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Slow Stepwise Resolution Protocol for Children with Food Allergies
Abstracts AB89
J ALLERGY CLIN IMMUNOL VOLUME 131, NUMBER 2
Clinical and Laboratory Predictors of the Outcome of Oral Food Challenges Farah Khan, DO1,2, Stephen J. McGeady, MD, FAAAAI1,2, Christopher Chang, MD, PhD, FAAAAI1,2; 1Alfred I duPont Hospital for Children, Wilmington, DE, 2Thomas Jefferson University Hospital, Philadelphia, PA. RATIONALE: Oral Food Challenges (OFC) are considered the standard in the diagnosis of food allergy. Anaphylaxis is the primary risk of OFCs. We conducted this study to identify clinical and laboratory predictors of the outcome of OFC, to establish criteria for optimal selection of patients for OFC. METHODS: We reviewed medical records of patients who underwent OFC at AI duPont Hospital for Children. 2-18 year olds who had OFC to wheat, soy, peanut, tree nut and shellfish were included. A multiple logistic regression model was used to evaluate the following factors as predictors of successful OFC: age of onset, age at OFC, gender, type of reaction, coexisting food allergy, atopy, family history of atopy, food specific IgE ImmunoCAP, and skin prick wheal size at challenge. RESULTS: 104 patients met inclusion criteria. There were 12 soy/wheat (8 passed, 67%), 47 peanut (37 passed, 79%), 31 tree nut (27 passed, 87%) and 14 shellfish (14 passed, 100%) challenges. Overall 86/104 (83%) passed the challenge. A positive association was found between failed challenge and positive skin prick test; the larger the wheal, the lower the pass rate. A food-specific serum immunoglobulin E (sIgE) ImmunoCAP of <0.35kU/L correlated with a greater chance of passing the OFC. Females were more likely to fail than males (OR 5 2.154). None of the associations reached statistical significance. CONCLUSIONS: This study suggests that skin test wheal size and specific sIgE ImmunoCAP may be reliable predictors of OFC outcomes. The lack of statistical significance may be in part due to small sample size.
321
The Difference of Positive Predictive Value of Ovm-Specific IgE for Heated Hen's Egg Oral Food Challenge by Transition of Ovm-Specific IgE Osamu Natsume, MD, Fukuie Tatsuki, Matsunaga Mayumi, Tajima Iwao, Suzuki Tsukasa, Taguchi Tomohide, Ogata Tsutomu; Hamamatsu university school of medicine, Hamamatsu, Japan. RATIONALE: Food-specific IgE is useful for predicting oral food challenge (OFC) outcomes, and several probability curves (PC) of foodspecific IgE were proposed. In those study PCs were different from age, however there are no report about the difference of PC adding consideration of transition of food-specific IgE. METHODS: A retrospective study conducted in 62 children who were over 2 years old. We used heated whole hen’s egg for OFC and the negative test was defined as no allergic symptom with loading over 14.5g of whole egg (about 1/4 egg) in this study. About transition of ovomucoid (OVM)specific IgE, we used highest decreasing rate of OVM-specific IgE within 2 years. Patients were divided into the decreasing group and the nondecreasing group by OVM-specific IgE decreasing rate was over 50% or not. RESULTS: There were 40 OFC positive patients and 22 negative patients in this study. PCs were different between the decreasing group and the nondecreasing group, and the decreasing group’s PC showed significantly lower positive predicted value. Positive predictive value was about 50% in the decreasing group, 80% in the non-decreasing group at 10 UA/ml of OVM-specific IgE. Confine to OVM-specific IgE value was 0.7 to 17.5, the odd’s ratio between these groups was 4.7 (p50.031). CONCLUSIONS: This study indicates that PC can be varied based on transition of specific IgE, and positive predictive value may not be governed by the same specific IgE when different transition is taken into account.
322
Egg White Skin Prick Tests: A Reliable Predictor of Heated Egg Tolerance in Egg-Allergic Children Nithya Swamy, MD1, Maria G. Crain, RN2, J. Andrew Bird, MD3; 1University of Texas Southwest Medical Center, Dallas, TX, 2Children’s Medical Center, Dallas, TX, 3Childrens Medical Center. RATIONALE: Studies have shown egg allergic individuals often tolerate heated egg. Currently, there is no consensus on predictors of heated egg tolerance. By evaluating both clinical and laboratory criteria, we aimed to identify predictors of heated egg tolerance. METHODS: We conducted retrospective review of 61 egg allergic children who participated in a heated egg challenge. Factors such as age, sex, comorbid atopic conditions (allergic rhinitis, asthma, atopic dermatitis), egg skin prick test (SPT) wheal diameters, egg white-specific IgE and ovomucoid-specific IgE levels were recorded. Data was correlated with challenge outcomes. RESULTS: The majority of egg allergic subjects tolerated the heated egg challenge (n541/61; 67%). Significantly larger egg SPT wheal diameters were observed in heated egg reactive subjects compared to heated egg tolerant subjects (mean 17mm vs 10mm; p50.002). An egg white SPT wheal diameter cutoff of 11kUA/L had a negative predictive value of 85% (sensitivity 76%, specificity of 70%). There were no significant differences in egg white-specific IgE (mean 20.02kUA/L vs 10.90kUA/L; p50.07), ovomucoid-specific IgE (mean 6.55kUA/L vs 3.76kUA/L; p50.72), age, sex and history of atopic conditions between both groups. Interestingly, there were positive correlations between systemic reactions to heated egg and egg white SPT wheal diameter (r50.86), egg white specific IgE (r50.74) and number of comorbid atopic conditions (r50.59). CONCLUSIONS: Egg white SPT is predictive of heated egg tolerance. Although no other predictors were identified, higher levels of egg whitespecific IgE, number of atopic conditions and egg white SPT wheal diameters correlated with an increased likelihood of heated egg systemic reactions.
323
Slow Stepwise Resolution Protocol for Children with Food Allergies Kumiko Mukaida, MD PhD, Takashi Kusunoki, MD, PhD, Ikuko Hiejima, MD, Fumihito Nozaki, MD, Anri Hayashi, MD, Tomohiro Kumada, MD, PhD, Tomoko Miyajima, MD, Tatsuya Fujii, MD, PhD; Department of Pediatrics, Shiga Medical Center for Children, Shiga, Japan. RATIONALE: In order to introduce foods in a slow, stepwise manner, we developed a protocol based on the efficacy of oral immunotherapy for children with food allergies. METHODS: Children participating in the study were at least 3 years of age with allergies to egg, milk, or wheat, and met at least one of the following criteria: 1) past history of severe (grade 3 or more) anaphylaxis; 2) mild or moderate (grade 2 or less) anaphylaxis within the previous year; _17.5 KU/L). A food and 3) specific IgE levels of class 4 or greater (> challenge test with a minimum provoking dose (up to 0.4 g of boiled egg whites or wheat noodles, up to 0.4 ml of milk) was performed, but threshold doses were not determined. Those who passed the challenge were given these amounts of foods 5 days a week, followed by amounts increased weekly by 1.2-1.5 times. Goals were set at 30 g of boiled egg whites, 100 g of wheat noodles, and 100 ml of milk. RESULTS: Forty-two of 53 children met the inclusion criteria. Thirty-five of the 42 children tested reached the goal, four stopped due to adverse reactions, and three were still being tested. Adverse reactions, most of which were mild, were observed in 18 cases. Children with anaphylaxis within the previous year experienced more adverse reactions (64%) than those without it (35%). CONCLUSIONS: This protocol gives children with food allergies an opportunity to introduce foods safely without the need to establish threshold doses.
SUNDAY
320
J ALLERGY CLIN IMMUNOL VOLUME 131, NUMBER 2
Clinical and Laboratory Predictors of the Outcome of Oral Food Challenges Farah Khan, DO1,2, Stephen J. McGeady, MD, FAAAAI1,2, Christopher Chang, MD, PhD, FAAAAI1,2; 1Alfred I duPont Hospital for Children, Wilmington, DE, 2Thomas Jefferson University Hospital, Philadelphia, PA. RATIONALE: Oral Food Challenges (OFC) are considered the standard in the diagnosis of food allergy. Anaphylaxis is the primary risk of OFCs. We conducted this study to identify clinical and laboratory predictors of the outcome of OFC, to establish criteria for optimal selection of patients for OFC. METHODS: We reviewed medical records of patients who underwent OFC at AI duPont Hospital for Children. 2-18 year olds who had OFC to wheat, soy, peanut, tree nut and shellfish were included. A multiple logistic regression model was used to evaluate the following factors as predictors of successful OFC: age of onset, age at OFC, gender, type of reaction, coexisting food allergy, atopy, family history of atopy, food specific IgE ImmunoCAP, and skin prick wheal size at challenge. RESULTS: 104 patients met inclusion criteria. There were 12 soy/wheat (8 passed, 67%), 47 peanut (37 passed, 79%), 31 tree nut (27 passed, 87%) and 14 shellfish (14 passed, 100%) challenges. Overall 86/104 (83%) passed the challenge. A positive association was found between failed challenge and positive skin prick test; the larger the wheal, the lower the pass rate. A food-specific serum immunoglobulin E (sIgE) ImmunoCAP of <0.35kU/L correlated with a greater chance of passing the OFC. Females were more likely to fail than males (OR 5 2.154). None of the associations reached statistical significance. CONCLUSIONS: This study suggests that skin test wheal size and specific sIgE ImmunoCAP may be reliable predictors of OFC outcomes. The lack of statistical significance may be in part due to small sample size.
321
The Difference of Positive Predictive Value of Ovm-Specific IgE for Heated Hen's Egg Oral Food Challenge by Transition of Ovm-Specific IgE Osamu Natsume, MD, Fukuie Tatsuki, Matsunaga Mayumi, Tajima Iwao, Suzuki Tsukasa, Taguchi Tomohide, Ogata Tsutomu; Hamamatsu university school of medicine, Hamamatsu, Japan. RATIONALE: Food-specific IgE is useful for predicting oral food challenge (OFC) outcomes, and several probability curves (PC) of foodspecific IgE were proposed. In those study PCs were different from age, however there are no report about the difference of PC adding consideration of transition of food-specific IgE. METHODS: A retrospective study conducted in 62 children who were over 2 years old. We used heated whole hen’s egg for OFC and the negative test was defined as no allergic symptom with loading over 14.5g of whole egg (about 1/4 egg) in this study. About transition of ovomucoid (OVM)specific IgE, we used highest decreasing rate of OVM-specific IgE within 2 years. Patients were divided into the decreasing group and the nondecreasing group by OVM-specific IgE decreasing rate was over 50% or not. RESULTS: There were 40 OFC positive patients and 22 negative patients in this study. PCs were different between the decreasing group and the nondecreasing group, and the decreasing group’s PC showed significantly lower positive predicted value. Positive predictive value was about 50% in the decreasing group, 80% in the non-decreasing group at 10 UA/ml of OVM-specific IgE. Confine to OVM-specific IgE value was 0.7 to 17.5, the odd’s ratio between these groups was 4.7 (p50.031). CONCLUSIONS: This study indicates that PC can be varied based on transition of specific IgE, and positive predictive value may not be governed by the same specific IgE when different transition is taken into account.
322
Egg White Skin Prick Tests: A Reliable Predictor of Heated Egg Tolerance in Egg-Allergic Children Nithya Swamy, MD1, Maria G. Crain, RN2, J. Andrew Bird, MD3; 1University of Texas Southwest Medical Center, Dallas, TX, 2Children’s Medical Center, Dallas, TX, 3Childrens Medical Center. RATIONALE: Studies have shown egg allergic individuals often tolerate heated egg. Currently, there is no consensus on predictors of heated egg tolerance. By evaluating both clinical and laboratory criteria, we aimed to identify predictors of heated egg tolerance. METHODS: We conducted retrospective review of 61 egg allergic children who participated in a heated egg challenge. Factors such as age, sex, comorbid atopic conditions (allergic rhinitis, asthma, atopic dermatitis), egg skin prick test (SPT) wheal diameters, egg white-specific IgE and ovomucoid-specific IgE levels were recorded. Data was correlated with challenge outcomes. RESULTS: The majority of egg allergic subjects tolerated the heated egg challenge (n541/61; 67%). Significantly larger egg SPT wheal diameters were observed in heated egg reactive subjects compared to heated egg tolerant subjects (mean 17mm vs 10mm; p50.002). An egg white SPT wheal diameter cutoff of 11kUA/L had a negative predictive value of 85% (sensitivity 76%, specificity of 70%). There were no significant differences in egg white-specific IgE (mean 20.02kUA/L vs 10.90kUA/L; p50.07), ovomucoid-specific IgE (mean 6.55kUA/L vs 3.76kUA/L; p50.72), age, sex and history of atopic conditions between both groups. Interestingly, there were positive correlations between systemic reactions to heated egg and egg white SPT wheal diameter (r50.86), egg white specific IgE (r50.74) and number of comorbid atopic conditions (r50.59). CONCLUSIONS: Egg white SPT is predictive of heated egg tolerance. Although no other predictors were identified, higher levels of egg whitespecific IgE, number of atopic conditions and egg white SPT wheal diameters correlated with an increased likelihood of heated egg systemic reactions.
323
Slow Stepwise Resolution Protocol for Children with Food Allergies Kumiko Mukaida, MD PhD, Takashi Kusunoki, MD, PhD, Ikuko Hiejima, MD, Fumihito Nozaki, MD, Anri Hayashi, MD, Tomohiro Kumada, MD, PhD, Tomoko Miyajima, MD, Tatsuya Fujii, MD, PhD; Department of Pediatrics, Shiga Medical Center for Children, Shiga, Japan. RATIONALE: In order to introduce foods in a slow, stepwise manner, we developed a protocol based on the efficacy of oral immunotherapy for children with food allergies. METHODS: Children participating in the study were at least 3 years of age with allergies to egg, milk, or wheat, and met at least one of the following criteria: 1) past history of severe (grade 3 or more) anaphylaxis; 2) mild or moderate (grade 2 or less) anaphylaxis within the previous year; _17.5 KU/L). A food and 3) specific IgE levels of class 4 or greater (> challenge test with a minimum provoking dose (up to 0.4 g of boiled egg whites or wheat noodles, up to 0.4 ml of milk) was performed, but threshold doses were not determined. Those who passed the challenge were given these amounts of foods 5 days a week, followed by amounts increased weekly by 1.2-1.5 times. Goals were set at 30 g of boiled egg whites, 100 g of wheat noodles, and 100 ml of milk. RESULTS: Forty-two of 53 children met the inclusion criteria. Thirty-five of the 42 children tested reached the goal, four stopped due to adverse reactions, and three were still being tested. Adverse reactions, most of which were mild, were observed in 18 cases. Children with anaphylaxis within the previous year experienced more adverse reactions (64%) than those without it (35%). CONCLUSIONS: This protocol gives children with food allergies an opportunity to introduce foods safely without the need to establish threshold doses.
SUNDAY
320