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Sensitization To Recombinant Allergens Of Hevea Brasilensis In Patients With Latex Anaphylaxis
105
Gene Expression Profiling Of Food-Induced Anaphylaxis Associated With Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) Dr. Rosa M. Munoz-Cano, MD, PhD1,2, Dr. Joan Bartra, MD, PhD2, Dr. Jorg Scheffel, PhD1, Dr. Mariona Pascal, PhD3, Dr. Barbara Dema, PhD1, Dr. Antonio Valero, MD, PhD2, Dr. Ana Olivera, PhD1, Prof. Cesar Picado, MD, PhD2, Dr. Juan Rivera, PhD1; 1National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), National Institutes of Health, Bethesda, MD, 2Unitat d’Al.lergia. Servei de Neumologia i Al.lergia Respiratoria. Hospital Clinic. Barcelona. Institut d’Investigacions Biomediques August Pi i Sunyer (IDIBAPS)., Barcelona, Spain, 3 Servei d’Immunologia, Centre de Diagnostic Biomedic. Hospital Clinic., Barcelona, Spain. RATIONALE: Lipid transfer protein (LTP), an abundant protein in fruits, vegetables and nuts, is a major allergen linked to food anaphylaxis in Mediterranean areas. However, anaphylaxis to LTP occurs in most patients when non-steroidal anti-inflammatory drugs (NSAIDs) are also ingested. To better understand the underlying causes for the requirement of NSAID in a subset of LTP-induced anaphylaxis patients, we compared their gene expression profile. METHODS: Adult patients with a proven clinical history of LTP-induced anaphylaxis were selected by positive skin prick test and serum-specific IgE to LTP, regardless of age or sex, excluding patients with allergy/ intolerance to NSAID alone. Whole-genome expression analysis (RNA Seq) was performed in blood cells from 14 individuals with NSAIDsrelated LTP-induced anaphylaxis (NLA), 7 NSAIDs-unrelated LTPinduced anaphylaxis (LA) and 13 healthy controls. RESULTS: Gene ontology analysis revealed that in patients with NLA, genes related to cell death/survival/proliferation/development pathways were significantly upregulated. Additionally, genes related to adenosine metabolism and signaling, including adenosine receptor 3, were upregulated in these patients. Remarkably, we observed an enhanced expression of genes involved in pathways activated by IFN-gamma and in IgG receptor expression in the LA group, mirrored by the presence of LTPspecific IgG in this group. CONCLUSIONS: These findings suggest that the differential activation of the IFN-gamma pathway and IgG receptors could play a role in LTP-induced anaphylaxis. Furthermore, adenosine signaling may have a role in the pathogenesis of LTP-induced anaphylaxis related to NSAIDs, in agreement with previous reports of adenosine receptor gene polymorphisms associated with aspirin- induced asthma and urticaria.
106
Recurrence Rates Of Anaphylaxis In Children Dr. Andrew O’Keefe, MD1,2, Dr. Yuka Asai, MD3,4, Mr. Christopher Mill, BSc3, Dr. Harley Eisman, MD5, Dr. Sebastian La Vieille, MD6, Dr. Reza Alizadehfar, MD5,7, Ms. Emma Perkins, BSc3, Dr. Lawrence Joseph, PhD3, Dr. Ann Elaine Clarke, MD, MSc3,8, Dr. Moshe Ben-Shoshan, MD, MSc5,9; 1McGill University, Montreal, Canada, QC, Canada, 2Division of Pediatric Allergy and Clinical Immunology, Montreal Children’s Hospital, Canada, 3Division of Clinical Epidemiology, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada, 4Division of Dermatology, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada, 5 McGill University, Montreal, QC, Canada, 6Food Directorate, Health Canada, Ottawa, ON, Canada, 7Division of Paediatric Allergy and Clinical Immunology, Department of Paediatrics, McGill University Health Center, Montreal, QC, Canada, 8Montreal General Hospital, 9Montreal Children’s Hospital, Montreal, Canada. RATIONALE: To determine the recurrence rate of anaphylaxis in children presenting at the Emergency Department (ED). METHODS: As part of the Cross-Canada Anaphylaxis REgistry (CCARE), parents of children identified prospectively at the Montreal
Children’s Hospital ED with anaphylaxis were contacted one year after their presentation and queried on subsequent allergic reactions. RESULTS: Between April 2011 and April 2012, among 168 individuals presenting with anaphylaxis,102 consented to further follow-up and 80 completed the questionnaire. Demographic and clinical characteristics of anaphylaxis at recruitment were comparable between respondents and non-respondents (i.e. 80 versus 22) Fifteen patients (18.8%) reported 29 allergic reactions; 14 reactions in 11 patients met the definition of anaphylaxis. Among those with recurrent anaphylaxis, median age was 3.1 years (IQR: 2.4, 7.2) and the majority were males [60.0% (95%CI, 32.9%, 82.5%)]. Demographic data and history of atopy did not differ substantially between those with and without recurrent anaphylaxis. Food was the principal trigger [92.9%, (64.2%, 99.6%)]. Anaphylaxis was either moderate or severe. Only 35.7% (14.0%, 64.4%) of moderate/severe reactions used an epinephrine-autoinjector outside of the ED and only 50% (26.8%, 73.2%) were brought to the ED. All patients treated in the ED received epinephrine either in or outside of the ED. CONCLUSIONS: Recurrent anaphylaxis occurs in 13.8 % of those with previous anaphylaxis. Although all episodes of recurrent anaphylaxis were moderate /severe, epinephrine auto-injectors were underused prior to ED arrival and 50% of patients with anaphylaxis did not present to the ED.
107
Sensitization To Recombinant Allergens Of Hevea Brasilensis In Patients With Latex Anaphylaxis Dr. J. M. Escobar Montalvo, MD1, Ms. A. Gomez Infante, MD1, Dr. Silvia Martınez Blanco, MD2, Dr. R. Vives Conesa, MD1; 1Hospital Universitario 12 de Octubre, Madrid, Spain, 2Hospital Universitario 12 de Octubre, Spain. RATIONALE: The study of Hevea brasilensis’ recombinant allergens increases the diagnostic accuracy in the cases of latex allergy. The objective of this study was to describe the sensitization profiles to Hevea brasilensis’recombinant allergens in patients diagnosed with latex anaphylaxis in the Service of Allergology of the Hospital Universitario 12 de Octubre during 2012. METHODS: Descriptive study of the sensitization profiles to latex recombinant allergens in patients diagnosed with latex anaphylaxis was performed. The analyzed variables were age, sex, atopy, pollinosis, prick test (SPT-latex) and specific immunoglobulin E for latex (IgE-latex) and their recombinant allergens. Every serum was evaluated for 8 latex recombinants using Phadia-ImmunoCAPÒ250. RESULTS: During 2012, four cases of latex anaphylaxis were diagnosed. Three of them occurred during a surgical procedure and the other case was after mucocutaneous contact. The study of other possible causes was performed with negative results. SPT-latex results were positive in three cases. IgE-latex assays were positive in all the cases (median 5 5,65 kUa/L; 6 5,5). In the perioperative anaphylaxis cases, one patient was sensitized to r Hevb 8; a second one, to r Hevb 6.01 and r Hevb 6.02; and the third one, to r Hevb 8, r Hevb 6.01 and r Hevb 6.02. The patient with mucocutaneous contact anaphylaxis was sensitized to r Hevb 6.01 and r Hevb6.02. The study of other recombinants was negative. CONCLUSIONS: In this latex anaphylaxis cases, only the assay of r Hevb 6.01, r Hevb 6.02, and r Hevb 8 had positive results.
SATURDAY
Abstracts AB29
J ALLERGY CLIN IMMUNOL VOLUME 133, NUMBER 2
Gene Expression Profiling Of Food-Induced Anaphylaxis Associated With Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) Dr. Rosa M. Munoz-Cano, MD, PhD1,2, Dr. Joan Bartra, MD, PhD2, Dr. Jorg Scheffel, PhD1, Dr. Mariona Pascal, PhD3, Dr. Barbara Dema, PhD1, Dr. Antonio Valero, MD, PhD2, Dr. Ana Olivera, PhD1, Prof. Cesar Picado, MD, PhD2, Dr. Juan Rivera, PhD1; 1National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), National Institutes of Health, Bethesda, MD, 2Unitat d’Al.lergia. Servei de Neumologia i Al.lergia Respiratoria. Hospital Clinic. Barcelona. Institut d’Investigacions Biomediques August Pi i Sunyer (IDIBAPS)., Barcelona, Spain, 3 Servei d’Immunologia, Centre de Diagnostic Biomedic. Hospital Clinic., Barcelona, Spain. RATIONALE: Lipid transfer protein (LTP), an abundant protein in fruits, vegetables and nuts, is a major allergen linked to food anaphylaxis in Mediterranean areas. However, anaphylaxis to LTP occurs in most patients when non-steroidal anti-inflammatory drugs (NSAIDs) are also ingested. To better understand the underlying causes for the requirement of NSAID in a subset of LTP-induced anaphylaxis patients, we compared their gene expression profile. METHODS: Adult patients with a proven clinical history of LTP-induced anaphylaxis were selected by positive skin prick test and serum-specific IgE to LTP, regardless of age or sex, excluding patients with allergy/ intolerance to NSAID alone. Whole-genome expression analysis (RNA Seq) was performed in blood cells from 14 individuals with NSAIDsrelated LTP-induced anaphylaxis (NLA), 7 NSAIDs-unrelated LTPinduced anaphylaxis (LA) and 13 healthy controls. RESULTS: Gene ontology analysis revealed that in patients with NLA, genes related to cell death/survival/proliferation/development pathways were significantly upregulated. Additionally, genes related to adenosine metabolism and signaling, including adenosine receptor 3, were upregulated in these patients. Remarkably, we observed an enhanced expression of genes involved in pathways activated by IFN-gamma and in IgG receptor expression in the LA group, mirrored by the presence of LTPspecific IgG in this group. CONCLUSIONS: These findings suggest that the differential activation of the IFN-gamma pathway and IgG receptors could play a role in LTP-induced anaphylaxis. Furthermore, adenosine signaling may have a role in the pathogenesis of LTP-induced anaphylaxis related to NSAIDs, in agreement with previous reports of adenosine receptor gene polymorphisms associated with aspirin- induced asthma and urticaria.
106
Recurrence Rates Of Anaphylaxis In Children Dr. Andrew O’Keefe, MD1,2, Dr. Yuka Asai, MD3,4, Mr. Christopher Mill, BSc3, Dr. Harley Eisman, MD5, Dr. Sebastian La Vieille, MD6, Dr. Reza Alizadehfar, MD5,7, Ms. Emma Perkins, BSc3, Dr. Lawrence Joseph, PhD3, Dr. Ann Elaine Clarke, MD, MSc3,8, Dr. Moshe Ben-Shoshan, MD, MSc5,9; 1McGill University, Montreal, Canada, QC, Canada, 2Division of Pediatric Allergy and Clinical Immunology, Montreal Children’s Hospital, Canada, 3Division of Clinical Epidemiology, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada, 4Division of Dermatology, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada, 5 McGill University, Montreal, QC, Canada, 6Food Directorate, Health Canada, Ottawa, ON, Canada, 7Division of Paediatric Allergy and Clinical Immunology, Department of Paediatrics, McGill University Health Center, Montreal, QC, Canada, 8Montreal General Hospital, 9Montreal Children’s Hospital, Montreal, Canada. RATIONALE: To determine the recurrence rate of anaphylaxis in children presenting at the Emergency Department (ED). METHODS: As part of the Cross-Canada Anaphylaxis REgistry (CCARE), parents of children identified prospectively at the Montreal
Children’s Hospital ED with anaphylaxis were contacted one year after their presentation and queried on subsequent allergic reactions. RESULTS: Between April 2011 and April 2012, among 168 individuals presenting with anaphylaxis,102 consented to further follow-up and 80 completed the questionnaire. Demographic and clinical characteristics of anaphylaxis at recruitment were comparable between respondents and non-respondents (i.e. 80 versus 22) Fifteen patients (18.8%) reported 29 allergic reactions; 14 reactions in 11 patients met the definition of anaphylaxis. Among those with recurrent anaphylaxis, median age was 3.1 years (IQR: 2.4, 7.2) and the majority were males [60.0% (95%CI, 32.9%, 82.5%)]. Demographic data and history of atopy did not differ substantially between those with and without recurrent anaphylaxis. Food was the principal trigger [92.9%, (64.2%, 99.6%)]. Anaphylaxis was either moderate or severe. Only 35.7% (14.0%, 64.4%) of moderate/severe reactions used an epinephrine-autoinjector outside of the ED and only 50% (26.8%, 73.2%) were brought to the ED. All patients treated in the ED received epinephrine either in or outside of the ED. CONCLUSIONS: Recurrent anaphylaxis occurs in 13.8 % of those with previous anaphylaxis. Although all episodes of recurrent anaphylaxis were moderate /severe, epinephrine auto-injectors were underused prior to ED arrival and 50% of patients with anaphylaxis did not present to the ED.
107
Sensitization To Recombinant Allergens Of Hevea Brasilensis In Patients With Latex Anaphylaxis Dr. J. M. Escobar Montalvo, MD1, Ms. A. Gomez Infante, MD1, Dr. Silvia Martınez Blanco, MD2, Dr. R. Vives Conesa, MD1; 1Hospital Universitario 12 de Octubre, Madrid, Spain, 2Hospital Universitario 12 de Octubre, Spain. RATIONALE: The study of Hevea brasilensis’ recombinant allergens increases the diagnostic accuracy in the cases of latex allergy. The objective of this study was to describe the sensitization profiles to Hevea brasilensis’recombinant allergens in patients diagnosed with latex anaphylaxis in the Service of Allergology of the Hospital Universitario 12 de Octubre during 2012. METHODS: Descriptive study of the sensitization profiles to latex recombinant allergens in patients diagnosed with latex anaphylaxis was performed. The analyzed variables were age, sex, atopy, pollinosis, prick test (SPT-latex) and specific immunoglobulin E for latex (IgE-latex) and their recombinant allergens. Every serum was evaluated for 8 latex recombinants using Phadia-ImmunoCAPÒ250. RESULTS: During 2012, four cases of latex anaphylaxis were diagnosed. Three of them occurred during a surgical procedure and the other case was after mucocutaneous contact. The study of other possible causes was performed with negative results. SPT-latex results were positive in three cases. IgE-latex assays were positive in all the cases (median 5 5,65 kUa/L; 6 5,5). In the perioperative anaphylaxis cases, one patient was sensitized to r Hevb 8; a second one, to r Hevb 6.01 and r Hevb 6.02; and the third one, to r Hevb 8, r Hevb 6.01 and r Hevb 6.02. The patient with mucocutaneous contact anaphylaxis was sensitized to r Hevb 6.01 and r Hevb6.02. The study of other recombinants was negative. CONCLUSIONS: In this latex anaphylaxis cases, only the assay of r Hevb 6.01, r Hevb 6.02, and r Hevb 8 had positive results.
SATURDAY
Abstracts AB29
J ALLERGY CLIN IMMUNOL VOLUME 133, NUMBER 2