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Retrospective Analysis of Allergy Skin Testing Results and Relationship to Asthma in the Tucson Adult Population
AB4 Abstracts
10
Spice Allergy: Asthma in the Food Industry
SATURDAY
Mariangelica Bermudez Martinez1, Ricardo Moreno-Borque2, Paula Sanchez-Lopez1, Pilar Gajate-Fernandez1; 1Hospital Rey Juan Carlos, Mostoles, Spain, 2Hospital Rey Juan Carlos, Spain. RATIONALE: Sesame (Sesamun Indicum) is common ingredient in cuisine around the world. In that sense, like other nuts, it can trigger allergic reactions in some people but is not a common inhalant occupational allergen. METHODS: We studied the clinic case of a 28 years-old woman working as a kitchen assistant; after preparing a chicken dish and incorporating the use of several species, she reported a cough, dyspnea, sneezing and rhinorrhea. A deeper look into the ingredients used, it was determined she had used sesame, black pepper, garlic, thyme, nutmeg, and parsley. The aforementioned symptoms manifested themselves immediately after using the subject species. After obtaining the medical history and patient consent, skin prick testing is utilized to the most commonly commercially used spices (sesame, black pepper, garlic, nutmeg, thyme, oregano). In addition. Skin prick testing is also applied to determine the allergens effect of nuts (walnuts, almonds, pistachios and peanuts). We measure specific IgE levels (ImmunoCAP, Phadia) to each different spices. RESULTS: Skin prick test results were POSITIVE to sesame and thyme. The weal diameter for the sesame was 13mm and for the thyme 8mm. The sesame specific IgE levels (ImmunoCAP, PHADIA) were above 2.71 KU/L. No specific IgE was detected with thyme. A methacoline inhalation challenge was positive with a 24% decrease in FEV1. CONCLUSIONS: Our case confirms that sesame can be a sensitizing agent through inhalation in an exposed individual and might explain to a large extend the increase levels to IgE mediated as an occupational disease.
11
Characteristics of Asthma Exacerbations in the Emergency Department at a Tertiary Hospital
Beatriz Pola; La Paz Hospital, Madrid, Spain. RATIONALE: There are few studies in Spain describing the clinical profile of asthmatic patients with asthma exacerbations attending the Emergency Department. Identifying the risk factors, recognizing severity signs and starting an adequate and prompt treatment are essential tools to improve asthma control. METHODS: We included all patients aged 18 years or older who were attended during the year 2014 in the Emergency Department of our hospital due to an asthma exacerbation. We performed an epidemiological, retrospective, open and observational study. RESULTS: A total of 831 patients were included, with a mean age of 57 years, 67.7% were women, and 18% were active smokers. Higher number of asthma exacerbations were observed in January and May due to respiratory infections and exposure to seasonal allergens (pollen), respectively. 43% of the patients did not have a previous diagnosis of asthma. Of the already diagnosed asthmatic patients 10% were not receiving any treatment and 13% had suffered an exacerbation the previous year. Of the study patients, 32% patients required hospital ward admission, 6 required admission into the intensive care unit and 3 patients died. 54 patients presented a relapse of the exacerbation during the following fifteen days. In our patients, blood eosinophilia was associated to higher rate of hospital admission. CONCLUSIONS: Asthmatic exacerbations are still a frequent cause of urgent medical assistance in the Emergency Department. Many patients do not receive any therapy regularly. The hospital ward admission rate is high, 32% of patients could not be controlled with treatment in the Emergency Department.
J ALLERGY CLIN IMMUNOL FEBRUARY 2016
12
The Association with Exercise Capacity and Anemia in Chronic Airway Disease
Hyun Jung Jin, MD1, Jin Hong Chung2; 1Yeungnam University College of Medicine, Daegu, South Korea, 2Yeungnam University College of Medicine, South Korea. RATIONALE: Anemia is frequently accompanied with many chronic diseases, which may contribute to dyspnea and exercise limitation in chronic airway disease patients. The aim of this study was to investigate the association of anemia and degree of dyspnea and exercise capacity in COPD patients. METHODS: A total 87 male COPD patients were enrolled. Subjects were divided as anemic (n56) and non-anemic groups (n581) by the WHO criteria, which meant that the Hemoglobin concentration was below 13 g/ dL in men. We compared the clinical characteristics of two groups. We measured the shortness of breath using the modified Medical research Council Dyspnea scale (mMRCs) and COPD assessment test (CAT). The exercise capacity was assessed by six minute walking distance (6MWD). The Saint George Respiratory Questionnaire was used to investigate HRQL. RESULTS: Anemic patients (7.4%) showed a significantly lower 6MWD (293.17 682.60m, 380.15 6 91.97m, P50.03). There were no differences in age, smoking habits, dyspnea scales including mMRC score, CAT score, lung function and quality of life between the two groups. However, there was no significant correlation with Hemoglobin concentration and 6 MWD. CONCLUSIONS: Anemia was related to a reduction of exercise capacity in COPD. Further studies about the relation of anemia and other parameter of exercise capacity including muscle strength and muscle mass are needed.
13
Retrospective Analysis of Allergy Skin Testing Results and Relationship to Asthma in the Tucson Adult Population
Ryan Buckley, MD1, Snehal Patel, DO1, Tara F. Carr, MD2; 1University of Arizona, Tucson, AZ, 2Banner University Medical Center, Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Tucson, AZ. RATIONALE: Numerous aeroallergens have been associated with the development of asthma, including alternaria, dust mite and pet dander. Tucson, Arizona is located in the Sonoran Desert, which has the highest diversity of vegetation of any desert in the world. Given the unique pollen profile in this region, we sought to identify the most common aeroallergens associated with allergic rhinitis and asthma diagnosis in the local adult population. METHODS: We conducted a retrospective electronic chart review of 226 consecutive adult patients who underwent aeroallergen skin prick testing for rhinitis at the University of Arizona Adult Allergy and Immunology Clinic over the course of 1 year. All subjects were tested to a standard panel of tree, grasses, weed, mold, dust mite, animal dander, cockroach and feather extracts. Asthma was diagnosed using the Expert Panel Report 3 guidelines. Data was analyzed using descriptive statistics. RESULTS: Skin testing was most commonly positive to Mesquite (54%), Bermuda (48%), Palo Verde (47%), Olive tree (43%) and Lambsquarters (43%). Compared with nonasthmatics, asthmatics were more often sensitized to molds (OR 2.25, CI 1.22-4.14, p50.005), including Alternaria alternata (2.58, 1.23-5.39, p50.011), cat dander (2.13, 1.24-3.69 p50.006) and any tree pollen (1.85, 0.99-3.55 p50.04). CONCLUSIONS: Regional pollens contribute significantly to allergic disease in this unique climate. Sensitization to Alternaria and other nonregional aeroallergens is related to asthma. This supports our current practice of testing and treating patients for allergy to both locally significant and ubiquitous aeroallergens.
10
Spice Allergy: Asthma in the Food Industry
SATURDAY
Mariangelica Bermudez Martinez1, Ricardo Moreno-Borque2, Paula Sanchez-Lopez1, Pilar Gajate-Fernandez1; 1Hospital Rey Juan Carlos, Mostoles, Spain, 2Hospital Rey Juan Carlos, Spain. RATIONALE: Sesame (Sesamun Indicum) is common ingredient in cuisine around the world. In that sense, like other nuts, it can trigger allergic reactions in some people but is not a common inhalant occupational allergen. METHODS: We studied the clinic case of a 28 years-old woman working as a kitchen assistant; after preparing a chicken dish and incorporating the use of several species, she reported a cough, dyspnea, sneezing and rhinorrhea. A deeper look into the ingredients used, it was determined she had used sesame, black pepper, garlic, thyme, nutmeg, and parsley. The aforementioned symptoms manifested themselves immediately after using the subject species. After obtaining the medical history and patient consent, skin prick testing is utilized to the most commonly commercially used spices (sesame, black pepper, garlic, nutmeg, thyme, oregano). In addition. Skin prick testing is also applied to determine the allergens effect of nuts (walnuts, almonds, pistachios and peanuts). We measure specific IgE levels (ImmunoCAP, Phadia) to each different spices. RESULTS: Skin prick test results were POSITIVE to sesame and thyme. The weal diameter for the sesame was 13mm and for the thyme 8mm. The sesame specific IgE levels (ImmunoCAP, PHADIA) were above 2.71 KU/L. No specific IgE was detected with thyme. A methacoline inhalation challenge was positive with a 24% decrease in FEV1. CONCLUSIONS: Our case confirms that sesame can be a sensitizing agent through inhalation in an exposed individual and might explain to a large extend the increase levels to IgE mediated as an occupational disease.
11
Characteristics of Asthma Exacerbations in the Emergency Department at a Tertiary Hospital
Beatriz Pola; La Paz Hospital, Madrid, Spain. RATIONALE: There are few studies in Spain describing the clinical profile of asthmatic patients with asthma exacerbations attending the Emergency Department. Identifying the risk factors, recognizing severity signs and starting an adequate and prompt treatment are essential tools to improve asthma control. METHODS: We included all patients aged 18 years or older who were attended during the year 2014 in the Emergency Department of our hospital due to an asthma exacerbation. We performed an epidemiological, retrospective, open and observational study. RESULTS: A total of 831 patients were included, with a mean age of 57 years, 67.7% were women, and 18% were active smokers. Higher number of asthma exacerbations were observed in January and May due to respiratory infections and exposure to seasonal allergens (pollen), respectively. 43% of the patients did not have a previous diagnosis of asthma. Of the already diagnosed asthmatic patients 10% were not receiving any treatment and 13% had suffered an exacerbation the previous year. Of the study patients, 32% patients required hospital ward admission, 6 required admission into the intensive care unit and 3 patients died. 54 patients presented a relapse of the exacerbation during the following fifteen days. In our patients, blood eosinophilia was associated to higher rate of hospital admission. CONCLUSIONS: Asthmatic exacerbations are still a frequent cause of urgent medical assistance in the Emergency Department. Many patients do not receive any therapy regularly. The hospital ward admission rate is high, 32% of patients could not be controlled with treatment in the Emergency Department.
J ALLERGY CLIN IMMUNOL FEBRUARY 2016
12
The Association with Exercise Capacity and Anemia in Chronic Airway Disease
Hyun Jung Jin, MD1, Jin Hong Chung2; 1Yeungnam University College of Medicine, Daegu, South Korea, 2Yeungnam University College of Medicine, South Korea. RATIONALE: Anemia is frequently accompanied with many chronic diseases, which may contribute to dyspnea and exercise limitation in chronic airway disease patients. The aim of this study was to investigate the association of anemia and degree of dyspnea and exercise capacity in COPD patients. METHODS: A total 87 male COPD patients were enrolled. Subjects were divided as anemic (n56) and non-anemic groups (n581) by the WHO criteria, which meant that the Hemoglobin concentration was below 13 g/ dL in men. We compared the clinical characteristics of two groups. We measured the shortness of breath using the modified Medical research Council Dyspnea scale (mMRCs) and COPD assessment test (CAT). The exercise capacity was assessed by six minute walking distance (6MWD). The Saint George Respiratory Questionnaire was used to investigate HRQL. RESULTS: Anemic patients (7.4%) showed a significantly lower 6MWD (293.17 682.60m, 380.15 6 91.97m, P50.03). There were no differences in age, smoking habits, dyspnea scales including mMRC score, CAT score, lung function and quality of life between the two groups. However, there was no significant correlation with Hemoglobin concentration and 6 MWD. CONCLUSIONS: Anemia was related to a reduction of exercise capacity in COPD. Further studies about the relation of anemia and other parameter of exercise capacity including muscle strength and muscle mass are needed.
13
Retrospective Analysis of Allergy Skin Testing Results and Relationship to Asthma in the Tucson Adult Population
Ryan Buckley, MD1, Snehal Patel, DO1, Tara F. Carr, MD2; 1University of Arizona, Tucson, AZ, 2Banner University Medical Center, Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Tucson, AZ. RATIONALE: Numerous aeroallergens have been associated with the development of asthma, including alternaria, dust mite and pet dander. Tucson, Arizona is located in the Sonoran Desert, which has the highest diversity of vegetation of any desert in the world. Given the unique pollen profile in this region, we sought to identify the most common aeroallergens associated with allergic rhinitis and asthma diagnosis in the local adult population. METHODS: We conducted a retrospective electronic chart review of 226 consecutive adult patients who underwent aeroallergen skin prick testing for rhinitis at the University of Arizona Adult Allergy and Immunology Clinic over the course of 1 year. All subjects were tested to a standard panel of tree, grasses, weed, mold, dust mite, animal dander, cockroach and feather extracts. Asthma was diagnosed using the Expert Panel Report 3 guidelines. Data was analyzed using descriptive statistics. RESULTS: Skin testing was most commonly positive to Mesquite (54%), Bermuda (48%), Palo Verde (47%), Olive tree (43%) and Lambsquarters (43%). Compared with nonasthmatics, asthmatics were more often sensitized to molds (OR 2.25, CI 1.22-4.14, p50.005), including Alternaria alternata (2.58, 1.23-5.39, p50.011), cat dander (2.13, 1.24-3.69 p50.006) and any tree pollen (1.85, 0.99-3.55 p50.04). CONCLUSIONS: Regional pollens contribute significantly to allergic disease in this unique climate. Sensitization to Alternaria and other nonregional aeroallergens is related to asthma. This supports our current practice of testing and treating patients for allergy to both locally significant and ubiquitous aeroallergens.