephrine administration was 16.8 (95% CI: 8.7, 29.3) per million camper-days compared to 1.1 (95% CI: 1.0, 1.3) per million student-days (based on Massachusetts public school data), with a relative risk ratio of 15.1 (95% CI: 7.7, 27.0). CONCLUSIONS: Camp personnel have significant deficits in knowledge about treatment of anaphylaxis that could put campers with food allergy at risk for incorrect management of their potentially life-threatening disease.
L32
Mixed Infant Feeding - Direct Breastfeeding, Pumping and Feeding, and Formula Food Poses a Risk for Food Allergy in Early Childhood
Ms Joacy Magdalene Gerard Mathias1,2, Dr Hongmei Zhang, PhD1, Dr Wilfried Karmaus, MD, DrMed, MPH1, Dr Nelis SotoRamirez, MPH, MS, PhD3, and Ms Yan Shen1; 1University of Memphis, Memphis, TN, 2Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, Memphis, TN, 3University of South Carolina, Columbia, SC. RATIONALE: The role of various infant feeding patterns (IFP) for food allergy is in dispute. When estimating risks, studies have not yet differentiated between direct feeding at breast (DBF) and pumping and feeding of breast milk (BM) when compared to formula feeding (FF). We hypothesize that mixed modes of IFP (DBFBMFF) in the first six months bear higher risk of food allergy in early childhood. METHODS: The Infant Feeding Practice Study 2 conducted by CDC/ FDA enrolled pregnant women and inquired infant feeding information using nine questionnaires. Participants were re-contacted after 6 years. Food allergy data was collected four times at 4, 9, 12, and 72 months. 1387 participants had complete IFP data and information on food allergy symptoms (FAS) and doctors’ diagnosed food allergy (DDFA). We used repeated measurement analysis controlling for confounders. RESULTS: Prevalence of FAS and DDFA (in %) were 9, 8, 8, and 8 and 1, 1, 2, and 1, respectively, at the four time points. For FAS, children who were exposed to DBFBMFF have a higher risk (RR51.57, 95% CI:1.092.25) of food allergy compared to the DBF group. Between 18-37% of symptomatic children were taken to doctor. No risk of IFP was found for DDFA. Paternal and maternal food allergy also pose a higher risk
((RR51.58, 95%CI:1.19-2.09; RR51.21, 95%CI:0.88-1.67), respectively). CONCLUSIONS: Considering the recommended six months of breastfeeding, most studies do not investigate actual modes of feeding. In this prospective birth cohort, it seems that multiple sources of allergens due to mixed feeding may pose a higher risk for food allergy.
L33
Response to Nasal Challenge Correlates with Seasonal Outcomes during Grass Pollen Immunotherapy with Either Subcutaneous or Sublingual Immunotherapy
Dr Guy Scadding, MD, PhD1, Dr Aarif O. Eifan, MD1, Dr Moises A. Calderon, MD, PhD1, Dr Mohamed H. Shamji, PhD1, Dr Martin Penagos, MD1, Dr Peter A. Wurtzen, PhD2, Dr Michelle L. Sever, PhD3, Henry T. Bahnson, MPH3, Kaitie Lawson, MS3, Dr Kristina M. Harris, PhD4, Tielin Qin, Biostatistics4, Dr Noha Lim, PhD4, Ms Audrey Plough, RN5, Dr Nadia K. Tchao, MD5, Dr Alkis Togias, MD, FAAAAI6, and Prof Stephen R. Durham, MA, MD, FRCP1; 1Imperial College London, London, United Kingdom, 2 ALK-Abelle, Hoersholm, Denmark, 3Rho, Inc., Chapel Hill, NC, 4Immune Tolerance Network, Bethesda, MD, 5Immune Tolerance Network, San Francisco, CA, 6NIAID/NIH, Bethesda, MD. RATIONALE: A randomised, double-blind, double-placebo, controlledtrial of subcutaneous (Alutard SQÒ Phleum Pratense ALK, Denmark) and sublingual (GRAZAXÒ ALK) grass pollen immunotherapy (105 patients,randomized 1:1:1). We previously reported the results of 2-years treatment and 1-year follow-up (year 3) using the total nasal symptom score (TNSS) at 0-10 hours after nasal allergen challenge as the primary outcome (Scadding G et al. Allergy 2016: 71, S102;3). Here we evaluate the relationship between the response to nasal allergen challenge and seasonal clinical outcomes. METHODS: Post-hoc correlation of response to out of season nasal allergen challenge TNSS and seasonal outcomes including weekly visual analogue score (VAS), rhinitis quality of life (miniRQLQ), and end of season global evaluation of hay fever severity at baseline, years 1, 2 and 3. RESULTS: Positive correlations were seen between response to nasal challenge and each of VAS, miniRQLQ and global evaluation at year-1 of treatment (r50.22, p50.02; r50.25, p50.01 and r50.24, p50.01, respectively), becoming stronger at year 2(r50.32, p50.002; r50.33, p50.002 and r50.31, p50.002). Correlations persisted at year 3, off treatment, for all three outcomes(r50.22, p50.04; r50.25, p50.01 and r50.42, p<0.001). No significant correlations were observed at baseline, possibly because overall spread of nasal challenge results was constrained _7/ by initial dose titration to achieve a minimum entry criterion of TNSS > 12 for study inclusion. CONCLUSIONS: Total nasal symptom score following nasal allergen challenge out of season correlated with seasonal outcomes during allergen immunotherapy. These data support the use of nasal allergen challenge as a useful clinical surrogate in immunotherapy trials.
J ALLERGY CLIN IMMUNOL VOLUME 139, NUMBER 2
L31
Understanding Anaphylaxis in Camps: A Study Measuring Demographics, Knowledge, and Incidence of Allergic Reactions
Dr Margaret Redmond, MD1, Dr Michael Pistiner, MD, MMSc2, Dr Rebecca Scherzer, MD, FAAAAI1, Dr Frank J. Twarog, MD, PhD, FAAAAI3, Dr David R. Stukus, MD, FAAAAI1, and Dr John Lee, MD3; 1Nationwide Children’s Hospital, Columbus, OH, 2Harvard Vanguard Medical Associates, Boston, MA, 3Boston Children’s Hospital, Boston, MA. RATIONALE: Little data is available regarding food allergy training and rates of epinephrine use at camps. METHODS: De-identified online survey data was collected from camps. 158 Directors and 141 medical personnel were asked about food allergy and epinephrine policies. 211 staff were asked about food allergy training and knowledge. Fifty-seven camps reported number of epinephrine administrations that occurred during the 2016 summer session. RESULTS: Of camps surveyed: 99% report at least one camper with food allergies; 35% require food allergy action plans; 81% carry stock epinephrine (62% auto-injector, 5.5% vial/ampule, 12.4% both); 17% estimate the longest time for medical personnel to reach a camper in anaphylaxis is over 10 minutes; and 34% of staff reported never receiving any food allergy training. Eighty-seven (41%) staff reported being authorized to administer epinephrine. In this group, 55% received training in the past 12 months, 49% were confident in their ability to treat anaphylaxis, 43% recognized transportation to a hospital should occur after all anaphylactic events, 68% properly identified the thigh for injection location, and 52% responded that administering epinephrine then calling 911 were appropriate first actions for anaphylaxis. Rate of epinephrine administration was 16.8 (95% CI: 8.7, 29.3) per million camper-days compared to 1.1 (95% CI: 1.0, 1.3) per million student-days (based on Massachusetts public school data), with a relative risk ratio of 15.1 (95% CI: 7.7, 27.0). CONCLUSIONS: Camp personnel have significant deficits in knowledge about treatment of anaphylaxis that could put campers with food allergy at risk for incorrect management of their potentially life-threatening disease.
L32
Mixed Infant Feeding - Direct Breastfeeding, Pumping and Feeding, and Formula Food Poses a Risk for Food Allergy in Early Childhood
Ms Joacy Magdalene Gerard Mathias1,2, Dr Hongmei Zhang, PhD1, Dr Wilfried Karmaus, MD, DrMed, MPH1, Dr Nelis SotoRamirez, MPH, MS, PhD3, and Ms Yan Shen1; 1University of Memphis, Memphis, TN, 2Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, Memphis, TN, 3University of South Carolina, Columbia, SC. RATIONALE: The role of various infant feeding patterns (IFP) for food allergy is in dispute. When estimating risks, studies have not yet differentiated between direct feeding at breast (DBF) and pumping and feeding of breast milk (BM) when compared to formula feeding (FF). We hypothesize that mixed modes of IFP (DBFBMFF) in the first six months bear higher risk of food allergy in early childhood. METHODS: The Infant Feeding Practice Study 2 conducted by CDC/ FDA enrolled pregnant women and inquired infant feeding information using nine questionnaires. Participants were re-contacted after 6 years. Food allergy data was collected four times at 4, 9, 12, and 72 months. 1387 participants had complete IFP data and information on food allergy symptoms (FAS) and doctors’ diagnosed food allergy (DDFA). We used repeated measurement analysis controlling for confounders. RESULTS: Prevalence of FAS and DDFA (in %) were 9, 8, 8, and 8 and 1, 1, 2, and 1, respectively, at the four time points. For FAS, children who were exposed to DBFBMFF have a higher risk (RR51.57, 95% CI:1.092.25) of food allergy compared to the DBF group. Between 18-37% of symptomatic children were taken to doctor. No risk of IFP was found for DDFA. Paternal and maternal food allergy also pose a higher risk
((RR51.58, 95%CI:1.19-2.09; RR51.21, 95%CI:0.88-1.67), respectively). CONCLUSIONS: Considering the recommended six months of breastfeeding, most studies do not investigate actual modes of feeding. In this prospective birth cohort, it seems that multiple sources of allergens due to mixed feeding may pose a higher risk for food allergy.
L33
Response to Nasal Challenge Correlates with Seasonal Outcomes during Grass Pollen Immunotherapy with Either Subcutaneous or Sublingual Immunotherapy
Dr Guy Scadding, MD, PhD1, Dr Aarif O. Eifan, MD1, Dr Moises A. Calderon, MD, PhD1, Dr Mohamed H. Shamji, PhD1, Dr Martin Penagos, MD1, Dr Peter A. Wurtzen, PhD2, Dr Michelle L. Sever, PhD3, Henry T. Bahnson, MPH3, Kaitie Lawson, MS3, Dr Kristina M. Harris, PhD4, Tielin Qin, Biostatistics4, Dr Noha Lim, PhD4, Ms Audrey Plough, RN5, Dr Nadia K. Tchao, MD5, Dr Alkis Togias, MD, FAAAAI6, and Prof Stephen R. Durham, MA, MD, FRCP1; 1Imperial College London, London, United Kingdom, 2 ALK-Abelle, Hoersholm, Denmark, 3Rho, Inc., Chapel Hill, NC, 4Immune Tolerance Network, Bethesda, MD, 5Immune Tolerance Network, San Francisco, CA, 6NIAID/NIH, Bethesda, MD. RATIONALE: A randomised, double-blind, double-placebo, controlledtrial of subcutaneous (Alutard SQÒ Phleum Pratense ALK, Denmark) and sublingual (GRAZAXÒ ALK) grass pollen immunotherapy (105 patients,randomized 1:1:1). We previously reported the results of 2-years treatment and 1-year follow-up (year 3) using the total nasal symptom score (TNSS) at 0-10 hours after nasal allergen challenge as the primary outcome (Scadding G et al. Allergy 2016: 71, S102;3). Here we evaluate the relationship between the response to nasal allergen challenge and seasonal clinical outcomes. METHODS: Post-hoc correlation of response to out of season nasal allergen challenge TNSS and seasonal outcomes including weekly visual analogue score (VAS), rhinitis quality of life (miniRQLQ), and end of season global evaluation of hay fever severity at baseline, years 1, 2 and 3. RESULTS: Positive correlations were seen between response to nasal challenge and each of VAS, miniRQLQ and global evaluation at year-1 of treatment (r50.22, p50.02; r50.25, p50.01 and r50.24, p50.01, respectively), becoming stronger at year 2(r50.32, p50.002; r50.33, p50.002 and r50.31, p50.002). Correlations persisted at year 3, off treatment, for all three outcomes(r50.22, p50.04; r50.25, p50.01 and r50.42, p<0.001). No significant correlations were observed at baseline, possibly because overall spread of nasal challenge results was constrained _7/ by initial dose titration to achieve a minimum entry criterion of TNSS > 12 for study inclusion. CONCLUSIONS: Total nasal symptom score following nasal allergen challenge out of season correlated with seasonal outcomes during allergen immunotherapy. These data support the use of nasal allergen challenge as a useful clinical surrogate in immunotherapy trials.